The aim of this prospective study was to assess the clinical results of arthroscopic ankle arthrodesis for end stage ankle arthritis in middle-aged active adults, as an alternative to open ankle arthrodesis based on the hypothesis that arthroscopic technique yields similar or better results but with less complications and shorter hospital stay. Patients and methods: The Between May 2012 and October 2014, this prospective case study was conducted on 19 middle aged active patients who met the criteria and followed for at least 2 years. Clinical grading was done at 6 months post-operative and final subjective clinical and radiologic assessment is done at least 2 years postoperative dividing results into four groups (excellent, good, fair, and poor). Results: After an average of 27.5 months follow-up 18/19 patients (94.7%) had their arthrodesis united, and 16 of them (84.2%) were satisfied. Three patients (15.8%) were dissatisfied after arthrodesis. Two of them (10.5%) were dissatisfied because of pain despite fusion occurred. Conclusion: The results of arthroscopic ankle arthrodesis for end stage ankle arthritis in middle-aged active adults in selected patients were clinically and radiologically satisfactory and could be used as an alternative to open technique but with fewer hazards and complications.