Ankle sprains are prevalent musculoskeletal injuries, especially in active populations. Although most respond well to conservative management, approximately 20–30% of patients develop chronic lateral ankle instability (CAI), characterized by recurrent sprains, persistent pain, and functional limitations. This condition serves as a critical transition point leading to secondary complications including osteochondral defects, impingement syndromes, and progressive osteoarthritis. Modern arthroscopic techniques have revolutionized ankle surgery, offering superior visualization and reduced complications compared to traditional open procedures. For lateral ankle instability, anatomic repair techniques have become first-line treatment, with arthroscopic Broström repair achieving success rates exceeding 80%. Treatment of osteochondral defects follows an algorithmic approach based on lesion size and cartilage integrity. Bone marrow stimulation treats smaller lesions, while larger defects require sophisticated strategies such as osteochondral autografting or matrix-induced chondrocyte implantation. Ankle impingement syndromes respond well to arthroscopic debridement, achieving good to excellent outcomes in over 80% of cases. Modern surgical management emphasizes anatomic restoration and comprehensive treatment of all associated pathologies in a single intervention. Success requires careful patient selection, thorough preoperative planning with advanced imaging, meticulous surgical technique, and individualized rehabilitation protocols.