An osteochondral lesion of the talus (OLT) is a frequent cause of chronic ankle pain in young, active individuals because of cartilage and subchondral bone damage with limited healing capacity. This review outlines updated classification systems incor...
An osteochondral lesion of the talus (OLT) is a frequent cause of chronic ankle pain in young, active individuals because of cartilage and subchondral bone damage with limited healing capacity. This review outlines updated classification systems incorporating the etiology, lesion morphology, and associated factors like instability or malalignment, offering tailored treatment pathways. Although small, stable lesions may respond to conservative treatment or bone marrow stimulations, the long-term outcomes are often limited because of fibro cartilage degeneration. For larger or unstable lesions, arthroscopic osteochondral autograft transfer and chondrocyte implantation could provide more durable cartilage restoration, with recent advances minimizing surgical morbidity. Adjuncts may enhance healing, includ ing bone marrow aspirate concentrate and other adjuvants used in autologous matrix-induced chondrogenesis. Arthroscopic techniques allow access to previously difficult lesions, enabling comprehensive, minimally invasive management. The optimal outcomes depend on matching the treatment to the lesion type and correcting the coexisting pathologies. Although further long-term studies are needed, re cent developments have improved the clinical approach to OLT.