Effectiveness of Trigger Point Needling in the Management of Knee Osteoarthritis: A Systematic Review and Three-level Meta-analysis of Randomized Controlled Trials.

Abstract

To evaluate the efficacy of trigger point needling (TPN) for pain relief and improvement in WOMAC scores in patients with knee osteoarthritis (KOA). A systematic review with meta-analysis of randomized controlled trials (RCTs) from major databases up to June 2025. Pain intensity (measured by VAS/NRS) and WOMAC scores were the primary outcomes assessed. Data were pooled using a random-effects model. Eighteen RCTs involving 875 participants were included. TPN resulted in significant improvements in both pain (MD=-1.42, P<0.0001) and WOMAC scores (SMD=-1.42, P<0.001) immediately post-treatment. However, these benefits were not sustained at one-, three-, or six-month follow-up. TPN was found to be superior to traditional Chinese acupuncture in terms of pain relief (MD=-2.11, P<0.0001) and WOMAC score improvement (SMD=-1.42, P=0.003), but its effects were similar to those of sham TPN (P>0.05). TPN may offer greater therapeutic benefits than traditional Chinese acupuncture in patients with KOA. Improvements in pain and WOMAC scores were primarily observed immediately after treatment, with no significant benefits at longer follow-up intervals. Additionally, the possibility of a placebo effect cannot be excluded, as the therapeutic effects of TPN were comparable to those of sham needling.