RESUMEN
Context: Knee osteoarthritis (KOA) is a degenerative disorder that significantly affects patients' quality of life. Acupuncture and exercise are the most popular treatments currently. The outcomes for acupuncture for KOA, however, are controversial, with some researchers finding that the addition of acupuncture to exercise therapy provided no additional improvement in pain scores. Objective: The study intended to evaluate the therapeutic effects for KOA of exercise in combination with acupuncture on acupoints selected using the Traditional Chinse Medicine (TCM) theory of Equal Impact on Tendons, Bones, and Muscles (EITBM) in comparison with that of acupoints selected using classical consensus for the treatment. Design: The research team performed a randomized controlled trial. Setting: The study took place in the Department of Acupuncture and Moxibustion at the First Affiliated Hospital of Hebei University of Chinese Medicine in Shijiazhuang, Hebei, China. Participants: Participants were 70 patients with KOA who visited the hospital between December 2020 and February 2021. Intervention: Participants in both group received acupuncture plus exercise therapy. The research team randomly assigned participants to one of two groups: (1) 35 to the intervention group, which received acupuncture using acupoints selected using EITBM, and (2) 35 to the control group, which received acupuncture using the classical consensus acupoints. Both groups performed a 25-min session of acupuncture three times weekly for 4 weeks, with the exercise therapy following the acupuncture each time. Outcome Measures: The research team assessed clinical efficacy at baseline and postintervention. The primary outcome measures included assessments: (1) of knee joint pain using a visual analog scale (VAS), (2) of knee joint pain, flexibility, and function using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale; and (3) joint range of motion (ROM). The secondary outcome measures included measurement of serum levels of interleukin-1 beta (IL-1ß), tumor necrosis factor alpha (TNF-α), and matrix metalloproteinase-13 (MMP-13) using enzyme-linked immunosorbent assays (ELISA). Results: The VAS and WOMAC scores significantly decreased for both groups between baseline and postintervention, and the intervention group's decrease was significantly greater than that of the control group. The ROM of knee flexion was significantly higher in both groups postintervention than at baseline, and the intervention group's increase was significantly higher than that of the control group. The serum IL-1ß, TNF-α, and MMP-13 also significantly decreased postintervention in both groups, and the intervention group's levels were significantly lower than those of the control group. The total effective rate was 94.1% in the intervention group, 32 out of 34 participants, and 75.8% in the control group, 25 out of 33 participants, which was significantly different. Conclusions: Acupuncture, in combination with exercise, can relieve symptoms, improve joint function, and reduce pro-inflammatory cytokines (IL-1ß and TNF-a) as well as MMP-13 for patients with KOA. The outcomes for acupuncture using EITBM acupoints were significantly better than those of the acupoints selected using classical consensus.