Surgical options are limited for the patient who has symptomatic severe ankle joint degeneration that is unresponsive to nonoperative treatment. Arthrodesis of the tibiotalar joint is a procedure that can produce a pain-free ankle that can withstand the rigors of daily life, even in a young, high-demand, working individual. Minimally invasive orthopedic techniques have been applied to ankle arthrodesis, and arthroscopic ankle fusion has been shown to be an effective technique to achieve tibiotalar arthrodesis, with high rates of fusion and low rates of complication. This article covers indications, contraindications, and procedural techniques for arthroscopic ankle arthrodesis. Results of arthroscopic versus open ankle arthrodesis are compared.