Ankle arthroscopy: keyhole surgery for an ankle that never settled

You rolled your ankle months ago. The swelling went down, but the ankle never felt right: it aches at the front when you squat or climb stairs, swells after sport, catches, or gives way on uneven ground. In a classic 1991 study, surgeons argued that the vague label “chronic sprain pain” should be dropped, because lingering pain after a sprain has several distinct causes, some of which can be found and treated inside the joint.^[9]

Why some ankles never settle

Most sprains heal well, but not all. A review of 31 studies found that 5% to 33% of people still had pain a year after a sprain, and only 36% to 85% reported a full recovery within three years.^[1]

When the ankle keeps giving way, the damage often goes beyond the ligament:

• Cartilage injuries. A meta-analysis of 2,170 ankles with chronic instability found a cartilage lesion in 32.2%, most of them on the talus, the bone at the bottom of the ankle joint.^[2] In an earlier series of 148 patients, 66% of ankles with an outer ligament injury had cartilage damage.^[10]
• Problems imaging can miss. In a 2026 series of 179 patients, more than half had another problem inside the joint, most often inflamed or scarred soft tissue catching in the joint (43.6%), and the diagnosis before surgery matched what the camera found in only about a quarter of cases.^[11]

What ankle arthroscopy is

The surgeon usually makes two small incisions at the front of the ankle, passes in a slim camera and fine instruments, and works while watching a screen. Because the incisions are small, there is less damage to the surrounding soft tissue than with an open operation, and the camera can show cartilage damage and inflamed tissue that an MRI or CT may not.^[3] Most patients go home a few hours after surgery.^[4]

What it treats, and how well

Bone spurs and scar tissue pinching the front of the ankle

This is called anterior impingement, and it causes pain at the front of the ankle when the foot bends upward, as in squatting, climbing or running uphill.

• Across 28 studies (1,506 patients), 81% had good or excellent results, and every study that measured function found it improved.^[5] In an earlier review, 94% to 98% of patients said they would have the procedure again.^[12]
• Without arthritis, results last. Followed for five to eight years, every patient without arthritis had a good or excellent result.^[13]
• Athletes return. In 29 procedures on National Football League players, all returned to the same level of play, after an average of 8.4 weeks.^[14]
• Scar tissue after a sprain. In 31 patients with pain lasting about two years after an injury, 26 had good or excellent results after the scar tissue was removed, and athletes returned to sport after about six weeks on average.^[9]

Spurs can regrow on X-ray, but in a five-year study function stayed improved even when they did.^[15]

Cartilage injuries of the talus

For small cartilage injuries, the surgeon removes the damaged cartilage and makes tiny channels in the bone beneath it, so that marrow cells can form a repair tissue. This can be done through the arthroscope.

• About 85% success across the studies of this technique in a systematic review, which called it the treatment of choice for a first operation.^[6]
• Return to sport: 88% returned to sport, and 79% to their previous level.^[7]
• Return to work: 96% after arthroscopic procedures.^[16]

Size matters. In one study, lesions smaller than 150 mm² failed in 10.5%, against 80% for larger ones.^[17] A later review suggests the technique suits lesions under about 1 cm² best.^[18] Larger lesions call for other techniques; see the Center’s page on ankle cartilage repair (external site).

An ankle that keeps giving way

When the outer ligaments have stretched out, they can be tightened and repaired (the Broström repair), and arthroscopy now lets surgeons do this through small incisions too:

• Same stability, fewer wound problems. A meta-analysis found arthroscopic and open repair gave the same stability, with fewer wound complications after arthroscopy.^[19] A 2026 meta-analysis of 1,426 patients found slightly better pain and function scores and a shorter return to work with arthroscopic repair.^[20] A randomized trial found the two gave the same results at one year or more.^[21]
• A quicker recovery. In a randomized trial of ligament reconstruction using a tendon graft (a larger operation than the Broström repair), patients treated arthroscopically were walking fully weight-bearing at 8.9 weeks, against 11.7 weeks after open surgery, and back to recreational sport at 22.4 weeks, against 26.5.^[22]
• Nothing missed. Because more than half of these ankles have another problem inside the joint, looking in with the camera during the repair lets the surgeon find it and, where needed, treat it in the same operation.^[11]

Our article on ankles that keep rolling covers balance training and bracing, which come first.

How safe it is

A 2023 review of 7,942 ankle arthroscopies found complications in 4.09% and serious complications in 0.2%.^[8] The most common problem is injury to a small skin nerve near an incision, most often the superficial peroneal nerve, which causes numbness or tingling on the top of the foot. Most of these settle, though in that review about 1 in 5 nerve injuries was permanent.^[8] Infection occurred in about 2%, most of it superficial.^[23]

What it can’t do

Arthroscopy works best for a specific problem that can be seen and treated. A review of the evidence advised against it for general ankle arthritis, apart from isolated bone spurs,^[24] and in one study good or excellent results fell to 53% when the joint space had already narrowed from arthritis.^[13] Most of the evidence comes from case series rather than randomized trials,^[24] and we are not aware of a trial comparing arthroscopy directly with continued non-surgical care.

What recovery looks like

Recovery depends on what is treated:

• Scar tissue or bone spurs: on average about 6 to 9 weeks to return to sport in two studies, one of them in professional football players.^[9,14]
• Cartilage repair: a period of protected weight-bearing, with return to sport taking roughly 13 to 26 weeks across studies.^[7]
• Ligament surgery: rehabilitation, with full weight-bearing at about two months after arthroscopic ligament reconstruction in one trial.^[22]

How we decide

Dr. Efe Ozturk is a Foot and Ankle Surgeon and podiatrist. We examine the ankle, take X-rays and ultrasound at the practice, and order an MRI when it will change the plan. Bracing, balance and strength training come first. If the ankle still hurts, swells, catches or gives way after a fair trial, arthroscopy is performed through our Center for Lower Extremity Surgery (external site). Not sure whether your ankle was sprained or broken? Read sprain or fracture.

Common questions

Will I stay in the hospital?

Usually not. Most patients go home a few hours after arthroscopic surgery.^[4]

How big are the incisions?

About the size of a buttonhole, usually two at the front of the ankle.^[4,3]

Can bone spurs come back?

They can regrow on X-ray, but in a five-year study, function stayed improved even when they did.^[15]

Is it worth it if my MRI looked normal?

Possibly. The camera can show cartilage damage and inflamed tissue that an MRI may not. In one series of patients already having surgery for an unstable ankle, soft tissue pinching the joint was suspected before surgery in only 2 patients but found with the camera in 78.^[3,11]

When to see a podiatrist