A review of the first 10 arthroscopic ankle fusions at our institution was performed. Union was obtained in 7 of the 10 ankles with an average time to fusion of 4 months. There were 3 nonunions. Arthroscopic ankle fusion is less invasive than open techniques and less painful for the patient. However, there is a learning curve, and the arthroscopic technique is time-consuming. Arthroscopic ankle fusion has restricted indications, as patients with significant angulation, rotatory malalignment and extensive avascular necrosis of the talus can only be treated with open techniques.