LAUSR

Abstract 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.