Delayed diagnosis of osteochondral lesions of the talus is common; acute osteochondral injuries to the talar dome frequently go unrecognized. While acute lesions may be repaired, typically the focus of operative treatment for osteochondral lesions is on: (a) débridement and drilling/microfracture (leading to filling of the defect with fibrocartilage) or (b) salvage procedures, including osteochondral autograft transfer system and autologous chondrocyte implantation (potentially leading to resurfacing of the defect with hyaline cartilage). In this article, we review current trends in preoperative assessment, defining indications and surgical management of osteochondral lesions of the talus.