Talar articular cartilage is known to differ significantly from knee cartilage. Even so, recommendations for the treatment of talar cartilage lesions have been based on strategies for the knee. Arthroscopic management of osteochondral lesions of the talus is well documented. Results have been favorable with reparative techniques such as débridement with curettage and débridement with drilling, whether undertaken via early open techniques or more recent arthroscopic procedures. Salvage of failed reparative techniques is controversial. Early efforts to salvage failed débridement focused on osteochondral allografts and autografts that used the knee as a donor site. Results of these restorative techniques have been favorable, but concerns have been raised regarding knee donor site morbidity, the use of malleolar osteotomy, and incomplete restoration of the talar articular surface. More recent restorative techniques developed for the knee have been adapted for the ankle, such as autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation.