This chapter summarizes the progression of ankle arthroscopy techniques over time, highlighting the shift from diagnostic to therapeutic approaches and a shift from fixed distraction to the dorsiflexion method. This book focuses on “how to do it”. However, “why to do” is as important. This chapter reports on “how to do it” within the context of a proper preoperative diagnosis. There are 2 approaches to anterior ankle arthroscopy. The fixed distraction method in which the scope is also used for diagnostic purposes and the dorsiflexion technique in which the scope is used for therapy. A proper diagnosis is essential for preoperative planning, allowing the surgeon to determine whether the lesions should best be approached from the front, back, through a combined anterior and posterior arthroscopic approach. The dorsiflexion method finds its name in the dorsiflexion position in which the instruments (shavers and or scope) are introduced into the joint. After introduction of the instruments—in dorsiflexion—the joint can be brought in any position for the surgical intervention. Each pathology—even each part of the procedure—has its own optimal position: dorsiflexion, neutral, plantar flexion, forced plantar flexion or distraction. The technique is described in detail. The latest evidence on therapy as well as technical tips are given for treatment of anterior ankle impingement and ankle instability. A step by step description in text and figures is given for treatment of talar OCD.