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Background Knee joint disorders are a major cause of musculoskeletal morbidity and functional disability worldwide, involving a broad spectrum of traumatic, degenerative, cystic, and neoplastic pathologies. Accurate evaluation of these conditions is essential for appropriate clinical assessment. MRI provides detailed visualization of intra-articular and periarticular structures due to its superior soft tissue contrast and multiplanar capability. However, there remains a need for region-specific observational data describing the spectrum of MRI findings in routine clinical practice. Materials and methods This retrospective observational study was conducted in the Department of Radiodiagnosis at Hi-Tech Medical College and Hospital, Rourkela, India, following institutional ethics approval. A total of 236 patients who underwent MRI of the knee between August 2024 and July 2025 were included. Patients referred with clinical suspicion of knee joint pathology were evaluated. MRI findings were analyzed to determine the distribution of knee joint pathologies and their association with demographic variables. Results Of the 236 patients, 149 (63.13%) were males, and 87 (36.87%) were females. Ligamentous and meniscal injuries were the most common findings, observed in 134 patients (56.78%), with a predominance among younger male patients. Anterior cruciate ligament tears were the most frequent ligamentous injury, followed by medial meniscus tears. Osteoarthritis was identified in 47 cases (19.92%) and was more frequently observed in older female patients. Baker's cysts were observed in 25 cases (10.59%), fractures in 20 cases (8.47%), and malignant neoplasms in 10 cases (4.24%). Among fractures, patellar fractures were the most common pattern. Among malignant lesions, synovial sarcoma was the most frequently identified tumor. Conclusions Knee joint pathologies demonstrated a distinct distribution pattern, with ligamentous and meniscal injuries predominating in younger males and degenerative changes more frequent in older females. Within the framework of this observational study, MRI facilitated detailed characterization of a wide spectrum of knee abnormalities; however, in the absence of comparative or outcome-based data, conclusions regarding diagnostic accuracy or clinical impact cannot be established. These findings provide context-specific insights into the epidemiological and imaging profile of knee joint pathologies and may serve as a foundation for future prospective and comparative studies.