Seventeen randomized controlled trials including 2000 patients with knee osteoarthritis were included in this systematic review and meta-analysis comparing extracorporeal shockwave therapy (ESWT) combined with hyaluronic acid (HA) versus HA alone. Pooled outcomes of interest included clinical efficacy, visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and adverse effects. The pooled results showed significant improvements in pain, joint function, and overall clinical efficacy with ESWT combined with HA compared to HA alone. Minor side effects such as skin redness and swelling were observed. These findings suggest that ESWT combined with HA is a safe and effective treatment for improving pain and functionality in knee osteoarthritis patients​​.