Knee arthroscopy for patients with osteoarthritis remains controversial. The outcome of arthroscopic debridement in a patient with symptomatic arthritis, and in the absence of mechanical symptoms, is inconsistent and short lived. However, in carefully selected patients with mild or moderate arthritis on standing radiographs, with the acute onset of symptoms, well-localized joint line pain, and painful mechanical symptoms, improved knee function can be expected. Regardless, the natural history of the disease process is unaltered. Patients, especially higher demand middle-aged athletes, must be counseled about the prognosis of degenerative arthritis, the limited positive effects of the arthroscopic procedure, the potential for complications, and the probable need for reconstructive surgery in the future.