Knee osteoarthritis (KOA) is a leading cause of global pain and disability and warrants complementary therapy. This review provides evidence of the clinical efficacy of acupuncture and the multisystem regulatory mechanisms of KOA. We analyzed clinical trials and mechanistic studies of acupuncture in the treatment of KOA. Acupuncture-particularly electroacupuncture (EA) significantly reduced pain (VAS/WOMAC) compared with sham acupuncture and conventional care (P < 0.05). Clinical trials demonstrate that combining acupuncture with exercise significantly enhances functional outcomes. Mechanistically, acupuncture modulates neuroendocrine pathways through three key actions: (1) suppressing pro-inflammatory cytokines (eg, TNF-α, IL-1β); (2) activating the Melatonin/cAMP/PKA/CREB signaling cascade; (3) altering functional connectivity in central pain-processing regions. Controversies persist regarding the mechanisms, optimal techniques, and outcome standardization. Acupuncture is an effective complementary therapy for KOA. Future research should prioritize long-term efficacy, personalized protocols, technology integration, and multidisciplinary strategies.
Jiao et al. (2025) studied this question.