METHODS: We performed a comprehensive search on PubMed, the Cochrane Library, 
EMBASE, and four Chinese databases for articles published prior to June 2020. We 
included only randomized controlled trials (RCTs) that used acupotomy therapy as 
the major intervention in adults with knee OA, were published in either Chinese 
and English, included more than 20 subjects in each group, and included pain and 
function in the outcome measures. Knee OA was defined by the American College of 
Rheumatology or Chinese Orthopedic Association criteria in all studies. We 
extracted the visual analogue scale (VAS) pain score, the Western Ontario and 
McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total 
effectiveness rate, the modified Japanese Orthopedic Association (JOA) 
activities of daily living score, and Lysholm's score. We calculated the mean 
difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were 
conducted using random-effects models when appropriate.
RESULTS: We identified 1317 potentially relevant studies, thirty-two of which 
met the eligibility criteria and were conducted in China between 2007 and 2020. 
A total of 3021 knee OA patients (62.96% female, median age: 57 years, and 
median disease duration: 33 months) were included. The treatment duration ranged 
from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment 
involved releasing soft tissue adhesions and was performed once a week for 1-5 
weeks until the pain was relieved. The control group treatments included 
acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 
studies), radiofrequency electrotherapy (1 study), and nonsteroidal 
anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis 
showed that acupotomy led to superior improvements in the VAS pain score 
(MD = -1.11; 95% confidence interval (CI), -1.51 to -0.71; p < 0.00001) and 
WOMAC pain score (MD = -2.32; 95% CI, -2.94 to -1.69; p < 0.00001), a higher 
total effectiveness rate (RR = 1.15; 95% CI, 1.09-1.21; p < 0.00001), and 
superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11-9.76; 
p < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61-22.89; p = 0.01) for 
overall pain and function. No serious adverse events were reported.
CONCLUSION: Chinese acupotomy therapy may relieve pain and improve function in 
patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs 
are warranted.