Eligibility Criteria:
Inclusion Criteria
* Age 19 years and older
* Diagnosed with unilateral or bilateral knee osteoarthritis according to American College of Rheumatology (ACR) criteria, with at least 3 of the following 6 features:
* Age ≥50 years
* Morning stiffness \<30 minutes
* Crepitus on active motion
* Bony tenderness
* Bony enlargement
* No palpable warmth
* Radiographic evidence of Kellgren-Lawrence grade I, II, or III osteoarthritis within 6 months prior to screening or at screening visit
* Weight-bearing pain Visual Analogue Scale (VAS) score ≥40 mm in at least one knee joint at screening
* Able to walk without assistive devices (walkers or canes), OR if using a walking aid routinely for past 6 months, able to continue using the same device throughout the study
* Able to understand and complete efficacy assessment questionnaires
* Willing and able to provide written informed consent
Exclusion Criteria
* Body Mass Index (BMI) ≥32 kg/m²
* Chronic inflammatory joint disease (e.g., rheumatoid arthritis)
* Inflammatory joint disease (e.g., septic arthritis)
* Secondary knee osteoarthritis due to ochronosis, hemochromatosis, or systemic disease
* Painful musculoskeletal conditions (e.g., Sudeck's atrophy, Paget's disease, herniated intervertebral disc)
* Polyarticular disease with severe osteoarthritis in other joints (e.g., hip) that may affect knee pain evaluation
* Radiographic evidence of definite loss of patellofemoral joint space
* Moderate to severe joint effusion confirmed by positive patellar tap test or equivalent
* History of myocardial infarction, congestive heart failure, other serious cardiac disease, or uncontrolled hypertension (≥140/90 mmHg despite treatment with ≥3 antihypertensive agents)
* History of autoimmune disease
* Active infection requiring parenteral antibiotics
* History of psychiatric disorder or epilepsy
* Cancer diagnosis within 5 years prior to screening
* Uncontrolled type 1 or type 2 diabetes mellitus (HbA1c \>7%)
* Surgical procedures (including arthroscopy) on target knee within 1 year (surgery on contralateral knee or hip may be exclusionary if it could affect target knee assessment)
* Intra-articular corticosteroid injection into target knee within 12 weeks
* Systemic corticosteroid use within 4 weeks (topical and inhaled corticosteroids permitted)
* Surgery or radiation therapy to knee joint within 12 weeks, or not fully recovered from side effects
* Immunosuppressive therapy (e.g., Cyclosporine A, Azathioprine) within 6 weeks
* Intra-articular injections (e.g., hyaluronic acid) into knee joint within 6 months
* Prohibited concomitant medications within 2 weeks (unless washout period is adequate)
* Anticoagulants (e.g., warfarin, NOACs), antiplatelet agents (e.g., aspirin \>100 mg/day, clopidogrel; low-dose aspirin ≤100 mg/day permitted), thrombolytic agents (e.g., urokinase, alteplase), or Vitamin E \>1000 IU/day within 2 weeks (unless adequate washout)
* Habitual use (≥3 months) of psychoactive drugs or narcotic analgesics that may affect pain perception
* History of cell therapy or gene therapy to target joint
* Planned cell therapy or gene therapy to target joint
* Abnormal laboratory values at screening:
* ALT, AST, BUN, or serum creatinine \>2× upper limit of normal
* Engaged in high-intensity aerobic or heavy anaerobic exercise that may affect the knee joint
* Dermatological disease at injection site or site deemed unsuitable for injection
* Ligament instability of Grade II or higher in target knee (Grade 0: none; Grade I: 0-5 mm; Grade II: 5-10 mm; Grade III: \>10 mm)
* Known hypersensitivity to investigational product or its components
* Pregnant or breastfeeding women
* Women or men of childbearing potential unwilling to use acceptable contraception during study (acceptable methods: intrauterine device, tubal ligation, sterilization surgery, condom or diaphragm with spermicide, natural family planning)
* Participation in another clinical trial within 4 weeks
* Cognitive impairment or dementia preventing informed consent
* Any other condition that makes the subject unsuitable for study participation per investigator judgment