Acutherapy for Knee Osteoarthritis Relief in the Elderly: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis represents one of the most comprehensive assessments of the effects of acupuncture on knee osteoarthritis in older adults ever performed. Researchers from Hong Kong Polytechnic University analyzed 17 randomized controlled trials involving 4,774 participants with a mean age of at least 50 years, all diagnosed with symptomatic knee osteoarthritis. The study used the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scale as the main outcome measure, assessing knee pain, stiffness, and physical function. The methodology rigorously followed PRISMA guidelines, with systematic searches of five major databases from inception through July 2017.

Quality criteria were assessed using the modified Jadad scale, including only studies with a score of 3 points or higher, ensuring high methodologic quality. The results revealed significant findings about the efficacy of acupuncture. Compared with usual care (standard medication, education, and daily exercise without acupuncture), acupuncture demonstrated statistically significant superiority across all parameters assessed: pain reduction (SMD = -0.73; p < 0.001), stiffness improvement (SMD = -0.66; p < 0.001), and improvement in physical function (SMD = -1.56; p < 0.001). The overall result indicated a significant effect of acupuncture in relieving knee osteoarthritis (SMD = -0.94; p < 0.001).

A particularly intriguing finding emerged from the analysis of different sham (placebo) control modalities. When true acupuncture was compared with sham acupuncture applied at the same acupuncture points, no significant differences were found (SMD = -0.09; p = 0.55). This suggests that even lighter stimuli at the correct points may produce therapeutic effects. On the other hand, when acupuncture was compared with sham interventions at non-acupuncture points (sites distant from true points), true acupuncture was significantly superior (SMD = -0.16; p = 0.04), especially for pain and physical function.

This difference points to the crucial importance of the specific location of acupuncture points. The points most frequently used in the included studies were Ex-LE5 (XiYan), ST-35 (DuBi), SP-9 (YingLingQuan), SP-10 (XueHai), GB-34 (YangLingQuan), and ST-36 (ZuSanLi) — all traditionally recognized in Chinese medicine for knee joint problems. The acupuncture modalities investigated included traditional needle acupuncture, electroacupuncture, laser acupuncture, acupressure, and moxibustion. Interestingly, combined therapies showed a tendency toward outcomes superior to single modalities.

The study also compared acupuncture with exercise-based physical therapy, finding no significant differences, suggesting that both approaches may be equally effective and potentially complementary. The clinical implications are substantial. Acupuncture emerges as a valid and effective therapeutic option for older adults with knee osteoarthritis, offering significant pain relief and functional improvement. The absence of differences with physical therapy suggests that it can be integrated into multimodal rehabilitation programs.

The importance of precise point location underscores the need for adequate training of practitioners.