Abstract：Objective：To observe the clinical effect of ZHANG's tendon-loosening manipulation combined with exercise therapy on knee osteoarthritis（KOA）at early and middle stages. Methods： A total of 106 cases of patients with KOA at early and middle stages， admitted to Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from January 2023 to June 2024， were selected and divided into the control group and the treatment group according to the random number table method， with 53 cases in each group. During the study， three cases were excluded from each group， and finally， 50 cases in each group completed the study. The control group received exercise therapy， and the treatment group received ZHANG's tendon-loosening manipulation in addition to exercise therapy. Both groups were treated for six weeks. After treatment， the clinical effects were compared between the two groups. Before treatment and at the 1st， 3rd， and 6th weeks of treatment， the Visual Analogue Scale（VAS）scores of pain， Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）scores， and knee range of motion （ROM）were compared between the two groups. Results：The excellent and good rate of clinical efficacy was 90.00% （45/50）in the treatment group，higher than that of 60.00%（30/50）in the control group（P＜0.05）. After one，three， and six weeks of treatment，the scores of VAS and WOMAC in the two groups were decreased when compared with those before treatment and decreased over time，with significant differences（P＜0.05）. The knee ROM in the two groups was increased when compared with that before treatment and continued to increase over time， with significant differences （P＜0.05）. The scores of VAS and WOMAC in the treatment group were lower than those in the control group at the same time points（P＜0.05），and the knee ROM was greater than that in the control group at the same time points（P＜ 0.05）. Conclusion： ZHANG's tendon-loosening manipulation combined with exercise therapy for KOA at early and middle stages can further enhance the curative effect， effectively relieve pain， improve knee joint function， and increase joint ROM.