Ankle osteochondral injuries are one of the most problematic clinical conditions. According to statistics, up to 50% of patients with acute ankle sprains and ankle fractures can have ankle osteochondral injuries. Osteochondral injuries of the ankle joint are commonly found in the talus, and osteochondral injuries of the talus occur mostly in the anterolateral and posterior medial talus. The former injury is shallow and flaky, mostly related to acute injury; the latter injury is deeper and cup-shaped, which can be caused by repeated minor injuries or by local ischemia due to other etiologies. Osteochondral injuries of the ankle joint occur in people aged 20 to 30 years, with men accounting for about 70%. Bilateral lesions (often due to various non-traumatic factors) account for about 10% of cases. Patients may present with ankle pain following trauma or with chronic pain without significant trauma. Swelling, stiffness, and physicality of the joint can be seen. Pain symptoms tend to worsen after prolonged weight bearing or exercise. Physical examination can reveal swelling of the joint and localized pressure pain in the joint. X-rays are not sensitive to detect osteochondral injuries of the ankle joint and the best non-invasive test is MRI. There are various treatments for osteochondral injuries, ranging from conservative treatment to ankle joint replacement to ankle joint fusion. However, the effectiveness of all methods is only about 70%. The following treatment principles are recommended: systemic diseases such as endocrine or metabolic diseases: treatment of the primary disease with surgery; lesions <15mm: arthroscopic debridement + microfracture; lesions >15mm: autologous osteochondral graft, or microfracture; cystic lesions >15mm: retrograde drilling, or autologous osteochondral graft allogeneic osteochondral graft, or total ankle replacement, or joint fusion; large lesions: allogeneic osteochondral graft; or autologous chondrocyte graft, or bone graft. Because osteochondral injuries can worsen with the duration of the injury, the therapeutic efficacy is inversely proportional to the degree of injury. Therefore, the general principle of treatment for osteochondral injuries is comprehensive evaluation, early treatment, and reasonable surgery.