Purpose: Number of arthroscopic surgery is gradually increasing with development of its equipment and technique. Arthroscopic ankle surgery performed with the traction device has various complications and need more time for preparation. We investigated whether the complication rate increased when surgery was performed without the traction device, and compared the complication rate of arthroscopic surgery with the traction device. Materials and Methods: From January 2009 to June 2012, arthroscopic ankle surgery was performed without the traction device in four hundred eleven cases. There were two hundred sixty-one males and one hundred fifty females. The average age at operation was 35 years (range, 17-56), and the average follow up period was 28 months (range, 12-41). Postoperative symptoms and complications were checked. Results: There were difficulties performing arthroscopic surgery without the traction device in five cases with severe traumatic osteoarthritis. However, after burring and shaving, we had enough space to work on. Superficial peroneal nerve symptom was found in two cases, grooving of talus was found in 11, and saphenous vein injury was found in five. Since preparing for the traction device was unnecessary, we were able to save time with the mean duration of surgery of 50 minutes (range, 30-120). Conclusion: With only manual traction, we could explore the entire ankle joint without damage on cartilage. Yet, skilled arthroscopic technique will be necessary for arthroscopic surgery without the traction device.