Chronic giving way and ankle dysfunction are common after ankle sprains. In our approach to chronic ankle pain and giving way, one must consider the differential diagnosis before treatment can be directed appropriately. One of the common diagnoses associated with ankle injury is osteochondral lesions of the talus. The advent of MRI has allowed us to make the diagnosis of occult lesions more readily. Arthroscopic and open management of these lesions continues to evolve. This article discusses osteochondral lesions of the talus, treatment options, and resurfacing techniques.