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Post-arthroscopic osteonecrosis is a rare complication that mostly occurs in the over 50s. It most commonly occurs in the medial femoral condyle, followed by the lateral femoral condyle then medial tibial plateau. We report the first case of lateral tibial plateau osteonecrosis in a young patient after arthroscopic lateral meniscectomy. This patient developed progressively deteriorating symptoms after uncomplicated arthroscopy; with a subsequent magnetic resonance imaging (MRI) showing bone oedema and some overlying cartilage damage. Conservative measures were unsuccessful, so core decompression was undertaken. This has resulted in improved symptoms and subsequent follow-up MRI demonstrates resolution of oedema with no progressive cartilage change. This is a rare condition with a poor outcome, usually resulting in arthroplasty. This technique may work in the younger patient. However, since post-arthroscopic osteonecrosis is so rare in this age group, there is limited evidence for its success, and it should be evaluated with further study. [ABSTRACT FROM AUTHOR]