Osteochondral lesions of the tibial plafond (OLTP) are rare, yet challenging injuries involving damage to the articular cartilage and underlying subchondral bone of the distal tibia. Despite extensive research on osteochondral lesions of the talus, limited evidence exists in terms of the clinical, radiological, and functional outcomes after treatment of OLTPs. These lesions typically result from repetitive microtrauma, ankle sprains, or fractures, and are often associated with chronic ankle instability. Diagnosis relies on advanced imaging modalities, such as magnetic resonance imaging (MRI), to assess the size and depth of the lesion, as well as associated subchondral abnormalities. Management strategies for OLTPs range from non-surgical approaches, including activity modification and immobilization, to surgical interventions such as bone marrow stimulation, osteochondral transplantation, and cartilage repair techniques like autologous chondrocyte implantation (ACI) or matrix-associated stem cell transplantation (MAST). Retrograde drilling as a minimally invasive option for lesions with intact cartilage and subchondral cysts is also available. Biomechanical factors, including the concave morphology and increased stiffness of tibial cartilage, provide protection against injury, but may influence the treatment response of the lesion. Treatment outcomes largely depend on lesion size, depth, and chronicity, with larger or more complex lesions requiring advanced surgical techniques. Although advancements in arthroscopic techniques and biologic therapies have broadened the therapeutic landscape, the long-term efficacy and optimal treatment protocols for OLTPs remain areas for further investigation.