The purpose of this study was to present our long-term experience with arthroscopic surgery of the elbow joint with special regard to diagnosis-specific results. Out of 121 patients undergoing elbow arthroscopy 103 were evaluated, with a mean follow-up of 6.2 years. The age of the patients at time of surgery ranged between 3 and 72 years. For documentation, the Figgie score was used. The results were related to the patients’ pathology. The total score improved significantly from 49.3 to 89.1 (P < 0.05). There was no age dependency of the results, but there were correlations with the preoperative duration of symptoms and the individual job situation. Comparing the different parameters of the Figgie score, the aspect pain showed the greatest improvement. While patients with free joint bodies as well as septic or rheumatoid arthritis obtained a measurable benefit from the arthroscopic procedure, the postoperative improvement for the patients with severe degenerative arthritis was only limited. Patients with unspecific preoperative complaints showed no improvement at all. Thus, while patients with free joint bodies or synovitis without degenerative joint disease are good candidates for elbow arthroscopy, there is only a limited indication for patients with severe degenerative joint disease or patients with a restricted range of motion.