Role of Arthroscopy in Various Ankle Disorders



Ankle arthroscopy has come a long way since it was thought, it is not feasible because of tight joint and anatomical characteristics of ankle joint. The same anatomical features like capsular attachment and safe accessory portals are used to access the whole joint even with a rigid arthroscope. Ankle distraction method was routinely used to access the anterior ankle. However, nowadays, anterior arthroscopy is done in dorsiflexion as this increases the anterior ankle joint volume, and thereby easy access to various anatomical structures. On the other hand, intermittent traction is used to access the posterior ankle. Initially used as a diagnostic tool, ankle arthroscopy is now used extensively as a therapeutic and reconstruction tool. New evidence is published for all inside ligament reconstructions, effective management of impingement syndromes, and osteochondral lesions. The indications are being extended to fracture management and arthrodesis.


This narrative review was performed following a literature search in the Pubmed database and Medline using the following keywords: ankle arthroscopy, portals, ankle OCD, functional outcome. Related articles were then reviewed.


Complications rate is reduced with a better understanding of the relative anatomy of surrounding neurovascular structures and tendons with regard to the position of ankle joint. This review on ankle arthroscopy focuses on anatomy, indications, and complications. Ankle arthroscopy is a safe and elegant tool as any other joint arthroscopy.

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  1. 1.

    Tol, J. L., & van Dijk, C. N. (2004). Etiology of the anterior ankle impingement syndrome: a descriptive anatomical study. Foot and Ankle International, 25(6), 382–386.

    PubMed  Article  Google Scholar 

  2. 2.

    Zengerink, M., & van Dijk, C. N. (2012). Complications in ankle arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy, 20(8), 1420–1431.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Dalmau-Pastor, M., Malagelada, F., Kerkhoffs, G. M., Karlsson, J., Guelfi, M., & Vega, J. (2020). Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy, 28(1), 18–23.

    PubMed  Article  Google Scholar 

  4. 4.

    Leontaritis, N., Hinojosa, L., & Panchbhavi, V. K. (2009). Arthroscopically detected intra-articular lesions associated with acute ankle fractures. Journal of Bone and Joint Surgery, 91(2), 333–339.

    Article  Google Scholar 

  5. 5.

    van Bergen, C. J. A., Kox, L. S., Maas, M., Sierevelt, I. N., Kerkhoffs, G. M. M. J., & van Dijk, C. N. (2013). Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. Journal of Bone and Joint Surgery, 95(6), 519–525.

    Article  Google Scholar 

  6. 6.

    Glazebrook MA, Ganapathy V, Bridge MA, Stone JW, Allard J-P. (2009). Evidence-based indications for ankle arthroscopy. Arthroscopy, 25(12), 1478–1490.

  7. 7.

    Bonasia, D. E., Rossi, R., Saltzman, C. L., & Amendola, A. (2011). The role of arthroscopy in the management of fractures about the ankle. Journal of American Academy of Orthopaedic Surgeons, 19(4), 226–235.

    Article  Google Scholar 

  8. 8.

    Quayle, J., Shafafy, R., Khan, M. A., Ghosh, K., Sakellariou, A., & Gougoulias, N. (2018). Arthroscopic versus open ankle arthrodesis. Foot and Ankle Surgery, 24(2), 137–142.

    PubMed  Article  Google Scholar 

  9. 9.

    Tonogai, I., Hayashi, F., Tsuruo, Y., & Sairyo, K. (2018). Comparison of ankle joint visualization between the 70° and 30° arthroscopes: a cadaveric study. Foot and Ankle Specialist, 11(1), 72–76.

    PubMed  Article  Google Scholar 

  10. 10.

    de Leeuw, P. A. J., Golanó, P., Sierevelt, I. N., & van Dijk, C. N. (2010). The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications. Knee Surgery, Sports Traumatology, Arthroscopy, 18(5), 612–617.

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, et al. (2020). the course of the distal saphenous nerve: a cadaveric investigation and clinical implications. Iowa Orthopedic Journal, 31, 231–235.

  12. 12.

    Prakash, R., Bhardwaj, A. K., Singh, D. K., Rajini, T., Jayanthi, V., & Singh, G. (2010). Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study. Italian Journal of Anatomy and Embryology, 115(3), 223–228.

    CAS  PubMed  Google Scholar 

  13. 13.

    Needleman, R. L. (2016). Use of cannulated instruments to localize the portals in anterior ankle arthroscopy: a technique tip. Journal of Foot and Ankle Surgery, 55(3), 659–663.

    Article  Google Scholar 

  14. 14.

    Ferkel, R.D. (1996). Diagnostic arthroscopic anatomy. In: T. L. Whipple (Ed.) Arthroscopic surgery. The foot and ankle. Philadelphia: Lippincot

  15. 15.

    Vega, J., Malagelada, F., Karlsson, J., Kerkhoffs, G. M., Guelfi, M., & Dalmau-Pastor, M. (2020). A step-by-step arthroscopic examination of the anterior ankle compartment. Knee Surgery, Sports Traumatology, Arthroscopy, 28(1), 24–33.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Phisitkul, P., Akoh, C. C., Rungprai, C., Barg, A., Amendola, A., Dibbern, K., et al. (2017). Optimizing arthroscopy for osteochondral lesions of the talus: the effect of ankle positions and distraction during anterior and posterior arthroscopy in a cadaveric model. Arthroscopy, 33(12), 2238–2245.

    PubMed  Article  Google Scholar 

  17. 17.

    Potter, H. G., Chong, L. R., & Sneag, D. B. (2008). Magnetic resonance imaging of cartilage repair. Sports Medicine and Arthroscopy Review, 16(4), 236–245.

    PubMed  Article  Google Scholar 

  18. 18.

    Elias, I., Raikin, S. M., Schweitzer, M. E., Besser, M. P., Morrison, W. B., & Zoga, A. C. (2009). Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid. Foot and Ankle International, 30(6), 524–529.

    PubMed  Article  Google Scholar 

  19. 19.

    Larsen, M. W., Pietrzak, W. S., & DeLee, J. C. (2005). Fixation of osteochondritisdissecans lesions using poly(l-lactic acid)/poly(glycolic acid) copolymer bioabsorbable screws. American Journal of Sports Medicine, 33(1), 68–76.

    Article  Google Scholar 

  20. 20.

    Ahmad, J., & Jones, K. (2016). Comparison of osteochondralautografts and allografts for treatment of recurrent or large talarosteochondral lesions. Foot and Ankle International, 37(1), 40–50.

    PubMed  Article  Google Scholar 

  21. 21.

    Giannini, S., Buda, R., Ruffilli, A., Cavallo, M., Pagliazzi, G., Bulzamini, M. C., et al. (2014). Arthroscopic autologous chondrocyte implantation in the ankle joint. Knee Surgery, Sports Traumatology, Arthroscopy, 22(6), 1311–1319.

    PubMed  Article  Google Scholar 

  22. 22.

    Giza, E., Delman, C., Coetzee, J. C., & Schon, L. C. (2014). Arthroscopic treatment of talus osteochondral lesions with particulated juvenile allograft cartilage. Foot and Ankle International, 35(10), 1087–1094.

    PubMed  Article  Google Scholar 

  23. 23.

    Wylie, J. D., Hartley, M. K., Kapron, A. L., Aoki, S. K., & Maak, T. G. (2015). What is the effect of matrices on cartilage repair? A systematic review. Clinical Orthopaedics and Related Research, 473(5), 1673–1682.

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Zengerink, M., Szerb, I., Hangody, L., Dopirak, R. M., Ferkel, R. D., & van Dijk, C. N. (2006). Current concepts: treatment of osteochondral ankle defects. Foot and Ankle Clinics, 11(2), 331–359.

    PubMed  Article  Google Scholar 

  25. 25.

    Savage-Elliott, I., Ross, K. A., Smyth, N. A., Murawski, C. D., & Kennedy, J. G. (2014). Osteochondral lesions of the talus: a current concepts review and evidence-based treatment paradigm. Foot and Ankle Specialist, 7(5), 414–422.

    PubMed  Article  Google Scholar 

  26. 26.

    van Bergen, C. J. A., van Eekeren, I. C. M., Reilingh, M. L., Sierevelt, I. N., & van Dijk, C. N. (2013). Treatment of osteochondral defects of the talus with a metal resurfacing inlay implant after failed previous surgery: a prospective study. Bone Joint Journal, 95(12), 1650–2165.

    PubMed  Article  Google Scholar 

  27. 27.

    Mardani-Kivi, M., Mirbolook, A., Khajeh-Jahromi, S., Hassanzadeh, R., Hashemi-Motlagh, K., & Saheb-Ekhtiari, K. (2013). Arthroscopic treatment of patients with anterolateral impingement of the ankle with and without chondral lesions. Journal of Foot and Ankle Surgery, 52(2), 188–191.

    Article  Google Scholar 

  28. 28.

    Vega, J., Dalmau-Pastor, M., Malagelada, F., Fargues-Polo, B., & Peña, F. (2017). Ankle arthroscopy: an update. The Journal of Bone and Joint Surgery, 99, 1395–1407.

    PubMed  Article  Google Scholar 

  29. 29.

    Urgüden, M., Söyüncü, Y., Ozdemir, H., Sekban, H., Akyildiz, F. F., & Aydin, A. T. (2005). Arthroscopic treatment of anterolateral soft tissue impingement of the ankle: evaluation of factors affecting outcome. Arthroscopy, 21(3), 317–322.

    PubMed  Article  Google Scholar 

  30. 30.

    Parma, A., Buda, R., Vannini, F., Ruffilli, A., Cavallo, M., Ferruzzi, A., et al. (2014). Arthroscopic treatment of ankle anterior bony impingement: the long-term clinical outcome. Foot and Ankle International, 35(2), 148–155.

    PubMed  Article  Google Scholar 

  31. 31.

    Zwiers, R., Wiegerinck, J. I., Murawski, C. D., Fraser, E. J., Kennedy, J. G., & van Dijk, C. N. (2015). Arthroscopic treatment for anterior ankle impingement: a systematic review of the current literature. Arthroscopy, 31(8), 1585–1596.

    PubMed  Article  Google Scholar 

  32. 32.

    Walsh, S. J., Twaddle, B. C., Rosenfeldt, M. P., & Boyle, M. J. (2014). Arthroscopic treatment of anterior ankle impingement: a prospective study of 46 patients with 5-year follow-up. American Journal of Sports Medicine, 42(11), 2722–2726.

    Article  Google Scholar 

  33. 33.

    Feng, S.-M., Wang, A.-G., Sun, Q.-Q., & Zhang, Z.-Y. (2020). Functional Results of All-Inside Arthroscopic Broström-Gould Surgery With 2 Anchors Versus Single Anchor. Foot and Ankle International.

    Article  PubMed  Google Scholar 

  34. 34.

    Lan, S., Zeng, W., Yuan, G., Xu, F., Cai, X., Tang, M., et al. (2020). All-inside arthroscopic anterior talofibular ligament anatomic reconstruction with a gracilis tendon autograft for chronic ankle instability in high-demand patients. Journal of Foot and Ankle Surgery, 59(2), 222–230.

    Article  Google Scholar 

  35. 35.

    Vega, J., Golanó, P., Pellegrino, A., Rabat, E., & Peña, F. (2013). All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot and Ankle International, 34(12), 1701–1709.

    PubMed  Article  Google Scholar 

  36. 36.

    Higashiyama, R., Sekiguchi, H., Takata, K., Endo, T., Takamori, Y., & Takaso, M. (2020). Arthroscopic reconstruction of the anterior tibiotalar ligament using a free tendon graft. Arthroscopy Techniques, 9(4), e541–e547.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Dent, C., Patil, M., & Fairclough, J. (1993). Arthroscopic ankle arthrodesis. The Journal of Bone and Joint Surgery, 75(B5), 830–832.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Ferkel, R. D., & Hewitt, M. (2005). Long-term results of arthroscopic ankle arthrodesis. Foot and Ankle International, 26(4), 275–280.

    PubMed  Article  Google Scholar 

  39. 39.

    Crosby, L. A., Yee, T. C., Formanek, T. S., & Fitzgibbons, T. C. (1996). Complications following arthroscopic ankle arthrodesis. Foot and Ankle International, 17(6), 340–342.

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Vivek Panikkar K, Taylor A, Kamath S, Henry APJ. (2003).A comparison of open and arthroscopic ankle fusion. Foot and Ankle Surgery 9(3), 169–72.

  41. 41.

    Myerson, M. S., & Quill, G. (1991). Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment. ClinOrthopaedRelat Res, 268, 84–95.

    Google Scholar 

  42. 42.

    Vega, J., Golan׳o, P., & Peña, F. (2016). Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), 1304–1310.

    PubMed  Article  Google Scholar 

  43. 43.

    Young, B. H., Flanigan, R. M., & DiGiovanni, B. F. (2011). Complications of ankle arthroscopy utilizing a contemporary noninvasive distraction technique. Journal of Bone and Joint Surgery, 93(10), 963–968.

    Article  Google Scholar 

  44. 44.

    van Dijk, C. N., Scholten, P. E., & Krips, R. (2000). A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy, 16(8), 871–876.

    PubMed  Article  Google Scholar 

  45. 45.

    Hayashi, D., Roemer, F. W., D’Hooghe, P., & Guermazi, A. (2015). Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses. European Journal of Radiology, 84(11), 2231–2241.

    PubMed  Article  Google Scholar 

  46. 46.

    Yasui, Y., Hannon, C.P., Hurley, E., Kennedy, J.G. (2016). Posterior ankle impingement syndrome: a systematic four-stage approach. World Journal of Orthopedics 7(10), 657–663.

  47. 47.

    Ribbans, W. J., Ribbans, H. A., Cruickshank, J. A., & Wood, E. V. (2015). The management of posterior ankle impingement syndrome in sport: a review. Foot and Ankle Surgery, 21(1), 1–10.

    PubMed  Article  Google Scholar 

  48. 48.

    Labib, S. A., & Pendleton, A. M. (2012). Endoscopic calcaneoplasty: an improved technique. Journal of Surgical Orthopaedic Advances, 21(3), 176–180.

    PubMed  Article  Google Scholar 

  49. 49.

    Vega, J., Baduell, A., Malagelada, F., Allmendinger, J., & Dalmau-Pastor, M. (2018). Endoscopic achilles tendon augmentation with suture anchors after calcaneal exostectomy in Haglund syndrome. Foot and Ankle International, 39(5), 551–559.

    PubMed  Article  Google Scholar 

  50. 50.

    Hirtler, L., Schellander, K., & Schuh, R. (2019). Accessibility to talar dome in neutral position, dorsiflexion, or noninvasive distraction in posterior ankle arthroscopy. Foot and Ankle International, 40(8), 978–986.

    PubMed  Article  Google Scholar 

  51. 51.

    Kim, H. N., Kim, G. L., Park, J. Y., Woo, K. J., & Park, Y. W. (2013). Fixation of a posteromedial osteochondral lesion of the talus using a three-portal posterior arthroscopic technique. Journal of Foot and Ankle Surgery, 52(3), 402–405.

    Article  Google Scholar 

  52. 52.

    Nickisch, F., Barg, A., Saltzman, C. L., Beals, T. C., Bonasia, D. E., Phisitkul, P., et al. (2012). Postoperative complications of posterior ankle and hindfoot arthroscopy. Journal of Bone and Joint Surgery, 94(5), 439–446.

    Article  Google Scholar 

  53. 53.

    Zwiers, R., Wiegerinck, J. I., Murawski, C. D., Smyth, N. A., Kennedy, J. G., & van Dijk, C. N. (2013). Surgical treatment for posterior ankle impingement. Arthroscopy, 29(7), 1263–1270.

    PubMed  Article  Google Scholar 

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Correspondence to Vidya Sagar Bandikalla.

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Shah, R., Bandikalla, V.S. Role of Arthroscopy in Various Ankle Disorders. JOIO (2021).

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  • Anterior ankle arthroscopy
  • Posterior ankle arthroscopy
  • Arthroscopy portals