What Is Ankle Arthroscopy?

Ankle arthroscopy is a minimally invasive keyhole procedure that allows the surgeon to directly visualise, diagnose, and treat conditions inside the ankle joint. A small camera (arthroscope) is inserted through a tiny incision, projecting a high-definition image of the joint onto a screen. Surgical instruments are passed through a second incision to address the problem.

Because the procedure avoids the large incisions of traditional open surgery, there is significantly less soft tissue disruption, reduced scarring, and a faster return to normal activity.

Conditions Treated

Ankle arthroscopy is used to treat a range of conditions affecting the ankle joint, including:

  • Ankle instability — chronic ligament laxity causing the ankle to give way, often performed in conjunction with ligament reconstruction
  • Ankle impingement — bony or soft tissue pinching at the front or back of the joint that limits movement and causes pain
  • Loose bodies — fragments of bone or cartilage floating inside the joint that cause locking, clicking, or pain
  • Cartilage damage (osteochondral lesions) — areas of damaged cartilage on the surface of the talus or tibia, treated by drilling or microfracture to stimulate healing
  • Ankle arthritis — in selected cases, arthroscopy assists with joint preparation prior to ankle fusion

Anterior Ankle Arthroscopy

The most common form of ankle arthroscopy accesses the front of the joint. Two small incisions of 4–5mm are made at the front of the ankle — one on the inner side and one on the outer side. The arthroscope is passed through one portal and surgical instruments through the other, allowing the surgeon to work throughout the joint.

Most patients are able to walk on the day of surgery with the support of a bandage or protective shoe.

Posterior Ankle Arthroscopy

When the problem is at the back of the ankle — such as posterior impingement or os trigonum syndrome — a posterior approach is used. Two small incisions are made at the back of the ankle, on either side of the Achilles tendon. This gives clear access to the posterior ankle structures while protecting surrounding nerves and tendons.

Posterior ankle arthroscopy is particularly well suited to dancers and athletes with pain and restricted movement at the back of the ankle caused by a bony prominence or soft tissue entrapment.

Benefits of Keyhole Ankle Surgery

  • Minimal scarring from small 4–5mm incisions
  • Minimal soft tissue dissection compared with open surgery
  • Reduced post-operative pain and swelling
  • Rapid rehabilitation and early discharge
  • Lower risk of wound complications

Recovery

Ankle arthroscopy is performed as a day procedure. On the day of surgery, the anaesthetist will provide a nerve block that offers pain relief for up to 24 hours after the procedure. Most patients go home the same day wearing a supportive bandage, shoe, or boot depending on the procedure performed.

A wound review is scheduled at 2 weeks, and a dedicated physiotherapy program begins shortly after to restore ankle strength, range of motion, and balance. Return to full activity depends on the specific procedure, but many patients resume light daily activities within a few weeks.