Objective. To determine the risk of intra- and periarticular cyst-like lesions of the knee joint in occupational kneeling. Methods. Magnetic resonance imaging of both knees (n = 282) was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42-70 years). The prevalence of cyst-like lesions was computed among floor layers and graphic designers, respectively, and associations with occupation summarized by odds ratio (OR) with 95% confidence intervals (CIs). Using logistic regression, models were adjusted for age, body mass index, knee injuries, and knee-straining sports. Results. Floor layers had a significantly higher prevalence of cyst-like lesions in the posterior part of the knee joint compared to graphic designers (OR 2.70, 95% CI 1.50-4.84). Floor layers also had a higher prevalence of fluid collections in the popliteus tendon recess (OR 2.17, 95% CI 0.99-4.77) and large cystic lesions of the popliteus muscle (OR 3.83, 95% CI 0.78-18.89). The prevalence of cystic lesions in the anterior part of the knee joint was low among floor layers (8.7%) and there was no significant difference between the two trade groups (P = 0.34). Conclusions. Occupational kneeling increases the risk of cyst-like lesions in the posterior part of the knee joint.