<p>Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability. Orthobiological therapies aim to regenerate articular cartilage and delay or stop the progression of the degenerative lesion. Intra-articular injections of biological derivatives have been increasingly used in the last decade, although the indications for using bone marrow aspirate concentrate (BMAC) are still unclear. The present expert opinion reviewed the current literature on BMAC in the management of knee OA, providing an update on the current indications for the selection of the ideal patient, as well as the preparations and efficacy of BMAC compared to other biological alternatives. Clinical studies that investigated BMAC in the management of knee OA were identified and discussed. BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular administration of BMAC has shown effectiveness in clinical trials, improving the functional outcomes of patients. However, the superiority of BMAC over other orthobiologic treatments cannot be assessed, given the conflicting results presently available.</p>