Action mechanism and research progress of acupotomy therapy in the treatment of knee osteoarthritis_West China Medical Journal

Authors：

LI Yinghong ¹ , WANG Yahui ¹ ,  JIANG Yichang ² , LIU Jiaxing ² , CAI Jinguang ¹

1. Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P. R. China;
2. Department of Orthopedics and Traumatology, the First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P. R. China;

Corresponding?author：

JIANG Yichang, Email: jiangyichang2008@126.com

Keywords：

Knee osteoarthritis; acupotomy; pathogenic factor; action mechanism

DOI：

10.7507/1002-0179.202410094

Video：

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Abstract Full text Figures/Tables Video References Cited by

Knee osteoarthritis (KOA) is a common chronic degenerative osteoarthritic disease with a high incidence especially among middle-aged and elderly people, and patients with KOA usually suffer from joint pain and dyskinesia, which is disabling and seriously affects their quality of life. Acupotomy therapy, as one of the characteristic treatments of traditional Chinese medicine, has been proven to significantly reduce the pain of KOA patients and effectively slow down the rapid deterioration of the disease. Therefore, this article reviews the pathogenic factors of KOA and explores the mechanism of action of acupotomy therapy for KOA from the perspectives of mechanical structure, level of inflammatory factors, cartilage repair, and cellular autophagy and apoptosis, in order to provide a more solid theoretical basis and therapeutic strategy for the application of acupotomy therapy in the clinical practice of KOA.

Citation： LI Yinghong, WANG Yahui, JIANG Yichang, LIU Jiaxing, CAI Jinguang. Action mechanism and research progress of acupotomy therapy in the treatment of knee osteoarthritis. West China Medical Journal, 2025, 40(4): 665-670. doi: 10.7507/1002-0179.202410094 Copy

1.	Hao Z, Wang Y, Wang L, et al. Burden evaluation and prediction of osteoarthritis and site-specific osteoarthritis coupled with attributable risk factors in China from 1990 to 2030. Clin Rheumatol, 2024, 43(6): 2061-2077.
2.	Sohn R, Assar T, Kaufhold I, et al. Osteoarthritis patients exhibit an autonomic dysfunction with indirect sympathetic dominance. J Transl Med, 2024, 22(1): 467.
3.	Kostev K, Gyasi RM, Konrad M, et al. Hospital length of stay and associated factors in patients with osteoarthritis from Germany: a cross-sectional study. J Clin Med, 2024, 13(9): 2628.
4.	Cao F, Xu Z, Li XX, et al. Trends and cross-country inequalities in the global burden of osteoarthritis, 1990-2019: a population-based study. Ageing Res Rev, 2024: 102382.
5.	Szilagyi IA, Waarsing JH, van Meurs JBJ, et al. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford), 2023, 62(6): 2037-2047.
6.	GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023, 5(9): e508-e522.
7.	Cui A, Li H, Wang D, et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine, 2020: 29-30.
8.	Hernandez PA, Bradford JC, Brahmachary P, et al. Unraveling sex-specific risks of knee osteoarthritis before menopause: do sex differences start early in life?. Osteoarthritis Cartilage, 2024, 32(9): 1032-1044.
9.	劉林楓, 胡笑燊, 史鵬博, 等. 性別差異與膝骨關節炎發病相關性的研究進展. 華西醫學, 2024, 39(4): 649-653.
10.	Ren Y, Hu J, Tan J, et al. Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study. BMC Public Health, 2020, 20(1): 1491.
11.	Zhou G, Zhao M, Wang X, et al. Demographic and radiographic factors for knee symptoms and range of motion in patients with knee osteoarthritis: a cross-sectional study in Beijing, China. BMC Musculoskelet Disord, 2023, 24(1): 378.
12.	Konstari S, S??ksj?rvi K, Heli?vaara M, et al. Associations of metabolic syndrome and its components with the risk of incident knee osteoarthritis leading to hospitalization: a 32-year follow-up study. Cartilage, 2021, 13(Suppl 1): 1445S-1456S.
13.	Sun AR, Udduttula A, Li J, et al. Cartilage tissue engineering for obesity-induced osteoarthritis: physiology, challenges, and future prospects. J Orthop Translat, 2021, 26: 3-15.
14.	Zhang C, Lin Y, Yan CH, et al. Adipokine signaling pathways in osteoarthritis. Front Bioeng Biotechnol, 2022, 10: 865370.
15.	Hulshof CTJ, Pega F, Neupane S, et al. The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: a systematic review and meta-analysis from the WHO/ILO joint estimates of the work-related burden of disease and injury. Environ Int, 2021, 150: 106349.
16.	汪正明, 葛海雅, 陸潔航, 等. 膝骨關節炎中骨、筋、肉認知與演變考析. 安徽中醫藥大學學報, 2024, 43(4): 1-4.
17.	潘細桂, 連曉文, 付解輝, 等. 超聲可視化針刀聯合康復訓練治療膝骨關節炎療效評價. 康復學報, 2024, 34(5): 508-515.
18.	栗曉東, 劉紅軍, 遲文, 等. 基于人體弓弦力學理論探討針刀治療膝骨關節炎的臨床效果. 中國醫藥科學, 2023, 13(19): 99-102.
19.	Lin S, Lai C, Wang J, et al. Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2023, 102(2): e32663.
20.	劉娜, 孫銀娣, 姜小凡, 等. 股內收肌群激痛點小針刀治療膝骨關節炎的臨床效果. 中國醫藥導報, 2022, 19(27): 132-136.
21.	章曉云, 曾浩, 孟林. 膝骨關節炎疼痛機制及治療研究進展. 中國疼痛醫學雜志, 2023, 29(1): 50-58.
22.	Dainese P, Wyngaert KV, De Mits S, et al. Association between knee inflammation and knee pain in patients with knee osteoarthritis: a systematic review. Osteoarthritis Cartilage, 2022, 30(4): 516-534.
23.	Wisniewska E, Laue D, Spinnen J, et al. Infrapatellar fat pad modulates osteoarthritis-associated cytokine and MMP expression in human articular chondrocytes. Cells, 2023, 12(24): 2850.
24.	Molnar V, Paveli? E, Vrdoljak K, et al. Mesenchymal stem cell mechanisms of action and clinical effects in osteoarthritis: a narrative review. Genes (Basel), 2022, 13(6): 949.
25.	劉廣宇, 張杰, 張曉峰, 等. 針刀松解聯合丹參注射液關節腔注射治療骨性關節炎模型兔. 中國組織工程研究, 2020, 24(2): 209-214.
26.	徐文博, 汪利合, 劉林楓, 等. 針刀干預對膝骨關節炎模型兔影響的 Meta 分析. 中醫正骨, 2023, 35(8): 43-50.
27.	Jiang X, Wang Q, Wang C, et al. The association between genetic polymorphisms of matrix metalloproteinases and knee osteoarthritis: a systematic review and meta‐analysis. Int J Rheum Dis, 2024, 27(3): e15123.
28.	張良志, 李陽陽, 劉洪, 等. 基于金屬蛋白酶抑制因子與基質金屬蛋白酶之間的平衡探討針刀對兔膝骨關節炎模型軟骨基質降解的影響. 中國醫藥導報, 2023, 20(28): 14-19, 65.
29.	Jimi E, Fei H, Nakatomi C. NF-κB signaling regulates physiological and pathological chondrogenesis. Int J Mol Sci, 2019, 20(24): 6275.
30.	Choi MC, Jo J, Park J, et al. NF-κB signaling pathways in osteoarthritic cartilage destruction. Cells, 2019, 8(7): 734.
31.	伍閑, 宋小鴿, 盧曼, 等. 基于 lncRNA/miRNA/NF-κB 通路探討針刀對膝骨關節炎兔的軟骨保護作用機制. 北京中醫藥大學學報, 2022, 45(6): 603-611.
32.	王柯, 葉寒露. 基于 TLR4/MyD88/NF-κB 信號通路探究結筋點刃針松解法對膝骨關節炎兔股四頭肌生物力學行為和炎癥反應的影響. 中國老年學雜志, 2024, 44(17): 4312-4316.
33.	王鋼, 李平順, 周孟茹, 等. 基于 RANKL-RANK-OPG 系統探討中醫藥干預 RA 性骨病的研究進展. 中華中醫藥雜志, 2020, 35(11): 5648-5655.
34.	Monti F, Perazza F, Leoni L, et al. RANK-RANKL-OPG axis in MASLD: current evidence linking bone and liver diseases and future perspectives. Int J Mol Sci, 2024, 25(17): 9193.
35.	孫晴, 駱承偉. 針刀與溫針灸聯合常規療法治療膝骨關節炎臨床研究. 新中醫, 2022, 54(4): 133-137.
36.	Luxue Q, Changqing G, Ruili Z, et al. Acupotomy inhibits aberrant formation of subchondral bone through regulating osteoprotegerin/receptor activator of nuclear factor-κB ligand pathway in rabbits with knee osteoarthritis induced by modified Videman method. J Tradit Chin Med, 2022, 42(3): 389-399.
37.	Wang T, Guo Y, Shi XW, et al. Acupotomy contributes to suppressing subchondral bone resorption in KOA rabbits by regulating the OPG/RANKL signaling pathway. Evid Based Complement Alternat Med, 2021, 2021: 8168657.
38.	Zheng Z, Wang D, Zhang W, et al. MiR-20 promotes cartilage repair in knee osteoarthritis rats via BMP2/Smad1 signaling pathway. Cell Mol Biol (Noisy-le-grand), 2023, 69(12): 256-261.
39.	張雁儒, 董家琪, 楊越, 等. BMP2/SMAD1 信號通路在絕經性骨質疏松中的蛋白互作功能. 中國老年學雜志, 2023, 43(9): 2133-2139.
40.	王慶豐, 楊艷梅, 程國平, 等. 股骨頭壞死愈膠囊聯合重組人骨形態發生蛋白-2 治療激素性股骨頭壞死的作用機制. 中國中醫骨傷科雜志, 2023, 31(11): 1-7.
41.	Xilin C, Yan G, Juan LU, et al. Acupotomy ameliorates subchondral bone absorption and mechanical properties in rabbits with knee osteoarthritis by regulating bone morphogenetic protein 2-Smad1 pathway. J Tradit Chin Med, 2023, 43(4): 734-743.
42.	Li GQ, Wang ZY. MiR-20b promotes osteocyte apoptosis in rats with steroid-induced necrosis of the femoral head through BMP signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(11): 4599-4608.
43.	Horigome Y, Ida-Yonemochi H, Waguri S, et al. Loss of autophagy in chondrocytes causes severe growth retardation. Autophagy, 2020, 16(3): 501-511.
44.	An F, Sun B, Liu Y, et al. Advances in understanding effects of miRNAs on apoptosis, autophagy, and pyroptosis in knee osteoarthritis. Mol Genet Genomics, 2023, 298(6): 1261-1278.
45.	張健, 焦永偉, 王響, 等. 老年膝骨性關節炎患者外周血 miR-155 和 NLRP3 表達的關系. 中國老年學雜志, 2021, 41(17): 3694-3697.
46.	Li G, Xiu L, Li X, et al. miR-155 inhibits chondrocyte pyroptosis in knee osteoarthritis by targeting SMAD2 and inhibiting the NLRP3/Caspase-1 pathway. J Orthop Surg Res, 2022, 17(1): 48.
47.	蔡慧倩, 粟勝勇, 張熙, 等. 溫和灸對神經根型頸椎病大鼠脊髓 Beclin-1/Bcl-2 表達的影響. 針刺研究, 2020, 45(10): 799-805.
48.	趙瑞, 林燕平, 黃佳純, 等. Beclin 1 基因突變對成骨細胞自噬-凋亡表達的影響. 中國骨質疏松雜志, 2024, 30(6): 790-795, 812.
49.	劉晶, 曾維銓, 林巧璇, 等. 基于自噬及凋亡調控探討針刀對膝關節骨關節炎兔軟骨的保護作用. 針刺研究, 2022, 47(12): 1080-1087.

1. Hao Z, Wang Y, Wang L, et al. Burden evaluation and prediction of osteoarthritis and site-specific osteoarthritis coupled with attributable risk factors in China from 1990 to 2030. Clin Rheumatol, 2024, 43(6): 2061-2077.
2. Sohn R, Assar T, Kaufhold I, et al. Osteoarthritis patients exhibit an autonomic dysfunction with indirect sympathetic dominance. J Transl Med, 2024, 22(1): 467.
3. Kostev K, Gyasi RM, Konrad M, et al. Hospital length of stay and associated factors in patients with osteoarthritis from Germany: a cross-sectional study. J Clin Med, 2024, 13(9): 2628.
4. Cao F, Xu Z, Li XX, et al. Trends and cross-country inequalities in the global burden of osteoarthritis, 1990-2019: a population-based study. Ageing Res Rev, 2024: 102382.
5. Szilagyi IA, Waarsing JH, van Meurs JBJ, et al. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford), 2023, 62(6): 2037-2047.
6. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol, 2023, 5(9): e508-e522.
7. Cui A, Li H, Wang D, et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine, 2020: 29-30.
8. Hernandez PA, Bradford JC, Brahmachary P, et al. Unraveling sex-specific risks of knee osteoarthritis before menopause: do sex differences start early in life?. Osteoarthritis Cartilage, 2024, 32(9): 1032-1044.
9. 劉林楓, 胡笑燊, 史鵬博, 等. 性別差異與膝骨關節炎發病相關性的研究進展. 華西醫學, 2024, 39(4): 649-653.
10. Ren Y, Hu J, Tan J, et al. Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study. BMC Public Health, 2020, 20(1): 1491.
11. Zhou G, Zhao M, Wang X, et al. Demographic and radiographic factors for knee symptoms and range of motion in patients with knee osteoarthritis: a cross-sectional study in Beijing, China. BMC Musculoskelet Disord, 2023, 24(1): 378.
12. Konstari S, S??ksj?rvi K, Heli?vaara M, et al. Associations of metabolic syndrome and its components with the risk of incident knee osteoarthritis leading to hospitalization: a 32-year follow-up study. Cartilage, 2021, 13(Suppl 1): 1445S-1456S.
13. Sun AR, Udduttula A, Li J, et al. Cartilage tissue engineering for obesity-induced osteoarthritis: physiology, challenges, and future prospects. J Orthop Translat, 2021, 26: 3-15.
14. Zhang C, Lin Y, Yan CH, et al. Adipokine signaling pathways in osteoarthritis. Front Bioeng Biotechnol, 2022, 10: 865370.
15. Hulshof CTJ, Pega F, Neupane S, et al. The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: a systematic review and meta-analysis from the WHO/ILO joint estimates of the work-related burden of disease and injury. Environ Int, 2021, 150: 106349.
16. 汪正明, 葛海雅, 陸潔航, 等. 膝骨關節炎中骨、筋、肉認知與演變考析. 安徽中醫藥大學學報, 2024, 43(4): 1-4.
17. 潘細桂, 連曉文, 付解輝, 等. 超聲可視化針刀聯合康復訓練治療膝骨關節炎療效評價. 康復學報, 2024, 34(5): 508-515.
18. 栗曉東, 劉紅軍, 遲文, 等. 基于人體弓弦力學理論探討針刀治療膝骨關節炎的臨床效果. 中國醫藥科學, 2023, 13(19): 99-102.
19. Lin S, Lai C, Wang J, et al. Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 2023, 102(2): e32663.
20. 劉娜, 孫銀娣, 姜小凡, 等. 股內收肌群激痛點小針刀治療膝骨關節炎的臨床效果. 中國醫藥導報, 2022, 19(27): 132-136.
21. 章曉云, 曾浩, 孟林. 膝骨關節炎疼痛機制及治療研究進展. 中國疼痛醫學雜志, 2023, 29(1): 50-58.
22. Dainese P, Wyngaert KV, De Mits S, et al. Association between knee inflammation and knee pain in patients with knee osteoarthritis: a systematic review. Osteoarthritis Cartilage, 2022, 30(4): 516-534.
23. Wisniewska E, Laue D, Spinnen J, et al. Infrapatellar fat pad modulates osteoarthritis-associated cytokine and MMP expression in human articular chondrocytes. Cells, 2023, 12(24): 2850.
24. Molnar V, Paveli? E, Vrdoljak K, et al. Mesenchymal stem cell mechanisms of action and clinical effects in osteoarthritis: a narrative review. Genes (Basel), 2022, 13(6): 949.
25. 劉廣宇, 張杰, 張曉峰, 等. 針刀松解聯合丹參注射液關節腔注射治療骨性關節炎模型兔. 中國組織工程研究, 2020, 24(2): 209-214.
26. 徐文博, 汪利合, 劉林楓, 等. 針刀干預對膝骨關節炎模型兔影響的 Meta 分析. 中醫正骨, 2023, 35(8): 43-50.
27. Jiang X, Wang Q, Wang C, et al. The association between genetic polymorphisms of matrix metalloproteinases and knee osteoarthritis: a systematic review and meta‐analysis. Int J Rheum Dis, 2024, 27(3): e15123.
28. 張良志, 李陽陽, 劉洪, 等. 基于金屬蛋白酶抑制因子與基質金屬蛋白酶之間的平衡探討針刀對兔膝骨關節炎模型軟骨基質降解的影響. 中國醫藥導報, 2023, 20(28): 14-19, 65.
29. Jimi E, Fei H, Nakatomi C. NF-κB signaling regulates physiological and pathological chondrogenesis. Int J Mol Sci, 2019, 20(24): 6275.
30. Choi MC, Jo J, Park J, et al. NF-κB signaling pathways in osteoarthritic cartilage destruction. Cells, 2019, 8(7): 734.
31. 伍閑, 宋小鴿, 盧曼, 等. 基于 lncRNA/miRNA/NF-κB 通路探討針刀對膝骨關節炎兔的軟骨保護作用機制. 北京中醫藥大學學報, 2022, 45(6): 603-611.
32. 王柯, 葉寒露. 基于 TLR4/MyD88/NF-κB 信號通路探究結筋點刃針松解法對膝骨關節炎兔股四頭肌生物力學行為和炎癥反應的影響. 中國老年學雜志, 2024, 44(17): 4312-4316.
33. 王鋼, 李平順, 周孟茹, 等. 基于 RANKL-RANK-OPG 系統探討中醫藥干預 RA 性骨病的研究進展. 中華中醫藥雜志, 2020, 35(11): 5648-5655.
34. Monti F, Perazza F, Leoni L, et al. RANK-RANKL-OPG axis in MASLD: current evidence linking bone and liver diseases and future perspectives. Int J Mol Sci, 2024, 25(17): 9193.
35. 孫晴, 駱承偉. 針刀與溫針灸聯合常規療法治療膝骨關節炎臨床研究. 新中醫, 2022, 54(4): 133-137.
36. Luxue Q, Changqing G, Ruili Z, et al. Acupotomy inhibits aberrant formation of subchondral bone through regulating osteoprotegerin/receptor activator of nuclear factor-κB ligand pathway in rabbits with knee osteoarthritis induced by modified Videman method. J Tradit Chin Med, 2022, 42(3): 389-399.
37. Wang T, Guo Y, Shi XW, et al. Acupotomy contributes to suppressing subchondral bone resorption in KOA rabbits by regulating the OPG/RANKL signaling pathway. Evid Based Complement Alternat Med, 2021, 2021: 8168657.
38. Zheng Z, Wang D, Zhang W, et al. MiR-20 promotes cartilage repair in knee osteoarthritis rats via BMP2/Smad1 signaling pathway. Cell Mol Biol (Noisy-le-grand), 2023, 69(12): 256-261.
39. 張雁儒, 董家琪, 楊越, 等. BMP2/SMAD1 信號通路在絕經性骨質疏松中的蛋白互作功能. 中國老年學雜志, 2023, 43(9): 2133-2139.
40. 王慶豐, 楊艷梅, 程國平, 等. 股骨頭壞死愈膠囊聯合重組人骨形態發生蛋白-2 治療激素性股骨頭壞死的作用機制. 中國中醫骨傷科雜志, 2023, 31(11): 1-7.
41. Xilin C, Yan G, Juan LU, et al. Acupotomy ameliorates subchondral bone absorption and mechanical properties in rabbits with knee osteoarthritis by regulating bone morphogenetic protein 2-Smad1 pathway. J Tradit Chin Med, 2023, 43(4): 734-743.
42. Li GQ, Wang ZY. MiR-20b promotes osteocyte apoptosis in rats with steroid-induced necrosis of the femoral head through BMP signaling pathway. Eur Rev Med Pharmacol Sci, 2019, 23(11): 4599-4608.
43. Horigome Y, Ida-Yonemochi H, Waguri S, et al. Loss of autophagy in chondrocytes causes severe growth retardation. Autophagy, 2020, 16(3): 501-511.
44. An F, Sun B, Liu Y, et al. Advances in understanding effects of miRNAs on apoptosis, autophagy, and pyroptosis in knee osteoarthritis. Mol Genet Genomics, 2023, 298(6): 1261-1278.
45. 張健, 焦永偉, 王響, 等. 老年膝骨性關節炎患者外周血 miR-155 和 NLRP3 表達的關系. 中國老年學雜志, 2021, 41(17): 3694-3697.
46. Li G, Xiu L, Li X, et al. miR-155 inhibits chondrocyte pyroptosis in knee osteoarthritis by targeting SMAD2 and inhibiting the NLRP3/Caspase-1 pathway. J Orthop Surg Res, 2022, 17(1): 48.
47. 蔡慧倩, 粟勝勇, 張熙, 等. 溫和灸對神經根型頸椎病大鼠脊髓 Beclin-1/Bcl-2 表達的影響. 針刺研究, 2020, 45(10): 799-805.
48. 趙瑞, 林燕平, 黃佳純, 等. Beclin 1 基因突變對成骨細胞自噬-凋亡表達的影響. 中國骨質疏松雜志, 2024, 30(6): 790-795, 812.
49. 劉晶, 曾維銓, 林巧璇, 等. 基于自噬及凋亡調控探討針刀對膝關節骨關節炎兔軟骨的保護作用. 針刺研究, 2022, 47(12): 1080-1087.

West China Medical Journal

Action mechanism and research progress of acupotomy therapy in the treatment of knee osteoarthritis

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