Abstract: The knee is the joint most commonly affected by osteoarthritis. Knee osteoarthritis (KOA) is a leading cause of patient functional impairment. KOA is a degenerative joint disease characterized primarily by knee pain. At the macroscopic level, the pathogenesis of KOA is associated with biomechanical changes in the joint caused by aging, trauma, joint instability, and obesity. At the microscopic level, its pathogenesis involves metabolic syndrome, abnormal bone metabolism, cytokines and related enzymes, gene mutations, and altered plasma adiponectin levels. Recent studies have found that chondrocyte autophagy is closely related to the pathogenesis of KOA. Autophagy degrades damaged proteins and senescent organelles via lysosomes, serving as an important mechanism for maintaining cellular homeostasis. This paper summarized the specific molecular mechanisms by which traditional Chinese medicine(TCM) modulates chondrocyte autophagy to prevent and treat KOA, and pointed out its bidirectional regulatory effects, namely promoting and inhibiting cellular autophagy. On one hand, TCM can accelerate the clearance of inflammatory factors, downregulate the release of pro-inflammatory cytokines, and thereby attenuate the inflammatory response by promoting cellular autophagy; on the other hand, TCM can alleviate chondrocyte inflammation by inhibiting excessive autophagy. This paper elucidated the relationship between chondrocyte autophagy and the onset and progression of KOA, and systematically summarized the latest findings on interventions in cellular autophagy for the treatment of KOA using TCM extracts and TCM formulas, with the aim of further elucidating the pathogenesis of KOA, providing new ideas for in-depth research on pharmacological treatments, and offering a theoretical basis for clinical medication.