الفهرس 
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Abstract
Arthroscopic surgery of the ankle is a relatively new and exciting addition to the orthopedic practice. Direct visualization of all intra-articular structures without an arthrotomy or malleolar osteotomy is now possible. Major technological advances in video cameras, fiberoptic light transmission, small-joint instrumentation, and distraction, combined with a sound knowledge of safe anatomic portals, have resulted in an improved ability to perform diagnostic and operative arthroscopy of the ankle.
This study is divided into two main parts the first part is the review part in which we tried to clarify the importance of understanding of the anatomy of the ankle region for successful arthroscopy of the ankle joint, and to present the pathologies can be managed by ankle arthroscopy, their clinical presentation and differential diagnosis. We also discussed the available diagnostic methods and possible complications; finally we introduced the different techniques used for distraction and ankle arthroscopy.
The second part of this study we included the methodology, results, case presentation, discussion and conclusions of the study, where 37 patient 26 male and 11 female, with chronic ankle pain for more than 6 months were included in
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the study, the patients ages ranged from 18 years to 58 years, it was done from October 2008 to May 2012 in El-helal hospital in cairo Egypt, royal commission hospital in Jubail Saudi Arabia and in Saudi German hospitals, in Riyadh and Jeddah Saudi Arabia.
26 of the patients (70.3%) claimed to have a significant initial trauma which was suspected to be the cause of their presenting symptoms. All patients in this study complained of chronic ankle pain; 24 patients (64.6%) had swelling, 22 patients complained of limitation of motion of the ankle joint (59.5%) of all cases, while 3 patients complained of locking or catching of their ankle (8.1%) of all cases. Complete systemic and local examination were done for all cases, local injection for diagnosis or as a therapeutic method were done for 19 patient (50.4%) , the needed radiological work up is done before surgery.
Throughout diagnostic arthroscopy were done for all patients, accordingly Patients with soft tissue pathologies like impingement syndromes and plica were treated arthroscopically by debridement and removal of the impingement; this was done for 22 cases (59.5%) of all cases.
Osteophyte removal, synovectomy and debridement were done for 4 cases with anterior bony impingement (10.8%) of all cases.
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Debridement of fibrillated articular surface and synovectomy were done in 5 patients with ankle arthritis (13.5%) of all cases, for two patients of them drilling of the associated articular ulcer were added.
Drilling was done for the 6 cases (16.2%) of all cases of OCD, 4 of them antegrade drilling was done as the arthroscopic diagnosis showed articular cartilage defect with exposed sub-chondral bone or unstable osteo-chondral fragment, in the other 2 cases retrograde drilling was done –under image intensifier - as the arthroscopy showed stable intact articular cartilage over the lesion.
All the patient in this study were followed up for at least 6 months, some patients were followed up to 24 months, essentially all patients were seen monthly for the first 3 months, then after 6 months from surgery, unless further appointments is needed the result of the modified scoring system of mazur et al (1979) at the 6 month visit is considered in this study.
Accordingly there were 14 patients with excellent results, with percentage of (37.8%) of all cases; there were another 14 patients with good results, with percentage of (37.8%) of all cases, there were 7 patients with fair results, with percentage of (18.9%) of all cases while the remaining 2 patients showed poor results.
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from the analysis of the results the role of ankle arthroscopy seems to be more effective in the soft tissue lesions, however its role in osteochondral lesions can be effective in selected cases and the future and the new techniques will open the door for better results and more wide patient indications.
9 patients had complications, 3 patients complained from recurrence of symptoms, 2 cases with skin dehiscence, 3 cases of neurological impairment, 1 case with reflex sympathetic dystrophy.
Finally, ankle arthroscopy seems to be a helpful tool, provided it is properly selected for the appropriate patients, and provided also that proper technique is followed.