A 35-years old male patient with chronic medial sided right ankle pain after a direct ankle trauma was evaluated. The patient had ankle pain during gait and kneels for three years and consecutive magnetic resonance imaging (MRI) detected bone bruise at the medial malleolus. His ankle- hind foot was well aligned and there was not instability at ankle-mortis radiography. Preoperative American orthopaedic foot and ankle society (AOFAS) ankle-hind foot and visual analogue scale (VAS) foot- ankle scores were 75 and 55, respectively. At ankle arthroscopy, 2x1 cm chondral defect with a flap lesion (Outerbridge grade 4, Noyes grade 3A) was detected at the medial malleolar border of the articular surface of tibial plafond and microfracture was performed. At the 3rd month postoperatively, AOFAS ankle-hind foot and VAS foot-ankle scores were 98 and 92, respectively. Diagnostic arthroscopy may be useful in cases with persistent pain and bone bruise of the medial malleolus after ankle trauma to detect the tibial cartilage lesions that even not detected on MRI.

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