Effectiveness of mesenchymal stem cells in treating osteoarthritis have been proven in animal experiments and clinical studies. More and more evidence indicate that mesenchymal stem cells works primarily through paracrine mechanisms and exosomes play an important role in this process. Exosomes are extracellular vesicles containing a variety of active substances and play a key role in intercellular and intracellular communication. This article reviews the research on the treatment of osteoarthritis by exosomes derived from different mesenchymal stem cells and discusses the future direction. This may provide new ideas for the treatment of osteoarthritis.