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Background: Hyaluronic acid injections are effective as intra-articular treatment, but their use in the ankle has been hindered for the difficulty of execution in this area. Use of a guidance of musculo-skeleletal ultrasound could improve the success rate and the subsequent clinical outcome, for the ameliorating placement of the needle tip. The aim of this pilot study was to assess the short-term efficacy in terms of functional outcomes and pain of a image-guided intra-articular hyaluronic acid injections of post-traumatic osteochondral lesions (OLs) of the ankle., Methods: Thirty sport active patients (21 males; mean age 27.6±7.46) with a clinical and radiological diagnosis of post-traumatic ankle OLs at initial stage, received a course of three injections within a month. Patients were evaluated for pain (with Numerical Rating Scale, NRS) e function (Ankle-Hindfoot Scale, AHS, and range of motion, ROM) before every injection and ninety days after the last injection (T0-T3)., Results: Pain showed a significant and clinically relevant improvement during the period of treatment (P<0.001), even if pain was still presented at last follow-up assessment. Also for AHS e ROM, it was recorded a similar positive trend during time (P<0.001 for both measurements). Before intervention, pain and function resulted correlated (P<0.001), while at follow-up assessment these correlations were reduced, remaining only between pain at rest and plantar-flexion range., Conclusions: These results showed positive effects of the intra-articular hyaluronic acid for the osteochondral lesions, with a full recovery of the functional activity and a significant reduction of pain.