Osteochondral lesions of the talus (OLTs) pose significant treatment challenges in athletes due to the unique characteristics of the osteochondral unit and high functional demands. This systematic review and meta-analysis, covering literature from January 1990 to April 2024, compares surgical techniques for treating OLTs. Data on surgical details, return-to-sport (RTS) rates, clinical scores, and demographics were analyzed. The mean age was 34.5 years, body mass index 25.7 kg/m², and lesion size 111.5 mm², with a follow-up of 4.7 years. No significant differences were found in postoperative clinical scores among techniques. Bone marrow stimulation showed an RTS rate of 83.3% and RTS to pre-injury level of 52.7%.