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.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Physician rater
The primary outcome showed a negative result indicating no clear superiority. PPT increased around the knee in both groups, with a group-by-time interaction observed at 6 out of 7 sites, suggesting that mechanical sensitisation modulation, rather than a joint-specific effect, may be responsible. Exploratory measures of pain and function (VAS 0.44–0.74; WOMAC function 3.6–4.9) persisted through week 14 but fell below the minimal individual-level clinically important improvement. A key practical consideration is tolerability: needling pain averaged +2.45, with acceptability at 36.7% compared with 72.9%. The study was conducted at a single center with expert operators and subjective endpoints were used.
Physician rater
The evidence does not confirm that MTrP-targeted dry needling is superior to acupuncture (RD 8.4 pp, 95% CI -2.5 to 19.3). The study was designed to detect an unlikely 18.7-percentage point difference. Therefore, the negative primary outcome should not be interpreted as evidence that MTrP targeting is ineffective. Instead, it reflects an uninformative result stemming from a design that could not identify a realistic small improvement. Although the exploratory findings related to pain, function, and gait align in direction, they are insufficient to overturn the primary outcome, which was mis-specified during the planning phase. The authors’ recommendation for future dose-matched, multicenter trials with predefined hierarchies remains the appropriate solution.
, McMaster University