Arthroscopic ankle arthrodesis provides the surgeon with an alternative to traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays. Adherence to sound surgical techniques, particularly with regard to joint preparation, is critical for success. Although total ankle replacement continues to grow in popularity, arthroscopic ankle arthrodesis remains a viable alternative for the management of end-stage arthritic ankle.