Gout is a group of clinical syndromes caused by purine metabolism disorders and/or uric acid excretion disorders, clinically characterized by hyperuricemia, manifested by recurrent arthritis, gout stone formation and joint deformities, and in severe cases, can lead to osteoarthropathy and joint mobility disorders and deformities. Gouty arthritis of the knee affects the knee joint function by causing severe pain, swelling, and limitation of activity of the knee joint as well as gout stone damage to intra-articular structures. Typical gout occurs in the lth metatarsophalangeal joint with elevated blood uric acid, which makes it easy to diagnose. Arthroscopy is a reliable and accurate means of diagnosis and differential diagnosis of gouty arthritis. Arthroscopic gouty arthritis is characterized by urate crystals and gout stones on all structures in the joints, including synovium, ligaments, cartilage and meniscus; the characteristic manifestation is the extensive inflammatory reaction of synovial membrane, the white urate crystals are deposited on various structures in the joints, and there are different degrees of white crystals on the cartilaginous surface of femur and tibia joints, the anterior and posterior cruciate ligaments, and meniscus, and in severe cases, cartilage destruction disappears and the fibrous tissue structure of cruciate ligament becomes chaotic and disorganized. In severe cases, the cartilage is destroyed and disappears, and the fibrous structure of the ligaments is disorganized and degenerated. In the late stage, the destruction of various structures by urate crystals may occur, and the severity of intra-articular structural damage is directly proportional to the duration of the disease and the age of the patient.