Osteoarthritis (OA) is a prevalent degenerative articular disease for which there is no effective treatment. Progress has been made in MSC-based therapy in OA, and the efficacy has been demonstrated to be due to paracrine exosomes from MSCs. Decellularized extracellular matrix (dECM) provides an optimum microenvironment for the expansion of MSCs. In this study, we aimed to investigate whether exosomes isolated from bone marrow mesenchymal stem cells (BMSCs) with dECM pretreatment (dECM-BMSC-Exos) enhance the amelioration of OA. Exosomes from BMSCs with or without dECM pretreatment were isolated. We measured and compared the effect of the BMSC-Exo and dECM-BMSC-Exo on IL-1β-induced chondrocytes by analyzing proliferation, anabolism and catabolism, migration and apoptosis in vitro. The in vivo experiment was performed by articular injection of exosomes into DMM mice, followed by histological evaluation of cartilage. miRNA sequencing of exosomes was performed on BMSC-Exo and dECM-BMSC-Exo to investigate the underlying mechanism. The function of miR-3473b was validated by the rescue studies in vitro and in vivo using antagomir-3473b. IL-1β-treated chondrocytes treated with dECM-BMSC-Exos showed enhanced proliferation, anabolism, migration and anti-apoptosis properties compared with BMSC-Exos. DMM mice injected with dECM-BMSC-Exo showed better cartilage regeneration than those injected with BMSC-Exo. Interestingly, miR-3473b was significantly elevated in dECM-BMSC-Exos and was found to mediate the protective effect in chondrocytes by targeting PTEN, which activated the PTEN/AKT signaling pathway. dECM-BMSC-Exo can enhance the alleviation of osteoarthritis via promoting migration, improving anabolism, and inhibiting apoptosis of chondrocytes by upregulating miR-3473b , which targets PTEN.