Abstract Background: Knee osteoarthritis (KOA) is one of the most common, chronic and degenerative diseases of the articular car-tilage of the knee joint. The clinical presentation include pain, stiffness, swelling, joint deformity and functional impairment, whilst at an advanced stage, muscular atrophy may also occur, which decreases patient quality of life. Physical therapy inter-vention in form of (exercise, stretching, myofascial release, braces and assistive devices), acupuncture and Tai chi. One of the causes of pain in KOA originates from the myofascial trig-ger points (MTrPs) located in the surrounding muscles. Aim of Study: To investigate the effect of adding deep front line myofascial release to selected exercises in decreasing pain, improving ROM and function on patients of KOA. Patients and Method: 42 patients with mild to moderate KOA were recruited and randomly assigned into 2 groups. The control group received selective exercises of stretching and strengthening. The study group received myofascial release with instrumental assisted soft tissue technique to the deep front line in addition to the same exercises. Each group received 3 sessions per week into four consecutive weeks. Results: There was a significant improvement in VAS, WOMAC and ROM post treatment in both groups compared with that pretreatment (p>0.001). Post treatment between group comparison revealed a significant improvement of VAS, WOMAC and knee flexion ROM of study group in favour of control group (p<0.05). While was no significant difference in extension ROM between groups post treatment (p>0.05). Conclusion: Adding the deep line myofascial release to exercises has a superior result than using exercises alone in pa-tients with KOA.