<p>Overload-related knee damage plays an important role in the development of the knee osteoarthritis (KOA). Multiple biomechanical conditions are of great importance in this process. The development and progression of the KOA depends on many mechanical factors such as the extent of axial deviations in the coronal plane due to varus- or valgus malalignment or less well investigated deviations in the sagittal plane due to the tibial slope geometry. Furthermore, pathologies such as meniscus damage, cartilage defects and ligamentous injuries can increase the mechanical overload in the joint compartment. Similarly, muscle dysfunction, anatomical anomalies, malalignments and imbalances (overload-related loss of joint stability due to altered force impact) favour the development of KOA. The joint homeostasis can also be impaired by obesity-induced inflammatory processes. Furthermore, instabilities due to patellar maltracking lead to the development of retropatellar KOA. Therefore, load-/training control or influencing the aforementioned biomechanical factors such as leg axis or patellar tracking should be considered as crucial aspects in the prevention and treatment of the overload-related KOA.</p>