Different techniques and the management of various lesions are described step by step, guiding the practitioner through the entire spectrum of care from evaluation of the injury to successful recovery. Chondral and osteochondral lesions of the talus can present as a consequence of repetitive ankle injuries, causing chronic pain, recurrent swelling, and weakness and stiffness of the ankle joint. An accurate early diagnosis is required, using clinical evaluation, imaging techniques and arthroscopy of the ankle. In acute and non-displaced chondral and osteochondral lesions, conservative treatment is the mainstay. Surgery is recommended for unstable and persistent lesions and consists in several techniques focused on regeneration of the cartilage. Returning to play is possible after testing balance and proprioception, strength, range of motion, and agility.