The advantages of arthroscopy are limited soft tissue injury and a microsurgical approach to manipulation of tissue. The benefits of this approach can be enjoyed by the patient and physician as earlier return to function and activity. Surgical ankle arthroscopy, like any other invasive ankle procedure, has complications. When it is compared to ankle arthrotomy, diminished morbidity and earlier return to function are usually realized for almost all procedures. Complications range from relatively inconsequential surface injury to substantial and morbid injury to fatal events. As with any surgery, the complications possible from arthroscopy must be weighed against the advantages of performing these procedures. Avoiding preventable complications is important to the success of ankle arthroscopy. The use of appropriate technique and the arthroscopist's experience can play a significant role in reducing the incidence of complications. Experience has been shown to reduce the frequency of complications. Appropriate technique appears to be particularly important in portal development and instrument manipulation. The portal creation maneuver is the source of many encountered complications. The learning curve for arthroscopic technique is steep. An inexperienced arthroscopist should expect complications. With appropriate indications and skills, the benefits of ankle arthroscopy are great. As with all invasive procedures, risks can never be eliminated. Maximizing and enhancing technique and controlling risk factors allow ankle arthroscopy the greatest potential for success with the least potential for complications.