Ultrasound imaging has emerged as a valuable tool in the assessment of knee osteoarthritis (OA), complementing conventional radiography and MRI. While traditional imaging methods have limitations in sensitivity and specificity, ultrasound offers real-time visualization, portability, and cost-effectiveness, making it suitable for both diagnostic and therapeutic applications. Ultrasound can detect structural changes such as cartilage degradation, osteophytes, and synovitis, and is increasingly used for guiding minimally invasive treatments. Recent advancements in ultrasound technology, including quantitative ultrasound (QUS) and tele-ultrasonography (TUS), enhance its diagnostic potential. QUS provides detailed information about tissue microstructure, while TUS enables remote monitoring and assessment, improving access to care in underserved areas. Ultrasound also shows promise in detecting early OA changes and monitoring treatment responses. In addition, ultrasound-guided interventions, such as intra-articular injections, are effective for managing OA symptoms. The integration of artificial intelligence with ultrasound imaging further enhances diagnostic accuracy and efficiency. Despite its advantages, ultrasound's role in OA assessment remains a topic of ongoing research and debate. Overall, ultrasound has the potential to significantly impact both clinical practice and research in OA management.Ultrasound imaging has emerged as a valuable tool in the assessment of knee osteoarthritis (OA), complementing conventional radiography and MRI. While traditional imaging methods have limitations in sensitivity and specificity, ultrasound offers real-time visualization, portability, and cost-effectiveness, making it suitable for both diagnostic and therapeutic applications. Ultrasound can detect structural changes such as cartilage degradation, osteophytes, and synovitis, and is increasingly used for guiding minimally invasive treatments. Recent advancements in ultrasound technology, including quantitative ultrasound (QUS) and tele-ultrasonography (TUS), enhance its diagnostic potential. QUS provides detailed information about tissue microstructure, while TUS enables remote monitoring and assessment, improving access to care in underserved areas. Ultrasound also shows promise in detecting early OA changes and monitoring treatment responses. In addition, ultrasound-guided interventions, such as intra-articular injections, are effective for managing OA symptoms. The integration of artificial intelligence with ultrasound imaging further enhances diagnostic accuracy and efficiency. Despite its advantages, ultrasound's role in OA assessment remains a topic of ongoing research and debate. Overall, ultrasound has the potential to significantly impact both clinical practice and research in OA management.