The main symptoms of ankle osteoarthritis are swelling and pain in the ankle joint, limited walking or dysfunction, which seriously affects the work and life of patients. The use of arthroscopy for ankle joint cleaning and removal of the hyperplastic synovial membrane and bone redundancy can well improve the function of the joint. If there is damage to the surrounding ligaments such as heel-fibular ligament, talofibular ligament, deltoid ligament and talo-heel interosseous ligament, simultaneous reconstruction and repair can be performed. Osteoarthritis of the ankle joint is caused by a combination of causes, resulting in increased pressure in the joint cavity, synovial congestion and hyperplasia, leading to ankle pain and affecting the degree of ankle movement. Conservative treatments such as oral medications can only relieve pain in the inactive state and are not effective for pain that occurs after activity. Sealing treatment is effective, but it is short-lived and cannot deal with the ankle synovial and cartilage lesions; while surgical treatment is traumatic, painful in early functional exercise, and not effective for cartilage damage on the joint surface. The ankle joint gap is narrow, the nerves and blood vessels are dense, the tendons and ligaments are complex, the space for arthroscopic surgery is narrow, the surgery is difficult to increase, and if the operator is not skilled, it is easy to damage the surrounding tissues and even destroy the surgical instruments. At present, the rate of missed diagnosis of cartilage lesions in the ankle joint is as high as 40%-50% on imaging. The cartilage surface should be carefully explored, the damaged articular cartilage surface should be shaved and repaired, and the periarticular bones should be ground, and then the cartilage surface should be treated with radiofrequency to make it smooth and flat, and microfracture techniques can be used to regenerate the subchondral bone vessels and promote the regeneration of fibrocartilage or hyaline cartilage to repair the damage to the cartilage surface. Using the ankle arthroscopy technique can comprehensively and systematically explore the ankle joint structure, not only can it deal with synovial and articular cartilage injuries, etc., but it can also perform intraoperative dynamic stress test of ligaments to examine and deal with soft tissue injuries. Minimally invasive arthroscopic surgery with small incisions and minimal injuries can reduce patient pain, provide early functional exercise, and have few complications and quick recovery.