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Background: An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). Materials and methods: Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Metaanalysis of outcome indicators was performed using Revman 5.4 software. Results: A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)= -2.94, 95% CI: -5.52, -0.37, P= 0.03, I²= 60%], Visual Analog Scale (VAS) (MD = - 2.0, 95% CI: - 2.5, - 1.5, P< 0.01, I²=0%), range of motion (ROM) (MD =17.55, 95% CI: 13.49, 21.61, P< 0.00001, I²=0%), and Lequesne index (MD = - 2.85, 95% CI: - 3.64, - 2.07, P<0.00001, I²=48%). Conclusion: Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA. [ABSTRACT FROM AUTHOR]