Knowledge of osteochondral lesions of the talus parallels that of similar lesions affecting the knee in many respects. Morbidity can be significant, and a variety of diagnostic and surgical techniques have been described. Although these lesions are significant for all patients, in athletic individuals they may bring about the end of their sporting careers. Fragment stability remains critical in the management of these injuries. With advances in diagnostic methods and further specialization in arthroscopy, outcomes will continue to improve.