Knee osteoarthritis (OA) is associated with high insulin resistance, particularly in individuals with metabolic syndrome and type 2 diabetes. In this cross-sectional study, we aimed to explore the relationship between insulin resistance indices and the prevalence of knee OA using data from 4,209 participants of the 2009-2010 Korea National Health and Nutrition Examination Survey. We used several insulin resistance indices in our analysis: Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), triglyceride-glucose (TyG) index, TyG-body mass index (TyG_BMI), TyG-waist circumference (TyG_WC), and visceral adiposity index (VAI). Without adjusting for confounding variables, the TyG_index increased the risk of knee OA by 1.056. After adjusting for confounders, the risk increased significantly by 1.082. Similarly, the TyG_BMI, TyG_WC, and VAI showed significant associations with knee OA. However, the association between HOMA-IR and knee OA was not significant. BMI (with and without confounding variable adjustments) was significantly associated with knee OA, whereas no significant associations were found for hypertension, dyslipidemia, diabetes, or WC. These results suggest that insulin resistance indices, particularly TyG-related indices, are significantly associated with knee OA. This highlights the potential benefits of managing knee OA in the context of metabolic syndrome, which is often associated with increased insulin resistance.