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.