Abstract: Objective：To evaluate the clinical efficacy of “4-position” arthroscopic treatment of popliteal cyst in patients aged over 60. Methods：From June 2013 to June 2015, 36 popliteal cyst patients aged over 60 with knee pain, swelling or limitation of activity were treated with arthroscopy. The fold of the joint capsule between the medial head of gastrocnemius muscle and the semimembranosus tendon was resected and enlarged up to 1 cm, and associated intra-articular diseases were treated at the same time. The preoperative and postoperative functions were evaluated with the Rauschning and Lindgren knee scores. Results：It was safe and convenient to build portals and work with 4-position. In 36 patients, 34 cases (94.4%) had intra-articular diseases, 24 cases (66.7%) had medial meniscus tear, 10 cases (27.8%) had lateral meniscus tear, 12 cases (33.3%) had cartilage lesion, and 8 cases (22.2%) had joint loose body. The follow-up time was 10-22 months, with an average of (16±4) months. The symptoms of knee joint discomfort were significantly relieved after operation. The Rauschning and Lindgren scores were significantly lower than those before operation (P<0.01). Conclusions：Arthroscopic treatment of popliteal cyst patients aged over 60 with “4-position” is simple, safe, and effective, which can deal with intra-articular diseases at the same time.