Background: Extra pulmonary tuberculosis (TB) accounts for 10% of all TB patients. Involvement of the musculoskeletal system accounts for only 3%, with ankle TB less than 1% of all musculoskeletal TB. In Indonesia the prevalence of TB is 660 within 100,000 persons, and data for extrapulmonary TB and musculoskeletal TB are unknown. Diagnosis of TB infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction, functional disability, and poorer prognosis. Methods: EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopic*”, “debridement” and “open.” English language studies with surgical management of ankle TB by arthroscopy or open debridement that were published between 2004 and 2019 were included. Studies of arthrodesis and multi-drug resistant TB were excluded. Results: After an initial search of 60 studies, 28 were excluded, and 20 were duplicates. Twelve studies (six case-control studies, four case series, and two cohort) were included. In total, 103 patients with a mean age of 43.8 (7 to 90) years were treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean time to surgery was 10.9 (1 to 80) months, and a mean postoperative treatment of 35.5 (1.5 to 260) months. All patients had a mean treatment time of 10 (4 to 21) months with rifampicin, isoniazid, pyrazinamide, and ethambutol. No patients were lost to follow-up. Conclusions: Early debridement is recommended to improve outcome in managing ankle TB. This review is limited by the lack of high evidence level studies from high-quality randomized controlled trials, lack of control groups, heterogenous outcomes reporting, small sample sizes, and no objective scoring were used to report the outcomes. However, larger sample sizes with long-term follow-up data were not found. Level of Evidence: Level IV.