Advances in Electroacupuncture for Treatment of Knee Osteoarthritis: Mechanisms, Efficacy, and Future Directions

Knee osteoarthritis (KOA) is a common chronic degenerative joint disease marked by progressive cartilage loss, subchondral bone remodeling, and synovial inflammation, resulting in persistent pain, functional disability, and diminished quality of life. Electroacupuncture (EA), a modality combining traditional acupuncture with electrical stimulation, has gained attention as a non-pharmacological intervention for KOA. Growing evidence suggests that EA not only reduces pain and enhances joint mobility but also modulates diverse biological processes-such as neuroendocrine signaling, inflammatory cascades, cartilage metabolism, and local hemodynamics. Mechanistically, EA acts through multi-target mechanisms, including suppression of pro-inflammatory mediators, promotion of anti-inflammatory and chondroprotective factors, and regulation of critical signaling pathways such as NF-κB, MAPK, and Wnt/β-catenin. Additionally, EA engages central and peripheral neuromodulatory systems involving opioid, serotonergic, and cannabinoid receptors, underpinning its analgesic properties. Despite encouraging outcomes, current support derives predominantly from small-scale clinical trials with short follow-up periods, underscoring the necessity for large-scale, randomized controlled studies with rigorous designs to establish standardized protocols and validate long-term benefits. This review synthesizes contemporary understanding of EA's mechanisms and efficacy in KOA management, addressing ongoing challenges and outlining future directions for refining EA-based strategies within integrated treatment frameworks.