Osteochondral lesions of the talus is one of the challenging diseases in sports medicine. Conservative treatment is often used in pediatric patients. Surgical options are often applied for adult populations whose symptoms may persist with conservative treatment. The current surgical options include arthroscopic subchondral bone marrow stimulation, autologous chondrocyte implantation, autologous osteochondral transplantation, allograft cartilage transplantation or particulated juvenile cartilage allograft transplantation. Arthroscopic bone marrow stimulation (especially microfracture) is the first-line treatment for smaller noncystic lesions. The short- and medium-term of clinical results is good; however, there is a lack of long-term evidence. Autologous osteochondral transplantation applied for lesions with greater area or for cystic lesions. It has showed good short- to medium-term results. However, the subchondral cysts and donor site complication often occurred after surgery. Recent developments have reported the clinical effectiveness of the biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate. The purpose of this article is to review the treatment of osteochondral lesions of the talus so that more efficiently treatment strategies can be used by clinicians.