Objective: To observe the expression of CTX-I (Ⅰ collagen C-terminal foreign body peptide) and TRACP (tartrate-resistant acid phosphatase) in different syndromes of knee osteoarthritis and their correlation with ADAMTS-4 (polyproteoglycan enzyme-4) and MMPS-3 (matrix metalloproteinase-3). Methods: A total of 98 patients diagnosed with knee osteoarthritis were enrolled from the Rehabilitation Pain Department and Rheumatology Department of Wuhan Caidian District People\'s Hospital. According to their syndrome types, they were divided into 40 cases of Yang deficiency and cold constipation type, 28 cases of qi stagnation and blood stasis type, and 30 cases of kidney jing deficiency type. The contents of bone metabolism indexes, ADAMTS-4 and MMPS-3 in different syndromes of the three groups were compared. Correlation of bone metabolism indexes with ADAMTS-4 and MMPS-3. Results: There were statistically significant differences in the contents of CTX-I, TRACP, ADAMTS-4 and MMPS-3 among three groups with different syndromes (P<0.05). There was a positive correlation between CTX-I, TRACP, ADAMTS-4 and MMPS-3 (P<0.05). The syndrome of qi stagnation and blood stasis was positively correlated with TRACP and ADAMTS-4, and negatively correlated with MMPS-3 (P<0.05). The renal essence deficiency syndrome was positively correlated with CTX-I, ADAMTS-4 and MMPS-3 (P<0.05). Bone metabolic indexes (CTX-I, TRACP) were positively correlated with ADAMTS-4 and MMPS-3 (P<0.05). Conclusion: Different syndromes of knee osteoarthritis are correlated with bone metabolism indexes, ADAMTS-4 and MMPS-3, which can provide a certain objective basis for clinical TCM syndrome differentiation and classification.