A proper diagnosis is essential for preoperative planning, allowing the surgeon to determine whether a lesion should best be approached from the front, back, or through a combined anterior and posterior arthroscopic approach. For a combined arthroscopic approach, there are several possibilities. The main options are a proper two-portal supine anterior arthroscopy with an auxiliary posterolateral portal, a proper two-portal prone posterior arthroscopy with an auxiliary anterior portal or a proper two-portal anterior scope supine followed by a proper two-portal posterior scope prone. For most cases of combined anterior and posterior pathology, it is advisable to use a proper anterior two-portal approach supine, finish the procedure, suture the portals, and apply an initial bandage. Thereafter, turn the patient and apply new draping and perform a proper two-portal posterior approach. This technique is described in detail in this chapter. Indications for this combined arthroscopic approach include a combination of symptomatic anterior and posterior pathologies. Frequent indications are combined anterior + posterior impingement and ankle instability combined with posterior impingement. Specific indications for a combined approach are arthrolysis for arthrofibrosis and synovectomy for chondromatosis. Examples of these indications are presented in this chapter.