BACKGROUND: A tourniquet is usually used during anterior ankle arthroscopy to allow for improved visibility and reduced operation time. However, this has not been demonstrated to be true in clinical studies on knee arthroscopy, while limited tourniquet time has been described as a possible factor to lower the complication rate of ankle arthroscopy. The purpose of this randomized controlled trial was to examine the effect of tourniquet use on arthroscopic visualization, operative time, postoperative intra-articular bleeding, postoperative pain scores, and outcome of anterior ankle arthroscopy. ----- METHODS: A consecutive series of 50 patients who were scheduled for anterior ankle arthroscopy were randomized to have the surgery done either without the tourniquet inflated (25 patients) or with the tourniquet inflated (25 patients). The patients were evaluated by the course of the surgery, postoperative intra-articular bleeding, and pain during the early postoperative period, and subjective and objective functional scores were used to evaluate the condition of the ankle before and 3 and 6 months after the surgery. Forty-nine patients were present at the final follow-up, 6 months after the surgery. ----- RESULTS: The results between the groups were comparable regarding the duration of the operative procedure, consumption of sterile saline, visualization, and functional scores. A notable difference between the groups in favor of the nontourniquet group was present regarding postoperative bleeding but was not statistically significant. A statistically significant difference in favor of the nontourniquet group was found regarding postoperative pain during several days in the early postoperative period. ----- CONCLUSION: Our study showed that anterior ankle arthroscopy was performed adequately without the use of a tourniquet and that it had the same operative course as cases in which the tourniquet was used and functional outcomes that were not worse than cases in which the tourniquet was used. ----- LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial.