Pigmented villonodular synovitis (PVNS) is a relatively rare condition. The disorder almost always involves a single joint and the knee is most commonly affected. We report on three cases of localized PVNS that involved the patella fat pad and synovium. Diagnostic and therapeutic arthroscopies were performed, and typical findings of localized PVNS were found. Complete resection of the lesions were performed arthroscopically. Arthroscopy can be used as an effective diagnostic and therapeutic tool for identification and resection of intraarticular localized PVNS of the knee.