The role of arthroscopy in the management of degenerative knee arthritis in the older athlete remains controversial. This patient population desires symptomatic improvement to maintain active lifestyles. For advanced tricompartmental osteoarthritis, total knee arthroplasty provides the most predictable results. For active patients with unicompartmental disease, osteotomy can provide symptomatic improvement and delay the time to total knee arthroplasty. Substantial morbidity is associated with both of these procedures. Arthroscopic management of degenerative arthritis is an attractive alternative to osteotomy or total knee arthroplasty if predictable improvement and durable results can be achieved. Arthroscopic lavage success rates are quite variable and decline rapidly over time. It is mainly a palliative procedure with limited long-term success. Success rates for arthroscopic partial meniscectomy and arthroscopic débridement vary between 50% and 75% depending on many factors, including the age of the patient, degree of arthritis, activity level of the patient, limb alignment, and extent of follow-up. Lavage is probably an important aspect of this procedure. Abrasion arthroplasty and the Pridie procedure do not appear to offer any additional benefit to arthroscopic débridement alone. In fact, studies comparing arthroscopic abrasion with arthroscopic débridement have shown that débridement alone gives better long-term results than débridement combined with abrasion. Several studies have shown that some patients become significantly worse following abrasion arthroplasty. Clearly, arthroscopic débridement is the preferred procedure to abrasion arthroplasty. The arthroscope is useful in the treatment of degenerative arthritis of the knee. It has low morbidity and does not preclude future reconstructive procedures. Although long-term success is difficult to predict, certain patient variables are associated with a better outcome: normal limb alignment, history of mechanical symptoms, minimal radiographic signs of degeneration, and short duration of symptoms. Long-term randomized prospective studies are needed to define the role of arthroscopy further in the older athlete with degenerative knee arthritis.