Twenty patients (22 knees) treated by arthroscopic removal of the anterior tibial osteophyte were selected for review from more than 150 arthroscopic debridements of the knee over a 5-year period (1986-1991). All the patients were middle-aged active individuals with competitive sports activity in their past. Their main complaint was flexion deformity of the knee (5 degrees-20 degrees) associated with pain and discomfort in recreational sporting activities and/or in activities of daily living. Roentgenographic examination in all cases showed an anterior tibial osteophyte located just anterior and medial to the anteromedial tibial spine of the intercondylar eminence. No varus or valgus malalignment or subchondral necrosis was detected. Arthroscopic treatment consisting of removal of the anterior tibial osteophyte by shaving and extraction of the bone, followed by a moderate notchplasty, was sufficient to improve the active extension of the knee and to decrease the pain and stiffness of the joint.