Knee osteoarthritis (KOA) is the most common degenerative disease of the knee joint, causing knee pain, bony enlargements, morning stiffness, knee activity limitations, and other symptoms. Knee pain and limited function are the primary factors affecting daily life and work in patients with KOA. Most people with KOA experience a partial or complete loss of the ability to work and self-care, which is the primary cause of chronic disability¹. Epidemiological data²^,³ show that the prevalence of KOA is positively correlated with age. With the aging Chinese population, the incidence of KOA is increasing every year. Globally, approximately 250 x 10⁶ patients have osteoarthritis, and its incidence is increasing annually. By 2030, osteoarthritis will be one of the main causes of disability⁴, with approximately 85% of osteoarthritis cases of the knee⁵^,⁶, which seriously affects the quality of life of patients and causes pain in their life and work, leading to a heavy economic burden to the country and individuals⁷^,⁸. Therefore, finding safe and minimally invasive treatments for patients with KOA is an area of intense research in orthopedics.

The main treatments for KOA include conservative therapies like patient education, lifestyle adjustments, physical therapy, orthopedic aids and orthotics, and medication and surgery. The vast majority of intra-knee surgery is performed through arthroscopic surgery with little trauma and a low infection rate. However, arthroscopic surgery still has some traumatic effects. Patients with KOA often undergo surgery after conservative treatment has failed⁹.

Acupotomy is a less invasive surgery than arthroscopy. Acupotomy can be performed in conjunction with conservative treatment. The needle knife is generally about 10-15 cm long and 0.4-1.2 mm in diameter. The needle knife consists of three parts: handle, needle body, and blade. The blade is thin and sharp. Its width is equal to the diameter of the needle body. Traditional acupotomy refers to the treatment of tendon pain points by a surgeon under the condition that the internal tissue structure of the human body cannot be directly observed; the interventional treatment is carried out according to his/her own experience and knowledge of the local anatomical tissue, combined with the symptoms and tender points of the patient. Due to the high risk of the procedure, including damage to the surrounding soft tissues, nerves, and blood vessels, infection, uncertain effects, and the possibility of multiple procedures, the use of traditional acupotomy is quite limited. With the development of imaging technology, the use of visualization has become a developing trend in acupotomology¹⁰ and has broadened the clinical application of acupotomy. Ultrasound can be used to visualize muscle and fascial lesions in real-time, allowing complete identification of the relative anatomy and the lesions¹¹^,¹², improving the accuracy and safety of acupotomy¹³. Currently, it is primarily used to treat joint pain in the neck, shoulder, waist, and leg¹⁴^,¹⁵. Ultrasound-guided acupotomy has the advantages of being a precisely targeted therapy, low risk, few complications, and high safety. Therefore, this study evaluated ultrasound-guided acupotomy as a new therapeutic approach for KOA.

Ultrasound-Guided Acupotomy Procedure to Treat Knee Osteoarthritis