Objective <p>Knee osteoarthritis (KOA) is the primary cause of lower-limb disability and poses a substantial socio-economic burden. This systematic review and meta-analysis aims to assess the prevalence of KOA in the Chinese population between 2013 and 2023.</p> Methods <p>Eight databases were searched, in addition to a grey Literature search and manual retrieval, to comprehensively collect cross-sectional studies on the prevalence of KOA in China. Stata 18.0 was used to perform a meta-analysis of the KOA prevalence data included in this study. Furthermore, a narrative review was conducted to evaluate the impact of gender, age, Body Mass Index (BMI), region, and other factors on the prevalence of KOA.</p> Results <p>The meta-analysis demonstrated that the overall prevalence of KOA in China from 2013 to 2023 was 28.0%. Subgroup analysis indicated a prevalence of 33.9% in women and 20.5% in men. The highest prevalence was observed in the 60–69 age group (32.8%), followed by those aged ≥ 80 and 70–79&#xa0;years. The highest prevalence was observed in individuals with a BMI ≥ 28&#xa0;kg/m², at 50.5%. Prevalence in northern China was 4.5% higher than in southern regions. Prevalence in high-altitude regions was 22.6% higher than in low-altitude regions. The prevalence rates in rural and urban areas were similar.</p> Conclusions <p>Over the past decade, the prevalence of KOA in China has remained high and increased with age, particularly among women. It is strongly associated with BMI and environmental factors. A large-scale KOA survey should be conducted nationwide to monitor the disease's development trends and avoid associated risk factors.</p> Systematic review registration <p>PROSPERO, identifier CRD42024590187.</p>