Background:Botulinum toxin A has the potential to be used for analgesia because of its anti-inflammatory effect. The utility of intra-articular injections of botulinum toxin A for knee osteoarthritis remains unclear. The aim of this study was to analyze the utility of such injections in knees with osteoarthritis.Methods: We conducted a literature search of 4 databases (Scopus, PubMed, ClinicalTrials.gov, and Europe PMC) up to September 10, 2022, using formulated keywords. Articles were included in the study if they had data on botulinum toxin A injection compared with the control group in patients with osteoarthritis of the knee. Results were summarized using the standardized mean difference (SMD) and accompanying 95% confidence interval (CI).Results: Pooled analysis of data from 6 trials involving 446 patients with knee osteoarthritis revealed that, compared with placebo, intra-articular injection of botulinum toxin A was associated with greater reductions in early visual analog scale (VAS) pain (SMD, 20.63 [95% CI,21.08 to 20.18], p = 0.007, I 2 = 79%), late VAS pain (SMD, 20.57 [95% CI,21.07 to 20.08], p = 0.02, I 2 = 81%), early Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (SMD, 20.84 [95% CI, 21.61 to 20.06], p = 0.03, I 2 = 90%), and late WOMAC (SMD, 21.12 [95% CI, 21.91 to 20.32], p = 0.006, I 2 = 93%) scores from baseline in patients with knee osteoarthritis.Conclusions: Intra-articular injection of botulinum toxin A may offer benefits in reducing pain and improving function in patients with knee osteoarthritis, with a relatively good safety profile. Larger randomized trials are warranted to confirm the results of our study.