[Objective] To evaluate the efficacy and safety of botulinum toxin type A in the treatment of knee osteoarthritis. [Methods] Databases including PubMed, Embase, The Cochrane Library, Web of Science, CBM, Wanfang database and CNKI database were searched to collect randomized controlled trials (RCTs) about the botulinum toxin type A for the treatment of knee osteoarthritis. Meta-analysis was performed using Stata14.0 software after two independent reviewers screened the literature, extracted the data, and evaluated the risk of bias in the included studies. [Results] A total of 7 RCTs were included, including 535 patients. Meta-analysis showed that compared with the control group, botulinum toxin type A can significantly reduce the 4-week WOMAC pain score [WMD=-9.83, 95% CI (-11.79, -7.88), P< 0.01], 4-week WOMAC stiffness score [WMD=-5.44, 95% CI (-7.10, -3.78), P<0.01], 4-week WOMAC dysfunction score [WMD=-4.43, 95% CI (-6.00, -2.87), P<0.01], 8-week WOMAC pain score [WMD=-14.29, 95% CI (-25.04,-3.54), P=0.009], 8-week WOMAC stiffness score [WMD=-5.33, 95% CI (-8.54, -2.12), P=0.001] and 8-week WOMAC dysfunction score [WMD= -7.99, 95% CI (-12.71, - 3.27), P = 0.001], the differences were statistically significant. [Conclusions] The current evidence showed that botulinum toxin type A can effectively alleviate knee pain, effectively treat knee osteoarthritis. Due to the limited quality of included studies, the above conclusions need to be verified by more RCTs.