Researchers find acupuncture effective for the treatment of knee osteoarthritis pain and joint dysfunction. Three independent studies confirm the benefits of acupuncture. One study finds acupuncture effective for increasing the efficacy of celecoxib treatment. Another finds acupuncture effective for increasing the positive patient outcome rates for patients taking Traditional Chinese Medicine (TCM) herbs. A third study compared two different types of acupuncture and determined that centro-square needling is exceptionally beneficial for the treatment of knee osteoarthritis. Let’s start with a brief overview of knee osteoarthritis and acupuncture before reviewing the independent investigations.
Knee osteoarthritis (KOA) is a common degenerative joint disease. It often develops from knee joint cartilage degeneration and bone hyperplasia, causing pain and limited joint movement. Long-term use of anti-inflammatory and analgesic oral medications, or intra-articular sodium hyaluronate, may lead to liver and kidney toxicity, as well as gastrointestinal damage. [1–2] It is therefore worthwhile to explore treatment methods to prevent these adverse effects.
The pathogenesis of KOA in TCM is often categorized as a combination of wind, cold, and dampness, together with heat-dampness and phlegm stagnation, all of which culminate in obstructed meridians and poor circulation of qi and blood. [3–4] The disease was first recorded in the “Huangdi Neijing (Yellow Emperor’s Inner Canon),” where systematic documentation of its cause, pathogenesis, symptoms and other related conditions were recorded. According to TCM principles, KOA stems from internal Zheng-qi deficiency, which allows external pathogens or injuries to damage meridians, leading to stagnant blood and consequent pathological responses.  The overall pathogenesis of KOA is often attributed to kidney and liver blood deficiency, external injuries, or external invasion of wind, cold, and dampness. 
Renowned Chinese TCM physician, Professor Jin Rui, uses a protocolized group of acupoints for treating KOA, named Xisanzhen (three on the knee): Xuehai (SP10), Liangqiu (ST34), Xiyan. Xisanzhen’s main clinical indications are knee pain, swelling, or weakness. Xuehai and Liangqiu regulate blood and qi flow, while Neixiyan and Waixiyan are special acupoints that reduce redness and swelling of the knee. 
In important type of acupuncture for KOA is warm needle acupuncture. Warm acupuncture is especially helpful for the treatment of KOA with cold-dampness origin. This type of acupuncture warms the meridians, dispels cold, removes wind and dampness, circulates blood and qi for the purposes of relieving swelling and pain. Fire acupuncture has a similar therapeutic effect.
Centro-square needling, a method of acupuncture wherein extra needles are inserted surrounding the main acupoint, is useful for treating cold-type arthritis. The increased stimulation from the extra needles strengthens the clearing, warming and qi stimulating properties of acupuncture. Centro-square needling is commonly utilized for the treatment of musculoskeletal diseases. [8–10] Centro-square needling to appropriate depths stimulates blood and lymph circulation, promotes the absorption of inflammatory exudates, and calms muscle spasms, thereby aiding tissue regeneration and pain relief. 
Zhengzhou Orthopedic Hospital of Traditional Chinese Medicine
A study by Li Jian (Zhengzhou Orthopedic Hospital of Traditional Chinese Medicine) determined that acupuncture enhances patient outcomes for patients taking celecoxib, a non-steroidal anti-inflammatory medication.  The study compared KOA patients receiving both acupuncture and celecoxib with KOA patients receiving only celecoxib. Acupuncture provided more significant and longer-lasting pain relief.
To evaluate treatment efficacy, patients were scored based on a KOA grading system and a Visual Analog Scale (VAS). The KOA grading system allocated a total score based on the severity of KOA symptoms. The VAS measures pain intensity levels. KOA and VAS scores were taken thrice throughout the course of the study, once before treatment, once immediately after treatment, and once 8 weeks after treatment. The differences in KOA and VAS scores before and after treatment were recorded.
The improvement in KOA scores for the acupuncture plus drug group was 13.9 ± 2.86 immediately after treatment, while that of the drug group was significantly less (P<0.05) at 12.1 ± 3.51. Eight weeks after treatment, the acupuncture plus drug group maintained a significant improvement of 12.7 ± 2.99, while the drug only group declined (P<0.05) and only achieved a final improvement of 6.51 ± 2.66.
The VAS scores showed a similar trend. Immediately after treatment, the acupuncture plus drug group recorded a VAS improvement of 5.78 ± 0.98, significantly higher than that of the drug group, which was 4.59 ± 1.45 (P<0.05). Eight weeks after treatment, the final VAS improvement of the acupuncture plus drug group was 5.09 ± 0.95, while that of the drug only group fell to 2.40 ± 1.01 (P<0.05). The researchers conclude that acupuncture significantly boost treatment efficacy for patients taking the NSAID celecoxib.