INTRODUCTION: Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability in the general population. SOURCE OF DATA: Recent published literature identified from PubMed, EMBASE, Google Scholar, and Scopus. AREAS OF AGREEMENT: Orthobiological therapies try to regenerate articular cartilage and stop the progression of the degenerative lesion. Intra-articular injections of biological derivates have been increasingly used in the last decade. AREAS OF CONTROVERSY: The indications for the use of bone marrow aspirate concentrate (BMAC) are still unclear. GROWING POINTS: We systematically reviewed the current literature on BMAC in the management of knee OA, giving an update on the current indications for the selection of the ideal patient and the preparations and efficacy of BMAC compared to other biological alternatives. AREAS TIMELY FOR DEVELOPING RESEARCH: BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular injection of BMAC has shown effectiveness in clinical trials improving functional outcomes of knee OA patients. The superiority of BMAC over other orthobiological treatments cannot be assessed because of conflicting results.