To explore the clinical effect of tendon-regulating manipulation combined with Xiaoyu ointment on the treatment of knee osteoarthritis.Methods:Seventy patients with knee osteoarthritis who were treated in the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese medicine from July 2019 to February 2021 were selected，and randomly separated into two groups according to the random number table method，with 35 cases in each group.Patients in the control group were treated with conventional western medicine，and patients in the study group were treated with traditional Chinese medicine(TCM) tendon-regulating manipulation combined with Xiaoyu ointment based on western medicine.The clinical effect，knee joint functions，inflammation level，and cartilage metabolism level were compared and analyzed between the two groups.Results:The curative effect of the study group was better than that of the control group(P<005).Before treatment，there was no statistical difference between the two groups in the all-dimension Western Ontario and McMaster University Osteoarthritis Index(WOMAC) scores，serum tumor necrosis factor-α(TNF-α)，and interleukin-1(IL-1) levels(P>005).After treatment，the all-dimension WOMAC scores，TNF-α，and IL-1 levels of the two groups decreased，and the study group was significantly lower than the control group(P<005).Before treatment，there was no significant difference in the levels of serum cartilage oligomeric matrix protein(COMP)，C telopeptide of type Ⅱ collagen(CTX-Ⅱ)，and keratan sulfate(KS) between the two groups(P>005).After treatment，the levels of COMP，CTX-Ⅱ，and KS of the two groups decreased，and the study group was significantly lower than the control group(P<005).Conclusion:Tendon-regulating manipulation combined with Xiaoyu ointment can significantly improve the clinical effect of patients with knee osteoarthritis，improve knee joint functions，down-regulate inflammatory response，and improve cartilage metabolism abnormalities.