Indications for anterior ankle arthroscopy are mainly therapeutic. Acknowledged indications include anterior ankle impingement, osteochondral lesions, ankle instability, loose body removal, end-stage osteoarthritis and fracture treatment. Anterior ankle arthroscopy is performed with the patient in the supine position, through anteromedial and anterolateral portals, with or without use of distraction. Detailed knowledge of anatomy is crucial to avoid complications. Preoperative identification of the superficial peroneal nerve can reduce the risk of injury. Blunt dissection and introduction of instruments with the dorsiflexed ankle will reduce the risk of iatrogenic chondral damage and iatrogenic nerve damage. Overall complication rate is approximately 4%, most commonly nerve injury with temporary paraesthesia. Results are dependent on indication. Good-to-excellent results are reported in 84–100% after arthroscopic treatment of anterior impingement, osteochondral lesions and loose body removal.