Knee osteoarthritis is becoming 3an increasingly prevalent issue, particularly in ageing and more active populations. There is growing interest in modifying the joint microenvironment through intra-and extra-articular injection therapy to manage pain and improve function in individuals with advanced joint degeneration. A broad spectrum of therapeutic options is available, including potent anti-inflammatory agents, pro-inflammatory mediators, fibrotic agents, muscle relaxants, biologics targeting specific inflammatory or pain pathways, and injections that facilitate the separation of synovial membrane layers. Some of these approaches have demonstrated some success, enabling patients to return to activity with reduced discomfort for varying durations.  This presentation aims to describe these options from a clinical and research perspective, examining current evidence, and considering the potential implications for future management strategies in knee osteoarthritis.