Dose-Response Effect of Intra-Articular Ozone in Knee Osteoarthritis

Inclusion Criteria: * Patients aged 40-75 years diagnosed with knee osteoarthritis according to the American College of Rheumatology 2019 criteria * Grade 2 or 3 knee osteoarthritis based on the Kellgren-Lawrence radiological classification system. * Presence of chronic knee pain lasting for more than 6 months. * Numerical Rating Scale score of 3 or higher during knee-loading activities Exclusion Criteria: * Presence or history of acute knee infection, major knee trauma, or inflammatory arthritis * History of knee fracture or surgical intervention involving the affected knee joint within the last 6 months. * History of intra-articular injections (e.g., corticosteroids, hyaluronic acid, PRP) into the affected knee joint within the last 6 months. * History of physical therapy or rehabilitation in the knee region within the last 6 months * Presence of osteomyelitis adjacent to the knee joint, bacteremia, or hemarthrosis. * History of malignancy involving the lower extremity. * Known hypersensitivity or allergy to medical ozone. * Severe anemia, thrombocytopenia, active bleeding disorders, or ongoing anticoagulant therapy. * Pregnancy or lactation * Active infection * Severe systemic diseases (e.g., advanced cardiopulmonary disease, uncontrolled diabetes mellitus). * Hyperthyroidism or progressive neuromuscular disorders. * Cognitive impairment or inability to cooperate with the assessment tools and study protocol.