This article reviews the current role and future perspectives of ultrasound imaging in the assessment of knee osteoarthritis (OA). While conventional radiography and MRI are well-established tools for diagnosing knee OA, ultrasound is emerging as a complementary and additional method. Ultrasound offers several advantages, including the ability to detect soft-tissue changes, outline bony surfaces, and provide real-time imaging. It is particularly useful for detecting anomalies such as cartilage degradation, osteophytes, and synovitis. Ultrasound also enables local diagnostic and minimally invasive therapeutic operations, guided by real-time imaging. The article highlights the growing awareness among radiologists and physicians about the potential of ultrasound, which can aid in tracking the response to various therapies. Tele-ultrasonography, a non-invasive and portable technology, can facilitate remote diagnostics and monitoring, addressing the limited access to specialized consultations. Quantitative ultrasound (QUS) techniques, which leverage raw radiofrequency data, offer more detailed assessments of cartilage and other articular structures. The article also discusses the use of ultrasound in therapeutic applications, such as pain management and soft tissue healing, and its integration with artificial intelligence (AI) for improved diagnostic accuracy. Overall, the rapid evolution of ultrasound technologies holds significant potential for enhancing both research and clinical practice in the field of knee OA.This article reviews the current role and future perspectives of ultrasound imaging in the assessment of knee osteoarthritis (OA). While conventional radiography and MRI are well-established tools for diagnosing knee OA, ultrasound is emerging as a complementary and additional method. Ultrasound offers several advantages, including the ability to detect soft-tissue changes, outline bony surfaces, and provide real-time imaging. It is particularly useful for detecting anomalies such as cartilage degradation, osteophytes, and synovitis. Ultrasound also enables local diagnostic and minimally invasive therapeutic operations, guided by real-time imaging. The article highlights the growing awareness among radiologists and physicians about the potential of ultrasound, which can aid in tracking the response to various therapies. Tele-ultrasonography, a non-invasive and portable technology, can facilitate remote diagnostics and monitoring, addressing the limited access to specialized consultations. Quantitative ultrasound (QUS) techniques, which leverage raw radiofrequency data, offer more detailed assessments of cartilage and other articular structures. The article also discusses the use of ultrasound in therapeutic applications, such as pain management and soft tissue healing, and its integration with artificial intelligence (AI) for improved diagnostic accuracy. Overall, the rapid evolution of ultrasound technologies holds significant potential for enhancing both research and clinical practice in the field of knee OA.