The first description of arthroscopy of the knee is more than a 100 years old, and progress has been steady. Today many—even complicated—knee procedures are done using the arthroscope. It is, however, only for the last approximately 30 years that arthroscopy of the ankle started to evolve. During the last two decades, significant progress has been made in what can be done arthroscopically, and the ankle is now accessible, both from an anterior and posterior approach. Accordingly, significant progress, first in terms of diagnostic evaluation, and, second, therapeutic approaches have been made. In the past, fixed distraction was deemed helpful in case of diagnostic evaluation, but is not as common today. Advancements in imaging have largely eliminated the need for routine diagnostic arthroscopy. The indications for ankle arthroscopy include impingement removal, removal of loose bodies, and fragments, as well as more advanced techniques, like osteochondral lesions, ankle instability, ankle fractures, syndesmotic instability, osteoarthritis, and more recently tendoscopy and repair/reconstruction of damaged Achilles tendon. Today, ankle arthroscopy is established as a standard procedure. Many—even complicated—ankle procedures are done using the arthroscope. Ankle arthroscopy is the third in frequency of arthroscopic procedures, after the knee and shoulder. This chapter summarizes the progression of ankle arthroscopy techniques over time, highlighting the shift from diagnostic to therapeutic approaches and a shift from fixed distraction to the dorsiflexion method. The most commonly used portals are described, both anterior and posterior, as well as the basic setup for ankle arthroscopy.