There remains some controversy and confusion regarding arthroscopic surgery of the knee in the elderly population, particularly for patients with osteoarthritis. A retrospective review was undertaken of 105 knees in patients 60 years or older who had arthroscopy during a 4-year period. The surgical outcomes were evaluated using a postoperative knee scoring system at a mean followup period of 11.7 months. Good and excellent results were obtained in 65% of knees. The most significant predictors of good outcome were preoperative mechanical symptoms, such as those resulting from loose bodies or flap tears of the meniscus, and only mild articular degeneration seen at arthroscopy. A review of the literature reflects similar success rates. Although the results are equivocal by orthopaedic standards, in selected patients arthroscopic surgery can offer significant relief of acute symptoms and defer more extensive surgical procedures with minimal risk.