Acupuncture stimulates cartilage repair for patients with knee osteoarthritis. Using MRIs, researchers have quantified the therapeutic effects of acupuncture. Within four weeks, acupuncture successfully improves the condition of cartilage in the anterior medial and lateral tibial regions of the knee. In addition, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores document that acupuncture reduces pain and stiffness levels while simultaneously improving physical function.

In a controlled trial (Zhang et al.), acupuncture was compared with the therapeutic benefits of physical therapy. The MRIs demonstrate that acupuncture improves cartilage in the knee region. Physical therapy did not stimulate cartilage repair. Pain, stiffness, and physical functioning improved with both therapies. However, acupuncture significantly outperformed physical therapy across all three WOMAC indices (pain, stiffness, and physical functioning).

MRI Results
The researchers used T2 MRIs (magnetic resonance imaging) to measure changes in knee cartilage integrity. The researchers selected T2 (transverse relaxation time) imaging because T2 pulses enhance visibility of fat, water content, and other anatomical structures in the body. The researchers note, "In the earliest stage of OA [osteoarthritis], collagen matrix of cartilage breaks down and cannot immobilize water protons, resulting in an elevation in T2 relaxation time." The researchers confirmed the findings with "Sagittal T2 Mapping images for the medial and lateral tibiofemoral joints." The T2 MRIs produced quality resolution documentation that acupuncture "improves medial tibial sub-region (MTa) and anterior lateral tibial sub-region (LTa)" cartilage.

Acupuncture
One group received physical therapy and another study group received acupuncture. For the acupuncture group, electroacupuncture was administered by licensed acupuncturists with a practice experience in excess of twenty years. Acupuncture was applied once, every other day, for a total of four weeks. Needle retention time per acupuncture session was 20 minutes.

The needles used in the study were Hanyi brand disposable stainless steel filiform needles, size 0.30 × 40 mm. The depth of insertion ranged from 0.8–3.5 cm. Manual needle stimulation was applied to elicit a deqi response for each needle. Additionally, medial and lateral Xiyan received 20 Hz electroacupuncture stimulation to patient tolerance levels. The acupoints used in the study were the following:

MN-LE16 Neixiyan (medial Xiyan)
ST35 Dubi (lateral Xiyan, Waixiyan)
EX-LE2 Heding
SP10 Xuehai
SP11 Jimen
ST34 Liangqiu
ST36 Zusanli

Medial and lateral Xiyan and Heding were chosen as the primary acupoints for all participants. Supplementary points were added to benefit local tissues. A total of 126 patient were screened for inclusion and 47 patients participants with 94 treated knees completed the clinical trials.

The researchers note that Traditional Chinese Medicine (TCM) principles were used to make the acupoint selection for the study. Local points were used to benefit local tissues and ST36 located on the stomach foot-yangming channel was selected because this channel "is full of energy and nutrition." The focus of ST36 stimulation was to invigorate qi through the channel.

The researchers note that acupuncture and physical therapy produced positive patient outcomes, especially for pain, stiffness in the morning, and joint dysfunction. The researchers note, "acupuncture treatment showed better curative effect than physiotherapy, suggesting that acupuncture may be a superior non-operative treatment for KOA [knee osteoarthritis] compared with physiotherapy."

Integrative Medicine
Tuina massage, qigong, and taiji are traditional approaches to aspects of physical and movement therapy and have long been important modalities within TCM. Given that both acupuncture and physiotherapy produced positive patient outcomes in the study and that TCM includes physiotherapy within its scope of practice, integration of physiotherapy with acupuncture may produce greater positive patient outcomes than either treatment modality as a standalone therapy. This combination is consistent with TCM historical approaches to patient care.

Morphology and Detection
The researchers note that osteoarthritis is a degenerative disease involving  articular cartilage degradation. They add, "With the influence of age, wearing, biochemical and genetic factors, natural extracellular environment no longer exist because of damaged collagen scaffold and degraded proteoglycans in the chondrocyte matrix, leading to decreased cell counts and abnormal distribution. Attenuated cartilaginous layers, bony cleft and even bone defect will then appear along with biomechanics changes."

Based on these morphological conditions, the researchers note, "As the quantitative MRI method, increased T2 values, to some extent, could represent damages of the cartilage collagen scaffold. T2 image could thus be used for the discrimination of the OA severities, which has been considered to be a sensitive method for detecting articular cartilage changes and curative effect evaluation in OA patients."

The researchers note that high stress regions are important factors relating to articular cartilage degeneration in knee osteoarthritis. Two naturally occurring regions of high stress due to weight bearing loads are the medial tibial sub-region (MTa) and anterior lateral tibial sub-region (LTa). The researchers add that medial and lateral Xiyan reach both of these sub-regions and were therefore chosen as primary acupoints for the study. MRIs reveal that acupuncture improved the conditions of the MTa and LTa, "This study revealed significant differences in T2 values before and after acupuncture in MTa and LTa, while no significant difference in T2 value was detected in the physiotherapy group."

The MRIs demonstrate that acupuncture "improves medial tibial sub-region (MTa) and anterior lateral tibial sub-region (LTa)" cartilage. The research team commented that prior research may give us clues as to the biochemical mechanisms responsible for acupuncture’s therapeutic and curative actions. "Previous studies have proved anti-inflammatory action of acupuncture by influencing expression of interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase and tissue inhibitor. Additionally, acupuncture may play roles in improving cartilage repairing by influencing expression of transforming growth factor-β1 and basic fibroblast growth factor."

The research confirms that acupuncture reduces pain and inflammation due to osteoarthritis of the knee. The MRI documentation demonstrates that acupuncture initiates cartilage repair. Patients seeking advice regarding acupuncture are advised to consult with local licensed acupuncturists.

Reference
Zhang, Yan, Fei Bao, Yan Wang, and Zhihong Wu. "Influence of acupuncture in treatment of knee osteoarthritis and cartilage repairing." American journal of translational research 8, no. 9 (2016): 3995.