The author believes that there are several reasons that justify the use of a preliminary diagnostic and therapeutic arthroscopic examination in conjunction with an ankle ligament reconstruction. First, a high percentage of symptomatic unstable ankles demonstrate associated intra-articular pathologic conditions. Second, not all of these conditions are appreciated on preoperative clinical examination. Third, these pathologic conditions are addressed easily with standard arthroscopic techniques. Fourth, this technique addresses all of the periarticular problems that cause dysfunction. Last, ankle arthroscopy adds minimal time to the procedure and does not appear to confer significant morbidity.