35 patients with osteochondral lesions of the talus were randomized to receive either three intra-articular hyaluronic acid (IA-HA) injections as an adjunct to microfracture surgery, or microfracture surgery alone. The purpose of this study was to determine whether the addition of IA-HA would yield benefits when compared to microfracture surgery alone, with regards to clinical and magnetic resonance imaging (MRI) outcomes. Findings indicated higher thickness indices and a lower T2 index in the IA-HA group compared to the non-injection group. Additionally, while clinical outcomes were similar at final follow-up, improvement from baseline was significantly greater in the in the IA-HA group compared to operative treatment alone.