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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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.

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.	刘林枫, 胡笑燊, 史鹏博, 等. 性别差异与膝骨关节炎发病相关性的研究进展. 华西医学, 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, Sääksjärvi K, Heliövaara 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, 陆洁航, 等. 膝骨关节炎中骨、筋、肉认知与演变考析. 安徽中医药大学学报, 2024, 43(4): 1-4.
17.	潘细桂, 连晓文, 付解辉, 等. 超声可视化针刀联合康复训练治疗膝骨关节炎疗效评价. 康复学报, 2024, 34(5): 508-515.
18.	栗晓东, 刘红军, 迟文, 等. 基于人体弓弦力学理论探讨针刀治疗膝骨关节炎的临床效果. 中国医药科学, 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.	刘娜, 孙银娣, 姜小凡, 等. 股内收肌群激痛点小针刀治疗膝骨关节炎的临床效果. 中国医药导报, 2022, 19(27): 132-136.
21.	章晓云, 曾浩, 孟林. 膝骨关节炎疼痛机制及治疗研究进展. 中国疼痛医学杂志, 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, Pavelić 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.	刘广宇, 张杰, 张晓峰, 等. 针刀松解联合丹参注射液关节腔注射治疗骨性关节炎模型兔. 中国组织工程研究, 2020, 24(2): 209-214.
26.	徐文博, 汪利合, 刘林枫, 等. 针刀干预对膝骨关节炎模型兔影响的 Meta 分析. 中医正骨, 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.	张良志, 李阳阳, 刘洪, 等. 基于金属蛋白酶抑制因子与基质金属蛋白酶之间的平衡探讨针刀对兔膝骨关节炎模型软骨基质降解的影响. 中国医药导报, 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.	伍闲, 宋小鸽, 卢曼, 等. 基于 lncRNA/miRNA/NF-κB 通路探讨针刀对膝骨关节炎兔的软骨保护作用机制. 北京中医药大学学报, 2022, 45(6): 603-611.
32.	王柯, 叶寒露. 基于 TLR4/MyD88/NF-κB 信号通路探究结筋点刃针松解法对膝骨关节炎兔股四头肌生物力学行为和炎症反应的影响. 中国老年学杂志, 2024, 44(17): 4312-4316.
33.	王钢, 李平顺, 周孟茹, 等. 基于 RANKL-RANK-OPG 系统探讨中医药干预 RA 性骨病的研究进展. 中华中医药杂志, 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.	孙晴, 骆承伟. 针刀与温针灸联合常规疗法治疗膝骨关节炎临床研究. 新中医, 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.	张雁儒, 董家琪, 杨越, 等. BMP2/SMAD1 信号通路在绝经性骨质疏松中的蛋白互作功能. 中国老年学杂志, 2023, 43(9): 2133-2139.
40.	王庆丰, 杨艳梅, 程国平, 等. 股骨头坏死愈胶囊联合重组人骨形态发生蛋白-2 治疗激素性股骨头坏死的作用机制. 中国中医骨伤科杂志, 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.	张健, 焦永伟, 王响, 等. 老年膝骨性关节炎患者外周血 miR-155 和 NLRP3 表达的关系. 中国老年学杂志, 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, 粟胜勇, 张熙, 等. 温和灸对神经根型颈椎病大鼠脊髓 Beclin-1/Bcl-2 表达的影响. 针刺研究, 2020, 45(10): 799-805.
48.	赵瑞, 林燕平, 黄佳纯, 等. Beclin 1 基因突变对成骨细胞自噬-凋亡表达的影响. 中国骨质疏松杂志, 2024, 30(6): 790-795, 812.
49.	刘晶, 曾维铨, 林巧璇, 等. 基于自噬及凋亡调控探讨针刀对膝关节骨关节炎兔软骨的保护作用. 针刺研究, 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. 刘林枫, 胡笑燊, 史鹏博, 等. 性别差异与膝骨关节炎发病相关性的研究进展. 华西医学, 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, Sääksjärvi K, Heliövaara 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, 陆洁航, 等. 膝骨关节炎中骨、筋、肉认知与演变考析. 安徽中医药大学学报, 2024, 43(4): 1-4.
17. 潘细桂, 连晓文, 付解辉, 等. 超声可视化针刀联合康复训练治疗膝骨关节炎疗效评价. 康复学报, 2024, 34(5): 508-515.
18. 栗晓东, 刘红军, 迟文, 等. 基于人体弓弦力学理论探讨针刀治疗膝骨关节炎的临床效果. 中国医药科学, 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. 刘娜, 孙银娣, 姜小凡, 等. 股内收肌群激痛点小针刀治疗膝骨关节炎的临床效果. 中国医药导报, 2022, 19(27): 132-136.
21. 章晓云, 曾浩, 孟林. 膝骨关节炎疼痛机制及治疗研究进展. 中国疼痛医学杂志, 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, Pavelić 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. 刘广宇, 张杰, 张晓峰, 等. 针刀松解联合丹参注射液关节腔注射治疗骨性关节炎模型兔. 中国组织工程研究, 2020, 24(2): 209-214.
26. 徐文博, 汪利合, 刘林枫, 等. 针刀干预对膝骨关节炎模型兔影响的 Meta 分析. 中医正骨, 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. 张良志, 李阳阳, 刘洪, 等. 基于金属蛋白酶抑制因子与基质金属蛋白酶之间的平衡探讨针刀对兔膝骨关节炎模型软骨基质降解的影响. 中国医药导报, 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. 伍闲, 宋小鸽, 卢曼, 等. 基于 lncRNA/miRNA/NF-κB 通路探讨针刀对膝骨关节炎兔的软骨保护作用机制. 北京中医药大学学报, 2022, 45(6): 603-611.
32. 王柯, 叶寒露. 基于 TLR4/MyD88/NF-κB 信号通路探究结筋点刃针松解法对膝骨关节炎兔股四头肌生物力学行为和炎症反应的影响. 中国老年学杂志, 2024, 44(17): 4312-4316.
33. 王钢, 李平顺, 周孟茹, 等. 基于 RANKL-RANK-OPG 系统探讨中医药干预 RA 性骨病的研究进展. 中华中医药杂志, 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. 孙晴, 骆承伟. 针刀与温针灸联合常规疗法治疗膝骨关节炎临床研究. 新中医, 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. 张雁儒, 董家琪, 杨越, 等. BMP2/SMAD1 信号通路在绝经性骨质疏松中的蛋白互作功能. 中国老年学杂志, 2023, 43(9): 2133-2139.
40. 王庆丰, 杨艳梅, 程国平, 等. 股骨头坏死愈胶囊联合重组人骨形态发生蛋白-2 治疗激素性股骨头坏死的作用机制. 中国中医骨伤科杂志, 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. 张健, 焦永伟, 王响, 等. 老年膝骨性关节炎患者外周血 miR-155 和 NLRP3 表达的关系. 中国老年学杂志, 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, 粟胜勇, 张熙, 等. 温和灸对神经根型颈椎病大鼠脊髓 Beclin-1/Bcl-2 表达的影响. 针刺研究, 2020, 45(10): 799-805.
48. 赵瑞, 林燕平, 黄佳纯, 等. Beclin 1 基因突变对成骨细胞自噬-凋亡表达的影响. 中国骨质疏松杂志, 2024, 30(6): 790-795, 812.
49. 刘晶, 曾维铨, 林巧璇, 等. 基于自噬及凋亡调控探讨针刀对膝关节骨关节炎兔软骨的保护作用. 针刺研究, 2022, 47(12): 1080-1087.

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