A distinctive lesion in the articular cartilage of the talar dome in anterior bony impingement syndrome of the ankle joint is reported. During arthroscopic treatment of anterior bony impingement syndrome of the ankle, we found six distinctive articular cartilage lesions in the talar dome. The cartilage lesions were full-thickness defects (grade IV), located in the anterior half of the medial aspect of the talar dome and were longitudinal with variable widths resembling a tram track; thus, "tram track lesion." All six patients were professional or collegiate soccer players and had large osteophytes in the anteromedial ridge of the tibial articular margin. Instability test results were negative. All patients had the typical tenderness in the anteromedial comer of the ankle. Overall, good and excellent results were achieved in five patients at a mean follow-up of 27 months after arthroscopic excision of osteophytes and drilling using K-wires.