Osteoarthritis(OA)is a chronic joint disease that seriously jeopardizes human health,primarily characterized by progressive degradation of articular cartilage.However,there is still a lack of effective treatment due to its limited ability to repair cartilage.Paracellularly secreted exosomes,which can participate in a variety of cellular activities,have good therapeutic efficacy in OA.However,the use of natural exosomes alone in the treatment of OA faces problems such as poor joint targeting,short half-life,and poor therapeutic efficacy.A rational pretreatment approach can enhance the targeting,stabilization and in vivo half-life of exosomes for the treatment of OA.In this paper,we review the pre-treatment strategies aimed at enhancing the efficacy of exosomes for OA,in order to provide a scientific basis for the clinical application of exosomes in the treatment of OA.