Arthrodesis is the standard treatment of end-stage arthrosis of the ankle. With internal compression techniques high fusion and satisfaction rates as well as acceptable complication rates have been achieved. From January 1986 until June 1998, 137 ankle arthrodeses were performed in 133 patients. The technique consisted of cartilage excision, anatomic repositioning of the talus, fusion using bone graft, and cannulated lag screws. Malleoli were spared in all cases.Ninety percent of patients fused after the index surgery, and 94% fused after revision surgery. Eighty-eight percent of patients were satisfied and had less pain, and 85% had increased function.Progressive arthrosis in surrounding joints developed in 33 of 41 ankles (80%) with greater than 24 month radiographic follow up. Despite this, only two of these patients required extension of their fusion. The anatomic compression arthrodesis technique (ACAT) provides many advantages, including minimal soft tissue disruption, ease of deformity correction, early rehabilitation, and a high rate of union.