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Effectiveness of Acupotomy Combined with Topical Diclofenac for Knee Osteoarthritis: A Randomized Controlled Trial.

Journal of pain research·December 2025·Kai Du, Wu-Zhong Cheng, Ao Li et al.
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Key Finding

Acupotomy combined with topical diclofenac achieved a 92.55% response rate for knee osteoarthritis at 4 weeks compared to 61.54% with diclofenac alone, with benefits persisting at 24 weeks (90.32% vs 38.46%).

What This Means For You

Researchers in Beijing studied whether combining acupotomy—a specialized technique that uses needle-knife instruments to release tight tissues—with a common topical pain gel could help people with knee osteoarthritis better than the gel alone. The study included 199 adults aged 40 to 80 who had moderate to severe knee pain from osteoarthritis. Half received four acupotomy treatments over four weeks plus applied diclofenac gel four times daily, while the other half used only the gel. The results were impressive: after four weeks, 93% of patients receiving acupotomy plus gel experienced meaningful improvements in pain and function, compared to just 62% using gel alone. Even more encouraging, these benefits lasted—at six months, 90% of the acupotomy group still had significant improvement versus only 38% in the gel-only group. Pain scores and functional ability measurements showed consistently better results in the acupotomy group at all checkpoints throughout the study. The treatment appeared safe, with participants tolerating it well. This research suggests that acupotomy combined with topical pain medication offers substantial and lasting relief for knee osteoarthritis sufferers, providing an option for those seeking alternatives or additions to conventional treatments. The difference of 31% more people responding to treatment is clinically meaningful and suggests acupotomy could be a valuable addition to osteoarthritis care. If you're considering acupotomy for knee osteoarthritis, consult with a licensed acupuncturist trained in this specialized technique to determine if it's appropriate for your condition.

Clinical Notes for Practitioners

This assessor-blinded, single-center RCT (n=199) evaluated acupotomy combined with topical diclofenac diethylamine emulgel versus diclofenac alone for knee osteoarthritis in patients aged 40-80 with pain scores ≥4. The intervention group received four acupotomy sessions over four weeks plus topical diclofenac QID; controls used diclofenac only. Primary outcome measured the proportion achieving minimal clinically important differences in pain and function. At 4 weeks, response rates were 92.55% (acupotomy group) versus 61.54% (control), with a rate difference of 31.01% (95% CI: 19.70%-42.33%; P<0.001). At 24 weeks, sustained superiority was demonstrated: 90.32% versus 38.46% (rate difference 51.86%; 95% CI: 40.20%-63.52%; P<0.001). Secondary outcomes including NRS and WOMAC scores showed significantly greater improvements in the acupotomy group at all timepoints (P<0.001). Study limitations include single-center design and inability to blind participants/practitioners. Clinical takeaway: acupotomy as adjunctive therapy demonstrates robust, durable efficacy for knee osteoarthritis management.

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