PURPOSE: Knee joint pain severely affects patients' quality of life and mental health and is a major factor in their seeking medical treatment. Given the increasing interest in non-invasive and complementary therapies for knee osteoarthritis, we conducted a systematic literature review and a meta-analysis of randomized clinical trials (RCTs) to evaluate the analgesic efficacy of laser acupuncture for knee osteoarthritis. METHODS: Data were searched from Cochrane CENTRAL, PubMed, EMBASE, MEDLINE, and three Chinese databases from inception to September 10, 2024, for RCTs of acupuncture for KOA. Paired reviewers independently extracted data and assessed the risk of bias. We used random effects models for all meta-analyses and the GRADE approach to assess the certainty of evidence. RESULTS: We included 5 RCTs (293 participants, 57% females). Low certainty evidence suggested that laser acupuncture may have no or little effects on reducing pain intensity compared to exercise (weighted mean difference (WMD) -0.84 cm on a 10 cm Visual Analogue Scale (VAS), 95% CI -1.12 to -0.56 cm; laser acupuncture may reduce more pain intensity compared to placebo laser acupuncture (WMD -2.33 cm, 95% CI -3.57 to -1.09 cm). Low evidence showed that laser acupuncture may improve the knee functioning of KOA patients compared to placebo acupuncture on 240-point WOMAC (WMD -39.06, 95% CI -63.79 to -14.32). CONCLUSION: Based on the low-certainty evidence from our meta-analysis, the effects of laser acupuncture on pain intensity compared to exercise are uncertain. However, compared to placebo laser acupuncture, laser acupuncture may lead to greater pain reduction and improved knee functioning in KOA patients. Due to the limited number of included studies and the low certainty of evidence, further high-quality RCTs are needed to confirm these findings.

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