Acupotomy Therapy for Knee Osteoarthritis Pain: Systematic Review and Meta‐Analysis

Abstract

Background and Purpose. Knee osteoarthritis (OA) is a major public health problem, and currently, few effective medical treatments exist. Chinese acupotomy therapy has been widely used for the treatment of knee OA in China. We conducted this systematic review and meta-analysis to evaluate the efficacy of Chinese acupotomy in treating knee OA to inform clinical practice. Methods. We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm’s score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate. Results. We identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1–5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = −1.11; 95% confidence interval (CI), −1.51 to −0.71; p < 0.00001) and WOMAC pain score (MD = −2.32; 95% CI, −2.94 to −1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09–1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11–9.76; p < 0.00001) and Lysholm’s score (MD = 12.75; 95% CI, 2.61–22.89; p = 0.01) for overall pain and function. No serious adverse events were reported. Conclusion. Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.

Preoperative Predictors of Prolonged Hospital Stay in Accelerated Rehabilitation for Patients Undergoing Orthopedic Surgery

“…Mailuo Shutong pills (Wan in Chinese) [22,23] are of great significance for the perioperative treatment of orthopedic patients, which can effectively shorten the hospitalization time of orthopedic patients, strengthen and accelerate rehabilitation, prevent and treat DVT of lower limbs, and enhance the satisfaction rate of patients and their families. e main risk factors of knee osteoarthritis patients [24,25] may be (or related to) obesity, rural residents, age, previous history of trauma, heredity, smoking, female (menopause), etc. e risk factors of patients with anterior cruciate ligament (ACL) [26] exercise mainly include women (before menopause), urban residents, previous history of trauma, no warm-up, irregular exercise, etc.…”

Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews

“…However, the results of SRs and MAs are conflicting, and the conclusions are comprised by the sample size and included study quality. 27 , 28 However, no consensus has been reached and their quality has not been evaluated yet, which is an indispensable step before treatment recommendations can confidently be made. A systemic review is a new approach designed to synthesize the results from multiple SRs and MAs.…”

“…Several recent SRs 27 , 28 , 30 have evaluated acupuncture interventions since the publication of the first systemic review in 2019. 31 Hence, to fully appraise the available data, we updated the prior analyses and included studies published during the last 3 years.…”

Effectiveness and safety of acupotomy for knee osteoarthritis: study protocol for a randomized controlled trial

“…Acupotomy, also named needle-scalpel, is the combination of the needle of acupuncture and the scalpel of western medicine [ 10 ]. Acupotomy combines traditional Chinese medicine meridian theory and modern surgical principles [ 11 ].…”