PURPOSE: Genicular nerve block (GNB) has emerged as a promising intervention for knee osteoarthritis (KOA), yet its comparative efficacy remains incompletely understood. The purpose of this review was to assess the effectiveness of GNB in reducing pain and improving function for primary or secondary KOA. METHODS: We conducted systematic searches of PubMed, Web of Science, and Embase up to October 9, 2024, for randomized controlled trials comparing GNB with other therapies. The data were analyzed using Review Manager (RevMan) 5.4, and study quality was assessed using the Cochrane risk of bias tool. RESULTS: This study included six RCTs involving a total of 420 participants. Results revealed that GNB significantly reduced pain (SMD = 1.00, 95% CI: 0.48-1.52, p=0.0002) and improved function (SMD = 1.07, 95% CI: 0.37-1.77, p=0.003) compared to other interventions. Subgroup analyses showed that GNB provided better pain relief at 2 weeks (SMD=1.21; 95% CI: 0.09-2.33; P=0.03) and greater functional improvement at 12 weeks (SMD=1.13; 95% CI: 0.10-2.16; P=0.03). CONCLUSION: This review suggested GNB as an effective intervention for KOA management, with distinct temporal patterns for pain relief and functional improvement.