Abstract: Objective To investigate the effects and correlations of Italian fascial release on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and biomechanics in patients with knee osteoarthritis. Methods This single-centre prospective study enrolled 120 patients with knee osteoarthritis (7 dropouts; final cohort: 113) between April 2023 and April 2025. Participants were randomised using a random number table into an FM group (n=56; Italian fascial release technique) and a conventional group (n=57; standard myofascial therapy). Baseline characteristics, WOMAC scores, biomechanical parameters, inflammatory markers, and gait metrics were compared between groups. A Pearson correlation model analysed post-treatment associations between disease severity and biomechanics. Results Pre-treatment WOMAC scores, biomechanical parameters, inflammatory cytokine levels, and gait metrics showed no significant differences between groups (P > 0.05). Post-treatment WOMAC scores decreased significantly in both groups, with the FM group exhibiting a greater reduction than the conventional group (P < 0.05). Biomechanical parameters improved markedly in both groups post-treatment, with the FM group demonstrating superior improvement (P < 0.05). Inflammatory factor levels were significantly lower in all groups post-treatment compared to pre-treatment, with the FM group exhibiting a greater reduction than the conventional group (P < 0.05). Gait parameters improved markedly in all groups post-treatment, with the FM group demonstrating superior improvement compared to the conventional group (P < 0.05). Pearson correlation analysis revealed negative correlations between disease severity (WOMAC total score) and the following parameters: medial knee joint space, lateral knee joint space, knee range of motion, walking speed, and stride length (r = ?0.63, ?0.58, ?0.54, ?0.44, ?0.41, P < 0.05). while the WOMAC total score showed positive correlations with the femoral-tibial angle and double support phase (r=0.59, 0.43, P<0.05). Conclusion Italian fascial release technique demonstrates relatively favourable outcomes for patients with knee osteoarthritis. It alleviates symptoms and disease severity, promotes joint function and gait recovery, effectively corrects biomechanical imbalances in the knee joint, and suppresses local inflammatory responses. Concurrently, knee biomechanical indicators serve as important references for assessing disease severity.