Background <p>Sports activities lead to loading stress for the osteochondral unit of the joints, especially for the lower extremity. Athletes frequently suffer from articular cartilage defects, meniscus and ligament injuries, which are often associated with subchondral bone marrow edema and osteonecrosis.</p> Objectives <p>Presentation of relevance, prognosis and therapeutic options for bone marrow edema and osteonecrosis in sport.</p> Material and methods <p>This review describes the clinical relevance, prognostic aspects and potential treatment options for bone marrow edema and osteonecrosis in athletes.</p> Results <p>Subchondral bone marrow edema and osteonecrosis frequently occur in athletes. Most commonly, they are caused by mechanical joint overload due to sporting activities, but they are also found posttraumatically and postoperatively. Their clinical relevance to athletes remains unclear. A&#xa0;stepwise treatment concept includes non-surgical as well as surgical treatment options for symptomatic bone marrow edema and osteonecrosis in sport with different clinical prognoses depending on severity and location of the lesion.</p> Conclusions <p>Bone marrow edema and osteonecrosis may have a&#xa0;relevant impact on the joint function in athletes. They play a&#xa0;decisive role in the rehabilitation following joint injuries and surgeries and are associated with the clinical outcomes following joint injuries and have critical influence on the return to sporting activities.</p> Level of Evidence <p>IV, narrative review</p>