Objective: Knee osteoarthritis is one of the important causes of disability worldwide. This study aims to analyze the disease burden of knee osteoarthritis, attributable risk factors among Chinese residents from 1990 to 2021, and predict the disease burden trend for 2035. Methods: Data related to knee osteoarthritis in China from 1990 to 2021, including the number of incident cases, incidence rate, number of prevalent cases, prevalence rate, and years lived with disability (YLDs), were collected from the Global Burden of Disease Study (GBD2021) database. Joinpoint regression analysis was used to assess time trends, and the Bayesian-Age-Period-Cohort (BAPC) regression model was employed for future predictions. Results: From 1990 to 2021, the number of incident cases of knee osteoarthritis among Chinese residents increased from 3.65 million to 8.51 million, a rise of 133.16%, with an average annual increase of 3.15%. The incidence rate increased from 310.33 per 100,000 to 598.31 per 100,000, a rise of 92.80%, with an average annual increase of 2.55%. The number of prevalent cases increased from 41.04 million to 110 million, a rise of 166.97%, with an average annual increase of 3.61%. The prevalence rate increased from 3488.78 per 100,000 to 7701.69 per 100,000, a rise of 120.76%, with an average annual increase of 3.00%. The number of YLDs increased from 1.34 million to 3.55 million, a rise of 165.32%, with an average annual increase of 3.59%. The YLD rate increased from 113.86 per 100,000 to 249.81 per 100,000, a rise of 119.39%, with an average annual increase of 2.99%. High BMI was the only significant attributable risk factor, with the proportion of YLDs it caused continuing to rise. Predictions for 2035: The number of incident cases is expected to decline slightly from 5.89 million in 2022 to 5.72 million in 2035. The number of prevalent cases is expected to peak at 72.42 million in 2029 and be around 72.69 million in 2035. The number of YLDs is expected to increase year by year, from 2.35 million in 2022 to 2.35 million in 2035. Conclusion: The study reveals the increasing prevalence and disease burden of knee osteoarthritis among Chinese residents, emphasizing the importance of interventions targeting controllable risk factors. Although the prediction shows a slight decline in the number of incident cases in 2035, the number of prevalent cases and years of disability are expected to remain high, indicating the need for continued monitoring and intervention.