The most frequent indications for ankle arthroscopy can be broken down to those procedures that are approached from the anterior aspect of the joint and those that are approached posteriorly. A summary of both is listed below (Table 25.2).

Complications can be broken down into various categories: systemic, preoperative, and procedure-related (Tables 25.3, 25.4, and 25.5). Most complications are related to the procedure itself.

The most common complication in foot and ankle arthroscopy is injury to one of the nerves that traverses the ankle joint secondary to improper portal placement or equipment handling. This usually involves a transient neuritis of one of the superficial nerves, but on occasion, it can be associated with permanent paresthesias or paresis. Neuromas can also form from injury to the nerve during the surgical procedure. A thorough understanding of the foot and ankle anatomy is paramount when performing placing portals so as not to iatrogenically injure neurovascular structures. At the ankle level, five nerves cross the joint from the leg to the foot. Two of them are deep: the posterior tibial nerve and deep peroneal nerve. Three are superficial: the superficial peroneal nerve, the saphenous nerve, and the sural nerve.

Ten portals have been described to gain access to the ankle (Figs. 25.1, 25.2, and 25.3a–c), but for nearly all cases typically only two or three are used. These include the anteromedial, anterolateral, and posterolateral portals.