Ankle joint arthroscopy has become an important tool for treatment of chronic and post-traumatic pathology of the ankle joint. After a clinical diagnosis, arthroscopy can confirm the diagnosis which subsequently can be treated by means of arthroscopy. Anterior problems that can be managed by means of routine ankle joint arthroscopy, include soft tissue and bony impingement, synovitis, and loose bodies or ossicles. More centrally-located complaints originating from an osteochondral defect or osteoarthritis can be diagnosed and treated arthroscopically. Posterior problems, such as a posterior impingement syndrome (os trigonum) or a flexor hallucis longus tendinitis can be treated by means of a two portal prone hindfoot approach see hindfoot procedures. The routine procedure for anterior and central pathologies is carried out in the supine position as an out-patient procedure. In the fully dorsiflexed position, the anterior working area opens up and most ankle pathology is located or can be brought into this anterior working area. It is unnecessary to routinely perform distraction. In patients without a definitive pre-operative diagnosis, there is only a very limited indication for diagnostic arthroscopy.