We reviewed retrospectively the results of knee arthroscopy in 23 patients (28 knees), 60 years and older. The majority of knees (71%) were initially evaluated at the Division of Sports Medicine because of symptoms attributed to a recent or past injury, and most had specific symptoms such as localized pain (64%), swelling (29%), locking (18%), catching (11%), or giving way (11%). Radiographic evidence of osteoarthritis, usually mild, was present in 63% of knees. Arthroscopy was performed when specific physical findings were suggestive of internal derangement in knees without radiographic evidence of severe degenerative disease. Partial meniscectomy was performed for tears of the medial and lateral meniscus in 75 and 43% of knees, respectively: six knees (21%) had tears of both medial and lateral menisci. Other procedures performed included shaving of chondromalacia patellae (18%) and removal of loose body (7%). At average follow-up 19 ± 13 months (range 2–36 months) after surgery in 17 of the 28 knees, most knees had significant improvement of pain (88%) and function (88%) compared with preoperative status. Further surgery was only rarely required. In older patients, arthroscopy of the knee is useful for the diagnosis and treatment of internal derangements, and results are satisfactory if severe osteoarthritis is not present.