Effectiveness of Dry Needling In Patellar Tendinopathy and Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Dry needling (DN) is widely used for knee pain, but its effectiveness in knee osteoarthritis (OA) and patellar tendinopathy (PT) remains uncertain. We systematically reviewed randomized controlled trials (RCTs) comparing DN, alone or added to a co-intervention, with sham needling, the same co-intervention without DN or another active treatment. MEDLINE/PubMed (through Europe PMC) was searched from inception to 23 October 2026 and supplemented by citation searching. Risk of bias was assessed with RoB 2 and certainty with GRADE. Standardized mean differences (Hedges' g) were pooled with random-effects models. Thirteen RCTs (11 knee OA, 2 PT) were included; seven contributed to meta-analyses. At the end of treatment, DN reduced pain in knee OA (4 RCTs, n=404; g −1.05, 95% CI −1.59 to −0.52; I²=78%) and improved function (3 RCTs, n=374; g −0.95, 95% CI −1.23 to −0.67; I²=30%). In PT, the pooled effect on pain was not statistically significant (2 RCTs, n=126; g −1.88, 95% CI −4.40 to 0.64; I²=97%); the larger trial had important reporting inconsistencies, and the sham-controlled trial found no between-group differences. Across conditions, excluding that trial attenuated the pain effect (g −0.96, 95% CI −1.40 to −0.52). Effects at 3–12 months were imprecise and inconsistent. Adverse events were frequent but minor and transient (post-needling soreness and bruising). Low-certainty evidence suggests that DN, mainly as an adjunct to exercise-based care, may reduce pain and improve function in the short term in knee OA. Evidence in PT is very low certainty and insufficient to support routine use.