Acupuncture in the Management of Knee Osteoarthritis

Abstract

Knee osteoarthritis (KOA) is a leading cause of global disability, with over 370 million patients worldwide, and its prevalence continues to rise amid aging populations. Current treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery are often limited by side effects, high costs, and variable efficacy. Acupuncture has re-emerged as a safe, nonpharmacological intervention with multimodal mechanisms and potential synergistic benefits. This review summarizes evidence supporting acupuncture’s efficacy in alleviating pain and improving function in KOA, primarily through anti-inflammatory, neuromodulatory, and cartilage-protective pathways. Clinical studies demonstrate significant improvements in scales such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS), with sustained effects and fewer adverse events compared to conventional treatments. Furthermore, the integration of acupuncture with established therapies, such as hyaluronic acid injections and physical rehabilitation, has shown enhanced therapeutic outcomes. However, heterogeneity in study designs and unclear mechanistic nuances remain challenges. This review aims to evaluate the clinical value, safety, and integrative potential of acupuncture in KOA management, while advocating for more large-scale trials and biomarker-guided strategies.