Myofascial Trigger Point-Augmented Acupuncture vs Conventional Acupuncture for Early- to Mid-Stage Knee Osteoarthritis: A Randomized Clinical Trial.

PURPOSE: To determine whether adding myofascial trigger point (MTrP)-targeted dry needling to conventional acupuncture improves short-term pain and function response in adults with early- to mid-stage knee osteoarthritis (KOA).

PATIENTS AND

METHODS

In this randomized, assessor-blinded, single-center trial, 106 adults with Kellgren-Lawrence grade II-III KOA were assigned 1:1 to conventional acupuncture or the same regimen plus 3 individualized MTrP-targeted insertions. Both groups received 10 sessions over 2 weeks. The primary outcome was the week-2 composite responder rate, defined as a ≥2-point reduction in visual analog scale (VAS) pain and a ≥6-point improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function. Secondary outcomes included pain, function, pressure pain threshold (PPT), gait, acceptability, and safety.

RESULTS

Of 106 randomized participants, 97 were included in the modified intention-to-treat analysis. At week 2, 47 of 49 participants (95.9%) in the MTrP-augmented group and 42 of 48 (87.5%) in the conventional group were responders (risk difference, 8.4 percentage points [95% CI, -2.5 to 19.3]; risk ratio, 1.10 [95% CI, 0.97 to 1.24]; P =0.13). Exploratory secondary analyses without comprehensive multiplicity adjustment favored MTrP augmentation for VAS pain and WOMAC outcomes. The week-2 between-group difference in gait-speed change was 0.072 m/s (95% CI, 0.040 to 0.103; nominal P <0.001), and group-by-time interactions occurred at 6 of 7 shared peri-knee PPT sites. At week 2, needling pain was 2.45 points higher and acceptability was lower with MTrP augmentation (36.7% vs 72.9%). No serious adverse events or related withdrawals occurred.

CONCLUSION

Adding MTrP-targeted dry needling to conventional acupuncture did not significantly improve the prespecified primary responder outcome; therefore, superiority was not established. Exploratory findings suggested possible incremental benefits through week 14, but these should be weighed against greater procedural pain and substantially lower short-term acceptability.