Arthroscopy of the elbow remains a technically demanding procedure. The potential for injury to major neurovascular structures is greater with this procedure than with arthroscopic procedures of the knee, shoulder, and ankle. An understanding of regional anatomy and the proximity of major neurovascular structures to the anterior portals is essential. Injury to these structures can be minimized by incising the skin only, using blunt dissection and blunt trocars, distending the joint, and placing the anterior portals in a more proximal position. Arthroscopy of the elbow offers major advantages in the treatment of many disorders of the elbow, particularly in the athlete. The technique can be performed safely using the portals outlined and principles discussed.