Acute chondral or osteochondral lesions of the ankle joint are typically co entities of ankle sprains and ankle fractures. The exact inicidence is not clear, however clinical and radiological studies suggest that this entity is more common then assumed and probably frequently missed in an acute trauma situation. The initial clinical examination and conventioanl radiographs are often inconclusive. In a severe ankle injury, CT scans and MRI are useful diagnostic tools to assess chondral or osteochondral injury. If diagnosed, surgical treatment consists of either debridment and bone marrow stimulation, or refixation. Return to sports depends on additional injury to the joint as well as patients and sports specific condition.