Arthroscopy is an important diagnostic and therapeutic technique for management of disorders of the ankle joint. Ankle arthroscopy can be useful in treating a variety of intra-articular disorders, which may be caused by trauma or by degenerative, inflammatory, or neoplastic conditions. In some cases, the ankle joint disorder is related to extra-articular anomalies, which may be regional (eg, mechanical malalignment in the lower extremity) or systemic (eg, inflammatory arthritis).

As the indications for ankle arthroscopy have increased, so has its usage. The availability of fiberoptic arthroscopy, modern arthroscopic instrumentation, and ankle distraction techniques has allowed orthopedic surgeons to manage a growing of ankle disorders arthroscopically. Surgical procedures of the ankle performed arthroscopically are generally associated with lower morbidity, faster rehabilitation, and better cosmetic results as compared with conventional open surgical methods.

Management of osteochondral defects with autologous cartilage replacement currently requires an open procedure to suture a periosteal patch under which harvested and cultured cells are injected. A biocompatible scaffold for cell proliferation, Hyalograft C, uses laboratory-expanded autologous chondrocytes that are grown on a 3-dimensional graft made of a benzyl ester of hyaluronic acid. The graft is implanted without the need for a periosteal flap and therefore can be implanted arthroscopically.

The role of arthroscopy in the treatment of acute ankle fractures is still unclear; further research is needed. Arthroscopy can assist in reduction and internal fixation of ankle and pilon fractures. It is also useful for treating syndesmosis disruptions, evaluating and treating posterior malleolar fractures of the tibial plafond, and assisting in removal of debris and reduction of talus fractures. Coincidental or concurrent osteochondral lesions can be managed with replacement of fragments or, if this is not feasible, microfracture surgery.