Most frequent indications for anterior ankle arthroscopy involve treatment of anterior ankle impingement (bony spurs, ossicles, as well as soft tissue), osteochondral defects and loose bodies. Other indications are synovectomy, arthroscopic treatment of instability, and arthroscopic-assisted ankle arthrodesis. For treatment of posterior ankle and hindfoot problems, a two-portal approach was developed and first published in 2000 (Van Dijk et al. 2000). Indications for posterior ankle arthroscopy are treatment of posterior ankle impingement, osteochondral defects, loose bodies and ossicles, synovectomy, capsulectomy, subtalar arthrodesis and groove deepening for recurrent peroneal tendon dislocation.

Within the spectrum of complications, neurological injury is most frequently described. Nerve lesions as well as neuromas are mentioned (Sprague et al. 1989; Guhl 1986, 1988; Barber et al. 1990; Amendola et al. 1996; Ferkel et al. 1996, 2001; Freedman and Barron 1998; Takao et al. 2001). Vascular injuries and false aneurysms occur (Darwish et al. 2004; Mariani et al. 2001; O’Farrell et al. 1997; Salgado et al. 1998) (Fig. 5.1). Infections and synovial fistula have been reported (Guhl 1986, 1988; Martin et al. 1989; Barber et al. 1990; Ferkel et al. 1996, 2001; Unger et al. 2000). Complications related to invasive distraction are ligament injuries, pin tract infections, and stress fractures (Sprague et al. 1989; Ferkel et al. 1996). Furthermore, instrument breakage (Fig. 5.2), complex regional pain syndrome (CRPS), compartment syndrome, thromboembolitic complications, and painful scars have been reported (Guhl 1988; Barber et al. 1990; Unger et al. 2000). Even iatrogenic excision of the distal fibula has been described (Schmidt and Reddy 1999). The most underreported complication of all is cartilage injury, which occurs iatrogenic or during treatment for osteochondral defects.

In the 1990s, the author developed in Amsterdam the dorsiflexion method in which the arthroscope and instruments are positioned in the “anterior working area.” Routine distraction is not used in this method but can be applied when indicated (Barber et al. 1990). We determined the complication rate for anterior ankle arthroscopy related to the dorsiflexion method for anterior ankle arthroscopy and the complications related to hindfoot endoscopy. To gain insight in the etiology of complications, we also determined the relationship between specific indications, surgical characteristics, and the number and type of complications that occurred. To answer these questions, we reviewed all ankle arthroscopies performed at our hospital since 1987 and clinically reexamined patients in which a complication had occurred. Apart from the prospective complication registration system patient records, outpatient charts and operative reports were reviewed. Patients with a complication were asked to visit our hospital for clinical examination and assessment of permanent damage (Zengerink and Van Dijk 2012).

An overall complication rate of 3.5 % in 1,305 procedures was found. In 1.9 % a neurological complication occurred (Table 5.2). All nerve injuries could be related to portal placement. Age was a significant risk factor for the occurrence of complications. Most complications were transient and resolved within six months.