/*~~acupotomie~~*/

====== AIGUILLE-SCALPEL (ACUPOTOMIE) ======
===== Présentation =====


{{:acupuncture:techniques:acupotome.jpg?nolink&300 |}}
The acupotome is a small surgical instrument that looks like a screwdriver at the first glance. It has a sharp blade at the tip and a flat handle. It's used for treating a variety of ailments affecting muscles and bones, especially chronic, acute pain in the limb joints, muscles and soft body tissues.
Professor Zhu Hanzhang, principal of Acupotomological Training School at Chinese Academy of Traditional Chinese Medicine (TCM) invented the needle-scalpel.
Made of stainless steel, the acupotome combines the functions of a "needle" for probing and a "scalpel" for cutting. As the name suggests, it allows practitioners to simultaneously use the techniques of acupuncture and surgery. It bears a little more resemblance to an acupuncture needle than a scalpel, as acupotomology is based on TCM. Professor Zhu added a blade to the tip of an acupuncture needle to create an instrument that could be used to cut soft tissue and excise bony growth, as well as stimulate the body at certain points.\\

==== Historique ====
//Vidéo// : présentation par le créateur Pr Zhu Hanzhang (12 min 11).\\
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{{:acupuncture:techniques instrumentales:acupotomology_founder--zhu_hangzhang.mp4|}}

==== L'instrument ====

[{{:acupuncture:techniques:needle-knife.jpg?nolink&400 | Needle-knife (Hanzhang Acupotome; Beijing Huaxia Acupotome Medical Equipment Factory, Beijing, China. Lin Munan 2014.) }}]
[{{:acupuncture:techniques instrumentales:acupotome-3.jpg?nolink&400 | Pointe de l'acupotome en tournevis}}]\\
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Acupotomes 
^ n° ^∅ ^ L |
^ 1# |0.35 |15mm |
^ 2# |0.35 |25mm |
^ 3# |0.35 | 40mm |
^ 4# |0.35 | 50mm |
^ 4# |0.35 | 75mm |

===== Techniques =====

[{{:acupuncture:techniques:needle-knife-2.jpg?nolink&300 |Therapeutic process of needle-knife treatment, including selecting acupoints (upper image) and needle-knife insertion (lower image). Lin Munan 2014.}}]\\
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{{:acupuncture:techniques instrumentales:acupotomy_treatment.mp4|}} \\ //Vidéo:// Traitement de la gonarthrose (3 min 07).
===== Sécurité et effets indésirables =====
Jin T, Zhang HL, Feng JC. Concealed cervical extradural hematoma related to small needle-scalpel surgery in China. Eur J Neurology 2011;18(Suppl.2):612.

<wrap lo> Objective: To present a case report which highlights a severe complication following the small needle-scalpel treatment in posterior cervical surgery.Introduction: Small needle-scalpel (or acupotomy) is a miniature surgical instrument, which combines traditional Chinese medicine with modern western medicine (the shape looks like a needle for acupuncture, 0.8mm in diameter, with a sharp bladed tip). It is increasingly used to treat cervical spondylopathy in China in the past two decades. However, the phenomenon of cervical extradural hematoma has not previously been reported. Methods: The authors report a 54-year-old man who presented with cervical myelopathy. The patient underwent small needle-scalpel treatment by a rural doctor, without  any new neurologic deficits but experienced delayed functional deterioration till quadriplegia in one month. Urgent MRI demonstrated a C3-C7 dorsally placed extradural hematoma with severe cord compression. Results: The patient refused urgent surgery and died of respiratory failure 9 days later. Conclusions: Although small needle-scalpel has many benefits, such as less pain, less expenditure, shorter period of therapy and better recovery of function, it also has the potential risk of extradural bleeding which otherwise reminds us to pay more attention insuring the operation gently. Our experience has shown that small needle-scalpel should be used judiciously with recognition of this potential complication.</wrap>
	

===== Indications et pratiques =====
==== Epaule gelée ====

{{:acupuncture:techniques instrumentales:acupotomy-_frozen-shoulder.mp4|}} \\
//Vidéo:// 10 min 00. 


==== Lombalgies ====


  * Kim So Yun, Kim Eunseok, Kwon Ojin, Han Chang-Hyun, Kim Young-Il . Effectiveness and Safety of Acupotomy for Lumbar Disc Herniation: A Randomized, Assessor-Blinded, Controlled Pilot Study. Evidence-Based Complementary and Alternative Medicine Volume 2018. {{:medias+securises:acupuncture:points:points+des+meridiens:vessie:kim-001.pdf|[001]}}[{{ 
 :acupuncture:points:points+des+meridiens:vessie:acupotomy-kim.png?600|The time × group interaction effect on VAS, ODI, MMST, and EQ-5D. (KIM 2018)}}]<wrap lo>Objective. Patients with lumbar disc herniation (LDH) suffer from pain, physical disabilities, and low quality of life. This study was designed to evaluate the effectiveness and safety of acupotomy in patients with LDH. Method. Fifty participants with LDH were recruited to this randomized, assessor-blinded, controlled study and randomly assigned to the acupotomy (n = 25) or manual acupuncture (n = 25) group. The acupotomy group received acupotomy four times in 2 weeks, while the manual acupuncture group received manual acupuncture six times in 2 weeks. The follow-up visit was planned in the 4th week (i.e., 2 weeks after the final intervention). The primary outcome was the change in the Visual Analogue Scale (VAS) at follow-up. The changes in the Oswestry Disability Index (ODI), Modified-Modified Schober Test (MMST), and EuroQol Five Dimensions (EQ-5D) questionnaire were also evaluated. An intention-to-treat analysis was applied and adverse events were recorded. Results. The acupotomy group showed significant changes in VAS, ODI, and EQ-5D after intervention. VAS and ODI in the 4th week were lower in the acupotomy than in the manual acupuncture group. The acupotomy group showed consistent changes in VAS and ODI in the 1st, 2nd, and 4th week. No serious adverse event was reported in the acupotomy group. Conclusion. This study suggests greater therapeutic effects of acupotomy on relieving pain and improving the functional disability associated with LDH than those observed with manual acupuncture.</wrap>

==== Gonarthrose ====


  * Needle-knife therapy improves the clinical symptoms of knee osteoarthritis by inhibiting the expression of inflammatory cytokines. Lin M, Li X, Liang W, Liu J, Guo J, Zheng J et al. Exp Ther Med 2014;7(4):835-842.{{:medias securises:acupuncture:techniques:lin-171100.pdf.|}} <wrap lo>Knee osteoarthritis (KOA) is a degenerative joint disease that occurs mainly in the elderly population. However, there are currently no effective treatments for treating this condition. In this study, the efficacy of needle-knife therapy, a technique of traditional Chinese medicine that has been widely used to treat KOA was investigated. Patients (n=170) with KOA were randomly divided for needle-knife therapy (treatment group) and acupuncture therapy (control group). Outcome evaluation included stiffness, pain, physiological function, overall changes, total symptom score, clinical curative effects and the concentrations of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) in the synovial fluid. The trial was completed in 151 patients (233 knees) from a total of 170 patients (264 knees); the treatment group comprised 76 patients (117 knees) who completed the trial and 9 patients (14 knees) who were removed from the study, and the control group comprised 75 patients (116 knees) who completed the trial and 10 patients (17 knees) who were removed from the study. The symptom scores of KOA in stages I-IV were reduced significantly in the treatment group and those of stages I-III were decreased significantly in the control group. The effective rate of the KOA therapy in the patients of stages III and IV in the treatment group was significantly higher than that in the control group. After treatment, the decrements of IL-1β, IL-6 and TNF-α in the treatment group were greater than those in the control group. These results showed that the use of needle-knife therapy to treat KOA effectively improved the clinical symptoms by inhibiting the expression of inflammatory cytokines.</wrap>
 
===== Evaluation =====

==== Evaluation générale ====

Kwon CY, Yoon SH, Lee B. Clinical effectiveness and safety of acupotomy: An overview of systematic reviews. Complement Ther Clin Pract. 2019;36:142-152.   {{:medias securises:acupuncture:techniques instrumentales:kwon-200286.pdf|[200286]}}.
 
^Background and purpose|Acupotomy is a modern type of acupuncture that uses a blade-needle combined with a flat surgical scalpel at its tip. This study was conducted to summarize and critically evaluate the current evidence on acupotomy. |
^Materials and methods| All relevant studies up to February 19, 2019, were included, through comprehensive searches in 11 electronic databases without language restrictions. RESULTS: Eleven systematic reviews (SRs) comprising of 69 randomized controlled trials were included, and the methodological quality was medium-to-high in AMSTAR. All the included studies reviewed musculoskeletal disorders and reported a significantly higher total effective and cure rates in the acupotomy group for frozen shoulder, cervical spondylosis, third lumbar vertebrae transverse process syndrome, trigger finger, knee osteoarthritis, and lumbar spinal stenosis, compared to the other active control groups. |
^Conclusion| Acupotomy showed promising results for some musculoskeletal disorders; however, additional high-quality evidence is required to make clinical recommendations regarding this procedure.|


==== Céphalées de tension ====




Kwon CY, Yoon SH, Chung SY, Kim JW. Clinical Efficacy and Safety of Miniscalpel-Needle Treatment for Tension-Type Headache: A Systematic Review and Meta-Analysis. Chinese Journal of Integrative Medicine. 2020;26(9):713-720. [220317]. [[https://doi.org/10.1007/s11655-020-3179-3|doi]]
^Objective|To investigate the clinical efficacy and safety of miniscalpel-needle (MSN) treatment for tension-type headache (TTH). |
^Method|Seven medical databases were searched to identify randomized controlled trials (RCTs) evaluating the effect and safety of MSN treatment. All articles published up to November 15, 2018 were retrieved. A meta-analysis was conducted for the included studies, and the risk of bias was assessed. Primary outcomes were visual analogue scale (VAS) or numeric rating scale (NRS) score. Secondary outcomes were clinical effective rates including total effective rate (TER), markedly effective rate (MER), and totally cured rate (TCR) determined by improvement in clinical symptoms or VAS scores, the frequency of adverse events (AEs) that occurred during the study, and participant quality of life (QOL).|
^ Results| Seven RCTs involving 724 participants were included. MSN treatment showed significantly higher MER and TCR [relative risk (RR) 1.27, 95% confidence interval (CI) 1.01 to 1.61; RR 1.31, 95% CI 1.09 to 1.57, respectively], but not TER (RR 1.03, 95% CI 0.96 to 1.10) compared to acupuncture. MSN treatment plus conventional treatment showed significant lower VAS and higher TER, MER, and TCR (mean difference -3.54, 95% CI -3.80 to -3.28; RR 1.14, 95% CI 1.06 to 1.23; RR 2.31, 95% CI 1.50 to 3.58; RR 3.01, 95% CI 2.25 to 4.02, respectively) compared to conventional treatment. |
^ Conclusions| According to current evidence, MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH. However, since the number and the sample size of studies included were both small and the methodological quality was poor, the findings of this review should be interpreted with great caution, and our confidence in the results is low. A high quality RCT using objective outcomes should be performed on this topic.|




==== Infirmité motrice cérébrale ====


Kwon CY , Lee B , Chang GT , Yoon SH. Efficacy of acupotomy for cerebral palsy: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(4).   {{:medias securises:acupuncture:evaluation:neuro-psychiatrie:kwon-192806.pdf|[192806].}}
^Background|In children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP. |
^Methods|Eleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes. |
^ Results| **Eight studies involving 530 participants** were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01-1.52, I = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75-13.49, I = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD -0.97, 95% CI -1.07 to -0.88, I = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low. |
^ Conclusion: | Current evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic. |


==== Doigt à ressaut ====

  * Liang YS, Chen LY, Cui YY, Du CX, Xu YX, Yin LH. Ultrasound-guided acupotomy for trigger finger: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Sep 13;18(1):678.  https://doi.org/10.1186/s13018-023-04127-3

^Background| Trigger finger is a common condition in the hand, and ultrasound-guided acupotomy for trigger finger has been widely used in recent years.|
^Purpose| This study aims to investigate the efficacy and safety of ultrasound-guided acupotomy for trigger finger.|
^Methods| We searched for relevant studies in the Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, PubMed, Chinese Biomedical Literature Database (CBM), Wanfang Data, and other resources from their inception to January 2023. Randomized controlled trials of ultrasound-guided acupotomy for trigger finger were included. The meta-analysis was carried out using Review Manager 5.4 and Stata 15.1.|
^Results| Overall, **15 studies with 988 patients** were included. The experimental group was treated with ultrasound-guided acupotomy, and the Control group received traditional acupotomy, traditional operation or injection of medication. Meta-analysis showed that the overall clinical effectiveness (OR = 4.83; 95% CI 2.49-9.37; I2 = 73.1%; P < 0.001) in the experimental group was significantly better than that of the control group. And the Visual Analogue Scale (VAS) score (WMD = - 1; 95% CI - 1.24, - 0.76; I2 = 99%; P < 0.001), the QuinneII classification (WMD = - 0.84; 95% CI - 1.28, - 0.39; I2 = 99.1%, P < 0.001), the incidence of complications (RR = 0.26; 95% CI 0.11, 0.63; I2 = 0%, P = 0.003), and the recurrence rate (RR = 0.14; 95% CI 0.03, 0.74; I2 = 0%; P = 0.021) were significantly lower in the experimental group.|
^Conclusion| Our systematic review and meta-analysis can prove the effectiveness and safety of ultrasound-guided acupotomy in the treatment of trigger finger, but this still needs to be verified by a clinical standard large sample test.|

  * Li D, Wang X, Fang T, Chen Y, Xiang S, Qi J, Liang C, Ren C, Zhao X, Qiu Z, Liu F, Yan X. Acupotomy in the treatment of tenosynovitis of hand flexor tendons: A systematic review and meta-analysis. Medicine (Baltimore). 2022 Nov 11;101(45):e31504.  https://doi.org/10.1097/MD.0000000000031504. |

^Background| Acupotomy was used to treat tenosynovitis of hand flexor tendons (THFT) in China. But it's uncertain about the efficacy of acupotomy for THFT. We plan to evaluate the efficacy and safety about acupotomy therapy in the treatment of THFT through this review.|
^Methods|The protocol about this review was registered in PROSPERO (registration number: CRD42022330568). We searched 6 databases from their respective inception dates to January 11, 2022. Studies searched was screened by our reviewers, and then the raw data was filtered out. We used RevMan 5.3 software to perform statistical analysis.|
^Results|**11 studies involving 828 patients** were shortlisted. The experimental group showed obvious advantages compared with the control group, such as effective rate (odds ratio [OR] = 6.77, 95% CI [confidence intervals] = [3.89, 11.77], P < .00001), cure rate (OR = 3.32, 95% CI = [1.81, 6.11], P = .0001) and Vas score (MD = -1.21, 95% CI = [-2.00, -0.42], Z = 3.01, P < .003).|
^Conclusions|According to the above results, Acupotomy is an effective and safe treatment for THFT. So it should be recommended for the treatment of THFT patients.|



  * Xie Lishuang, Zhou Xuelong, Wang Zhanyou, Liang Dongyue. [Meta-analysis of curative effect of small needle knife therapy on stenosing tenovaginitis of flexor digitorum]. Shandong Journal of TCM. 2016;35(6):522-5.   [168686]. 

^Objective|To compare the curative effect and safety of small needle knife therapy and blocking therapy on stenosing tenovaginitis of flexor digitorum by system evaluation.|
^Methods|Randomized controlled trials on treatment of stenosing tenovaginitis of flexor digitorum by small needle knife therapy and blocking therapy as the contrast were retrieved from Chinese national knowledge infrastructure ( 1962~2015 ), VIP database (1993~2015), WanFang database (2000~2015) and PubMed Chinese database (1994~2015) by computer, as well as related medical journals by manual work. The Meta-analysis was done by the RevMan 5.2 software after the selected data was cross checked by 2 valuators according to the requirements. |
^Results|A total of 7 randomized controlled trials met the inclusion criteria, including 1 174 patients, but there was no high-quality literature. The results of Meta-analysis showed that the total effective rate of the small needle knife group was significantly higher than that of the control group, OR=9.07,95%CI[4.64,17.76],Z=6.44,P<0.00001 and the cure rate of the small needle knife group was significantly higher than that of the control group, OR=7.86,95% CI[5.75,10.74],Z=12.93,P<0.00001. |
^Conclusion|The curative effect of small needle knife therapy was better than that of the control group. Since the study included a limited number of trials and the quality of the literature was not high, the funnel plot showed publication bias, so the conclusion need to be validated by more rigorous randomized controlled trials.|

  * Zhang JW, Jiang SM, Wu HB, et al. [System review of acupotomy treatment for stenosing tenovaginitis of flexor digitorum]. Chinese Journal of Information on TCM. 2016;23(7):46-50. [168559].

 ==== Cervicalgies  ====

  * Liu Fu-shui, Zhang Yi, Zhong Ding-wen. [Meta-analysis of acupotomology versus acupuncture for cervical spondylopathy]. Journal of Clinical Rehabilitative Tissue Engineering Research. 2012;9:1622.   [186993]

^Objective|To evaluate the efficacy and safety of acupotomy and acupuncture in the treatment of cervical spondylopathy.| 
^Methods|The data from CBM (1978/2010), CNKI (1979/2010), VIP (1989/2010), PubMed (1966/2010) and Cochrane Library (2010) were searched by computer, Supplemented by manual retrieval of relevant journals, acupuncture and acupuncture into the comparison of the treatment of cervical disease randomized controlled trials. Data were extracted and cross-checked by two reviewers according to Cochrane Systematic Review Handbook 5. 0, and Meta-analysis was performed using RevMan5.1 software. |
^Results and conclusions|A total of **10 randomized controlled trials involving 1085 patients** were included. Meta-analysis showed that the **total effective rate and cure rate of acupotomy group were significantly higher than those of acupuncture and moxibustion group, and the improvement of symptom scores was better than acupuncture and moxibustion group, which indicated that acupuncture treatment had better curative effect than acupuncture** . However, the number of articles included in the trial is limited and the quality of the literature is low, the need to design more stringent randomized controlled trials to further verify the above conclusions.|




  * Kan LL, Wang HD, Liu AG. [Meta-analysis of needle-knife treatment on cervical spondylosis]. Zhongguo Gu Shang. 2013;26(11):935-9. [186909]




^Purpose | To assess the efficacy of cervical spondylosis by needle-knife treatment according to the correlated literature of RCT,to compare advantages of needle-knife treatment.  |
^Methods | Randomized Controlled Trials about needle-knife treatment of cervical spondylosis were indexed from Chinese HowNet (CNKI) and Wanfang (WF) from 2000 to 2012, then were analyzed the efficacy by Review Manager 5.1 software.  |
^Results | A total of **13 RCT literatures and 1 419 patients** were included. The methods of included studies were poor in quality evaluation because of large sample and multi-center RCT studies was lacked, randomization method was not accurate enough, diagnostic criteria and efficacy evaluation were various, only four studies described long-term efficacy, most of the literature didn't describe the adverse event and fall off,all studies did not use the blind method. The Meta analysis outcome showed overall efficiency of needle-knife therapy was better than acupuncture and traction. Needle-knife therapy compared with Acupuncture, the total RR = 0.19, 95% confidence interval was (0.15, 0.24), P < 0.000.01. Compared with traction therapy the total RR = 1.30, 95% confidence intervalwas (1.18,1.42), P < 0.00001. |
^Conclusion | **Compared with acupuncture therapy,the overall effectiveness of needle-knife therapy is higher;compared with traction therapy, although,needle-knife therapy has a high overall effectiveness **, but because of the loss of total sample size, the outcome RCT researches to confirm. |

==== Névralgies cervico-brachiales ====



  * Zhao Meimei, Liu Fushui, Hong Tao, Zhou Fanzuo, Xie Hongwu. [Systematic review of acupotomy in the treatment of cervical spondylotic radiculopathy]. Traditional Chinese Medicine Journal (中医药通报). 2016;15(4):40-2;45.   [182982].
 
|系统评价针刀治疗神经根型颈椎病的临床疗效及其安全性。方法：计算机检索中国知网(1979-2015)、维普(1989-2015)、中国生物医学文献数据库(1978-2015)、Cochrane Library(2015年第4期)和美国图书馆PubMed (1966-2015),辅以手工检索相关论著及期刊,按照Cochrane系统评价员手册5.3的要求,采用RevMan5．3．0软件进行数据分析。结果：纳入7项临床随机对照试验,共941例神经根型颈椎病患者,Meta分析结果显示针刀组治疗神经根型颈椎病临床总有效率、治愈率高于其它治疗方式。针刀组报道了2例中等程度的不良反应,均为非直视下针刀进至神经根管内口进行铲切剥离操作时,突然出现剧烈的窜麻感。结论：临床治疗神经根型颈椎病可优先选择针刀疗法,同时应进一步改善针刀的可视性操作,提高其安全性；本研究纳入临床随机对照试验数量少且质量不高,建议在临床上设计并开展较为严格及完善的随机对照试验来验证上述结论.||
^Objective|Systematic review of the clinical efficacy and safety of needle knife in the treatment of cervical spondylotic radiculopathy. |
^Methods| Computer search of China HowNet (1979-2015), Weipu (1989-2015), Chinese Biomedical Literature Database (1978-2015), Cochrane Library (2015 Issue 4), and American Library PubMed (1966-2015) Relevant manuals and journals were supplemented by manual retrieval. According to the requirements of Cochrane systematic reviewer manual 5.3, RevMan 5.3.0 software was used for data analysis. |
^RESULTS| Seven randomized controlled trials were included. A total of 941 patients with cervical spondylotic radiculopathy were included. The meta-analysis showed that the total effective rate and cure rate of the needle-knife group in treating cervical spondylotic radiculopathy were higher than other treatment methods. The needle-knife group reported two cases of moderate-level adverse reactions. Both of them experienced a sharp numbness when they went to the inner root of the nerve root canal for cutting and stripping. |
^CONCLUSION| Needle-knife therapy should be preferentially selected for clinical treatment of nerve root type cervical spondylosis. At the same time, the visibility operation of needle-knife should be further improved to improve its safety. The number of randomized controlled trials included in this study is small and the quality is not high. Designed and carried out a more rigorous and complete randomized controlled trial to verify the above conclusions|

  * Liu XQ, Deng JF, Lin DK. [The evaluation of clinical articles about cervical spondylotic radiculopathy treated with acupotomy]. Chinese Journal of Traditional Medical Traumatology & Orthopedics 2007.15(4):34–37. [168341].

^Objective|To evaluate the quality of clinical study and efficacy of the treatment for cervical spondylotic radiculopathy(CSR)by acupotomy.|
^Methods|Dialog Online Retrieval system was used, extracting targeted articles were selected about the treatment in CSR by acupotomy assessed. Grades of recommendation and level of evidence to evaluate and compare the methodological quality in these articles, and the efficacy in the treatment for CSR by acupotomy.|
^Results|Seventy-six articles were evaluated 12 randomized controlled trials, 8 non- randomized controlled trials and 56 clinical retrospective studies. The grades of evidence recommendation and the frequency: B level 12, C level 8, D level 56.The level of evidence and the frequency: 2a level 2, 2b level 4, 4 level 8, 5 level 56.The methodological quality and the frequency of 20 clinical controlled trials: diagnostic criteria, 13A, 7B.The inclusive criteria, 5A, 15C; exclusive criteria, 7A, 13C; randomized method, 7A, 5B, ¤8C; base line, 9A, 11C; follow-up, 1A, 19C;therapeutical effect, 6A, 13B; statistical algorithm, 9A, 11B; the sample evaluation, the randomized assignment protocol hiding, blind trial and lost to follow are 20C. The total effective rate was 80%～100%; Three results of the Meta-analysis about these clinical controlled trial: there is a great difference between the treatment of acupuncture and acupotomy; the group of acupotomy is better than that of acupuncture; there`s no damage on the nerve or on the circulation system, or fainting during the treatment,etc.|
^Conclusions|There is no enough high grades of evidence recommendation. the level of evidence is rather low; there`s some defects in clinical study on the treatment for CSR by acupotomy; treatment for CSR by acupotomy is safe and efficient treatment for CSR, but the bad quality of articles and the deficiency of methodological decline the efficacy and the reliability.|
==== Epaule gelée ====



  * Ma Shining, Shang Qinghua, Fu Daerling, Luo Zhichao.  [Systematic review on comparing blockage and acupotomology in treating frozen shoulder]. World Chinese Medicine. 2014;9(3):361-4.   [168737].
 
^Objective|To evaluate the clinical safety and efficacy of blockage and acupotomology for frozen shoulder. |
^Methods|Randomized controlled trials ( RCTs) on blockage and acupotomology in the treatment of frozen shoulder were retrieved from CBM ( from year 1978 to 2013), CNKI (from year 1979 to 2013), VIP (from year 1989 to 2013), PubMed ( from year 1966 to 2013), and Cochrane Library (Issue,5,2013).Data were extracted and evaluated by two reviewers independently according to Cochrane Reviewers ’ Hand-book. The Cochrane Collaboration ’ s Revman 5.2.5 software was used for meta-analyses when necessary. |
^Results|Two trials involving 115 cases were included in the review .The results of meta-analyses showed that there was no significant difference of short-term curative rate for frozen shoulder between blockage and acupotomology (P>0.05).And the long-term effect rate [OR=0.09,95%CI (0.01, 0.93),P=0.04] and long-term total curative rate [OR=0.07,95%CI(0.02,0.26),P<0.0001] of acupotomology was superior to blockage in the treatment of frozen shoulder. |
^Conclusion| Acupotomology may be superior to blockage in the treatment for frozen shoulder. However, due to low quality of the included studies , rigorously designed RCTs are needed to confirm the conclusion. |





  * Wu Xiang, Jin Dezhong, Liu Fushui, Xu Hua.  [Meta-analysis of acupotomy on frozen shoulder]. Traditional Chinese Medicine Journal (中医药通报). 2013;12(6):55-8.   [170551].

|目的:采用Meta分析的方法评价针刀治疗肩周炎的疗效。方法:计算机检索中国生物医学文献数据库CBM(1978~2013年)、中国知网CNKI(1979~2013年)、维普数据库VIP(1989~2013年)、PubMed(1966~2013年)、EMBASE(1980~2013年)和Cochrane临床对照试验中心注册库(2013年第6期),并辅以手工检索,纳入治疗组采用针刀治疗、对照组采用非针刀疗法的随机对照试验。由2名评价者独立选择试验、提取资料并交叉核对,以Cochrane系统评价员手册4.2.8进行质量评估。采用RevMan5.1软件进行Meta分析。结果:共6个针刀治疗肩周炎的临床随机对照试验符合纳入标准,包括487例患者,仅有1篇高质量文献。Meta分析结果显示针刀治疗肩周炎的总有效率和治愈率均优于对照组,其中总有效率汇总为OR=6.31,95%CI(2.83,14.06),Z=4.51,P<0.01;治愈率汇总为OR=4.96,95%CI(3.12,7.87),Z=6.78,P<0.01。结论:针刀治疗肩周炎疗效较肯定,针刀治疗肩周炎较其他疗法可能有一定优势,但因纳入试验数有限且文献质量较低,需开展大样本高质量随机对照试验来进一步验证。||
^Objective|To evaluate the efficacy of needle-knife in the treatment of periarthritis of the shoulder with a meta-analysis. |
^ Methods| The computer searched Chinese biomedical literature database CBM (1978-2013), CNKI (1979-2013), VIP database (1989-2013), PubMed (1966-2013), EMBASE (1980-2013) 2013) and Cochrane Clinical Controlled Trials Center Register (2013 Issue 6), supplemented by manual search, were included in randomized controlled trials in which the treatment group was treated with a needle-knife therapy and the control group was treated with a non-needle-knife therapy. Two reviewers independently selected trials, extracted data, and cross-checked them for quality assessment with Cochrane System Reviewer's Manual 4.2.8. Meta-analysis was performed using RevMan 5.1 software. |
^Results|A total of 6 randomized controlled trials of acupuncture for periarthritis of shoulders met the inclusion criteria, including 487 patients, and only 1 high-quality literature. Meta-analysis results showed that the total effective rate and cure rate of acupuncture for periarthritis of the shoulder were better than those of the control group. The total effective rate was OR = 6.31, 95% CI (2.83, 14.06), Z = 4.51, P <0.01; The cure rate was OR = 4.96, 95% CI (3.12,7.87), Z = 6.78, P <0.01. |
^Conclusion| Needle-knife treatment of periarthritis of the shoulder is more effective. Needle-knife treatment of periarthritis of the shoulder may have certain advantages over other therapies. However, due to the limited number of included trials and the low quality of the literature, a large sample of high-quality randomized controlled trials is needed to further verify. |




  * Liu Fu-Shui, Jin Xiao-Fe, Guo Chang-Qing. [Systematic review of acupuncture versus acupotomology for frozen shoulder]. China Journal of Traditional Chinese Medicine and Pharmacy. 2012;3:582-585.   [186924].

^ Objective|To evaluate the clinical efficacy and safety of acupuncture versus acupotomology for frozen shoulder.|
^ Methods|Randomized controlled trials (RCTs) of acupuncture versus acupotomology in the treatment of frozen shoulder were retrieved from CBM (1978 to 2010), CNKI (1979 to 2010), VIP (1989 to 2010), PubMed (1966 to 2010), and Cochrane Library (Issue 4, 2010). And some relevant journals were manually searched. Data were extracted and evaluated by two reviewers independently according to Cochrane Reviewers’ Handbook. The Cochrane Collaboration’s RevMan5. 1 software was used for meta-analyses. |
^Results|**6 trials involving 570 cases** were included. The results of meta-analyses showed the total effect rate of acupotomology for frozen shoulder is higher than acupuncture, OR=7. 70, 95%CI [2. 58, 22. 99], Z=3. 66, P<0. 01. And the cure rate of acupotomology for frozen shoulder is higher than acupuncture, OR=5. 39, 95%CI [3. 48, 8. 32], Z=7. 58, P<0. 01. |
^Conclusion|**Acupotomology is superior to acupuncture in the treatment of frozen shoulder**. However, due to low quality of included studies, rigorously designed RCTs are needed to confirm the conclusions.|

==== Lombalgies ====



  * Xiang J, Xue ZH ,Chen G et al. [Meta Analysis of Curative Effect of Needle Knife in the Treatment of Piriformis Syndrome] Journal of Clinical Acupuncture and Moxibustion. 2015;31(7):67-70,71. {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:xian-188103.pdf|[188103]}} 

^Objective|To evaluate the effect of small needle knife treatment on piriformis syndrome.|
^ Methods|Through comprehensive searching in vIP, Wan-fang and CNKI database, the relevant literatures with clinical randomized controlled trials which had been published about needle knife therapy for piriformis synclrome were collected. Then we manually looked up books and periodicals on piriformis syndrome, using Cochorane system evaluation method, according to the standard screening of literatures into the exclusion, sorting data, and use the RevMan5. 2 software to make quality evaluation and meta analysis.|
^Results|There were totally **10 Chinese literatures, including 977 patients**. Meta analysis results: Comprehensively curative effect was well〔RR= 1. 16 ,95 % CI (1. 10, 1. 22) , Z = 5. 64 , P .c 0. 00001] , also with an instantly analgesic effect [ OR = 2. 68 ,95% C1 ( 1. 64 ,4. 36) , Z = 3. 95 , P < O. 0001].|
^Conclusion|Small needle knife in the treatment of piriformis syndrorne has **a good curative effect, and has a instantly analgesic effect**, but it also needs randomized clinical trials with more standardization and high quality to provide a reliable basis for clinical application.|


==== Canal lombaire étroit ====




  * Kwon CY, Yoon SH, Lee B, Leem J. Acupotomy for the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(32).   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:kwon-200288.pdf|[200288]}}.
 
^Background| Lumbar spinal stenosis (LSS) is caused by neural compression due to narrowing of the lumbar spinal canal or neural foramen. Surgical intervention is a standard treatment for LSS; however, the steep increase in the surgical rate, post-operative complications, and comparatively low long-term satisfaction are considered to be limitations of this surgical approach. Conversely, acupotomy is a minimally invasive technique that combines the effects of conventional acupuncture with micro-incision, which may offer an alternative to surgery for the treatment of LSS. This review was conducted to investigate and critically review the current evidence on the efficacy and safety of acupotomy for LSS. |
^Methods| Eleven databases were searched from their respective inception dates to December 28, 2018. Randomized controlled trials (RCTs) comparing acupotomy and wait-list, sham treatment, or active controls were included. The quality of the included studies was assessed using risk-of-bias tool.|
^ Results|Seven RCTs were included in this review and meta-analysis. The methodological quality of the included studies was generally poor. The acupotomy treatment group was associated with significantly lower visual analogue scale scores (range 0∼10) (5 RCTs; mean difference [MD] -1.55, 95% confidence interval [Cis] -2.60 to -0.50; I = 94%) and higher Japanese Orthopedic Association Score (3 RCTs; MD 4.70, 95% CI 3.73 to 5.68; I = 0%) compared to the active control group. In subgroup analysis based on the type of active controls, acupotomy retained significant benefits over lumbar traction and acupuncture, as well as over lumbar traction, spinal decompression, and acupuncture. Safety data were reported in only 1 study, and no adverse events occurred in either the acupotomy or the acupuncture control group. |
^Conclusion|According to current evidence, acupotomy might be beneficial for treating LSS. Acupotomy showed consistent superiority over lumbar traction, but the results were mixed in comparisons with other interventions, such as spinal decompression and acupuncture. However, the findings should be interpreted cautiously, given the poor methodological quality of the included studies, and potential small-study effects. Further larger, high-quality, rigorous RCTs should be conducted on this topic and rigorous reporting of acupotomy procedures and safety data should be encouraged. |

==== Hernie discale lombaire ====




  * Xu Yigao. [Meta-analysis of Simple Needle Knife on Lumbar Disc Herniation Cases]. Journal of Emergency in TCM. 2020.  [212924]. 

^Objective| To evaluate the effect of needle knife on LDH with the meta-analysis of the published literature on its therapeutic effect.|
^Methods| A comprehensive search of the literatures on therapeutic effect of needle knife on LDH from January 2010 to March 2019 in CNKI, VIP, Wanfang Data and other databases to select and make a meta-analysis. In order to reduce the interference factors, from a large number of literature, we selected the simple use of needle knife and other traditional therapy for LDH for mate-analysis. According to the Cochrane system evaluation method, the included methodological qualities study were evaluated, Data and the statistical analyses were carried out with Revman 5. 3 software.|
^Results| 8 articles were included with 1 329 patients, 665 cases in the treatment group and 664 cases in the control group. According to the meta-analysis, 8 studies were homogenous (Chi~2=4. 40, df=7, P = 0. 73>0. 1), and the fixed effect model was used for analysis and calculation. After OR combined, Z = 9. 32, P < 0. 00001, indicating that the effect of the simple needle knife group was superior to other traditional treatment groups.|
^Conclusion| The clinical effect of simple needle knife on LDH is better than other traditional therapies, such as acupuncture, physiotherapy, massage, electroacupuncture and traction.|


  * Wang Dexiang. [Network meta-analysis of needle knife and needle knife combined with other therapies in the treatment of lumbar disc herniation]. China Medical Herald. 2020.  [212920].

^Objective|To systematically evaluate the effect of needle knife and needle knife combined with other therapies in the treatment of lumbar disc herniation (LDH) by network meta-analysis.|
^Methods| The following databases were searched online: PubMed, Cochrane Library, CNKI, Wanfang database, VIP and China biomedical literature database (CBMdisc). The search was conducted using a combination of subject words and free words. The search keywords included needle knife, sharp needle and lumbar disc herniation. The search time limit was from January 2009 to July 2019. Two investigators independently screened the literature, extracted the data and evaluated the risk of bias in the included studies. Data was analyzed using Stata 15. 0, ADDIS v1. 16. 8 and Review Manager 5. 3 software.|
^Results| A total of 41 studies with 3962 patients were included, involving 17 interventions. The results of network meta-analysis showed that the 10 ten intervention measures in the order of total clinical effective rate were as followed: needle knife plus internal administration of traditional Chinese medicine, needle knife plus manipulation, needle knife plus epidural injection, needle knife plus external use of traditional Chinese medicine, needle knife plus acupuncture, traditional Chinese medicine internal administration, electroacupuncture, needle knife, manipulation, needle knife plus functional exercise.|
^Conclusion| The effect of needle knife combined with other therapies is better than that of needle knife alone. Needle knife therapy combined with manipulation for LDH is well developed. The therapeutic effect of needle knife combined with traditional Chinese medicine on LDH deserves further study.|




  * Zhou Fanyuan, Liu Fushui, Zhao Meimei, Fang Ting, Chen Mei. [Systematic Review and Meta-analysis of Acupotomy Versus Acupuncture for Lumbar Intervertebral Disc Herniation]. Liaoning Journal of Traditional Chinese Medicine. 2017;03:.   [52381]. 

^Objective| To evaluate the effectiveness and safety of acupotomy versus acupuncture for lumbar intervertebral disc herniation. |
^Methods| CNKI, Wanfang, VIP, Pub Med and The Cochrane Library (Issue1, 2016) were retrieved to identify randomized controlled trials of acupotomy versus acupuncture for lumbar intervertebral disc herniation. The data was extracted and evaluated by two reviewers independently according to Cochrane Reviewers’ Handbook (5. 0). The Cochrane Collaboration’s Rev Man 5. 2 software was used for Meta-analyses.|
^ Results| A total of 8 trials involving 772 patients were included. The Meta-analysis showed that both total effective rate and curative rate of acupotomy for the treatment of lumbar intervertebral disc herniation were higher than those of acupuncture in short term and long-term and the recurrence rate of the acupotomy was lower than that of acupuncture.|
^Conclusion|It showed that acupotomy was more effective than acupuncture in the treatment of lumbar intervertebral disc herniation.|



  * Zhang LY , Ye Y , Shao XN et al. [Meta - analysis of needle - knife therapy for lumbar intervertebral disc protrusion]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(2):49.{{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:zhang-169608.pdf|}}.
 
^Objective |To discuss the clinical curative effect of needle knife therapy on lumbar intervertebral disc protrusion and provide evidence - based medical evidence for clinical practice. |
^Methods|Comprehensively search CNKI (1989 - 2012), VIP( 1989 - 1989) , Wanfang( 1989 - 2012) , such as database, collect clinical randomized controlled trials about needle knife in the treatment of lumbar intervertebral disc protrusion. After screening, finally 12 standard articles were found as Meta analysis objects. Use Review Manage5. 0 specialized software Cochrane provided freely for statistical analysis.|
^Results|12 researches by Meta analysis combined showed that **12 studies** homogeneity test results, Chi square is 4. 65, degrees of freedom was 1 1 (P = 0. 95 >0,1), and 12 studies had homogeneity , so use  the fixed effects model  to analyze , calculate  and summarize statistics.  OR combination checked by Z: Z = 7.94(P<0.00001), which suggested that needle knife compared with other treatments had a statistical significance.| 
^Conclusion|**Current clinical evidence suggests that the curative effect of small needle knife therapy on lumbar intervertebral disc protrusion is better than electric acupuncture, massage, traction therapy**. But with this research low methodological quality, limited sample size, it needs more large samples of reasonable esign,execution,strict,scientific and standardization,and high quality clinical randomized controlled trials are needed to further verify its effectiveness.|

==== Gonarthrose ====




  * Zhang J, Pang T, Yao J, Li A, Dong L, Wang Y, Wang Y. Acupotomy therapy for knee osteoarthritis: An overview of systematic reviews. Medicine (Baltimore). 2024 Nov 22;103(47):e39700.  https://doi.org/10.1097/MD.0000000000039700

^Backgound| This study aimed to evaluate the methodological quality, report quality, and evidence quality of a meta-analysis (MA) and systematic review (SR) of the efficacy of acupotomy in the treatment of knee osteoarthritis (KOA), and provided a reference for clinical decision-making.|
^Methods| We searched 8 databases to collect systematic reviews and meta-analyses on the efficacy of acupotomy in the treatment of KOA from January 30, 2018, to January 31, 2023. The methodological quality of the studies was assessed using the assessment of multiple systematic reviews (AMSTAR) 2 scale, the quality of the literature reports was scored using the Preferred Reporting Items for Systems Reviews and Meta-Analyses 2020 Version (PRISMA 2020),and the quality of the evidence was graded using the grading of recommendations assessment, development, and evaluation (GRADE) scale.|
^Results| **Nine systematic reviews** including 35 outcome indicators were included. AMSTAR 2 evaluated the methodological quality of the included studies, and 1 was of low quality, 8 were of very low quality, and the entries with poor scores were 2, 3, 4, 8, 10, 12, and 13. By PRISMA 2020, there were some reporting deficiencies, and quality problems were mainly reflected in the abstract, information sources, search strategy, synthesis methods, reporting bias assessment, certainty assessment, reporting biases, certainly of evidence, registration and protocol. The GRADE classification results showed that there were 2 medium-quality evidences, 7 low-quality evidences, and 26 very low-quality evidences. The main factors of degradation were limitations, imprecision, and publication bias.|
^Conclusion| Acupotomy had been a promising complementary treatment for KOA. However, due to the low quality of the SRs/MAs supporting these results, high-quality studies with rigorous study designs and larger samples were needed before widespread recommendations could be made. |


  * Lee CJ, Luo WT, Tam KW, Huang TW. Comparison of the effects of acupotomy and acupuncture on knee osteoarthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2023 Feb;50:101712.  https://doi.org/10.1016/j.ctcp.2022.101712

^Background and purpose| Acupotomy and acupuncture are both treatments for knee osteoarthritis symptoms. However, acupotomy also has the additional anatomical effect of dissecting inflamed tissue. The problem this study aims to address is whether acupotomy is a better treatment than acupuncture in treating knee osteoarthritis.|
^Methods| We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Airiti Library, and Wanfang Data databases from inception to March 2022 for randomized controlled clinical trials (RCTs) comparing the effects of acupotomy and acupuncture in patients with knee osteoarthritis.|
^Results|In total, we identified **43 RCTs** in this meta-analysis. Compared to the acupuncture group, acupotomy had a higher cure rate (odds ratio (OR) 2.94, 95% confidence interval (CI) 2.36 to 3.65), indicating a better improvement in daily activity function. Acupotomy was also more effective in pain relief and knee score improvement. However, some RCTs indicated that adverse events in the acupotomy group were greater than in the acupuncture group (OR 1.23, 95% CI 0.42 to 3.60).|
^Conclusion| Our findings indicated that acupotomy was a more effective treatment for knee osteoarthritis than acupuncture. However, most of the included RCTs had moderate risk of bias, meaning that more high-quality RCTs were needed.|

  * Lin S, Lai C, Wang J, Lin Y, Tu Y, Yang Y, Zhang R. Efficacy of ultrasound-guided acupotomy for knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2023 Jan 13;102(2):e32663.  https://doi.org/10.1097/MD.0000000000032663.
 
^Background| This systematic review aimed to evaluate the effectiveness and safety of ultrasound-guided acupotomy (UGAT) therapy in the treatment of patients with knee osteoarthritis (KOA).|
^Methods|We conducted online researches in the databases including PubMed, the Cochrane Library, EMBASE, China national knowledge infrastructure, China biomedical literature database, and Wan Fang data. All data were collected until January 1, 2022. Relevant randomized controlled trials on the effectiveness of UGAT for the treatment of KOA were included. Meta-analyses were carried out by RevMan 5.3 software. Evidence quality was evaluated by the grading of recommendations, assessment development, and evaluation.|
^Results|**Eight studies** including **543 participants** were analyzed in this study. The pooled analysis indicated that UGAT was significantly more efficient than the control group in decreasing the visual analogue scale score (mean difference = -0.81, 95% confidence interval (CI) = [-1.15, -0.47], P < .00001, 8 studies), improving knee function on the Lysholm knee score (mean difference = 8.26, 95% CI = [1.56, 14.97], P = .02, 2 studies), and increasing clinical effective rate (relative risk = 1.14, 95% CI = [1.06, 1.23], P = .0005, 6 studies). For adverse events, UGAT was also associated with lower incidence of adverse event (odds ratio = 0.27, 95% CI = [0.12, 0.63], P = .002, 4 studies) compared to traditional acupotomy.|
^Conclusion|Current evidence suggested that UGAT therapy was effective and safe in the clinical treatments of KOA, thus could be suggested in the clinical managements of KOA. However, considering the unsatisfactory quality of the available trials, more large-scale, and better quality randomized controlled trials were recommend in future.|

  * Wu Q, Wu Z, Lu Z. Efficacy of acupotomy combined with sodium hyaluronate versus sodium hyaluronate alone in the treatment of knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2023 Sep 15;102(37):e34930.  https://doi.org/10.1097/MD.0000000000034930. 

^Background| The efficacy of acupotomy combined with hyaluronic sodium acid in the treatment of knee osteoarthritis (KOA) is unclear. Therefore, this meta-analysis aims to evaluate the efficacy of acupotomy combined with hyaluronic sodium acid compared with hyaluronic sodium acid alone in the treatment of KOA.|
^Methods| Studies from 8 Online databases were searched on KOA treatment using acupotomy combined with sodium hyaluronate until May 2022. The primary outcome indicator was clinical effectiveness, and the secondary outcome indicators included the visual analogue scale scores and Lysholm scores. We calculated the weighted mean difference (WMD) or relative risk for all relevant outcomes.|
^Results| **Nine studies were identified, involving 644 cases**. The results showed that acupotomy combined with intra-articular sodium hyaluronate injection for KOA was superior to sodium hyaluronate injection alone in terms of clinical effectiveness (relative risk = 1.17, 95% confidence interval [CI]: 1.09-1.25, P < .001) and visual analogue scale (WMD = -2.1, 95% CI: -2.25 to 1.95, P < .001), Lysholm score (WMD = 13.83, 95% CI: 3.47-24.19, P = .009).|
^Conclusion| Acupotomy combined with intra-articular sodium hyaluronate injection for KOA is superior to sodium hyaluronate injection alone. Limited by the number and quality of included studies, this conclusion still needs to be verified by more high-quality Research.|

  * Yin X, Liu Y, Liu W, Liang W, Liang Q. Blade needle therapy versus conventional acupuncture for knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2022 Jul 29;101(30):e29647.  https://doi.org/10.1097/MD.0000000000029647
 

^Background| This study investigated the hypothesis that the efficacy of blade needle therapy for the treatment of knee osteoarthritis (KOA) is superior to that of conventional acupuncture. In addition, the efficacy of blade needle therapy versus conventional acupuncture for the treatment of KOA was analyzed in a meta-analysis.|
^Methods| Randomized controlled trials (RCTs) of blade needle therapy and conventional acupuncture for treating KOA were retrieved from the electronic databases CNKL, Wanfang, VIP, PubMed, EMBASE and the Cochrane Library from the commencement of each database to July of 2021. Data were extracted and evaluated by 2 reviewers independently. RevMan 5.3 software was used to conduct the meta-analysis after the studies were evaluated.|
^Results| A total of 11 RCTs were included, all from China, involving 1142 patients. The meta-analysis results showed that the effective rate of the blade needle group was better than that of the conventional acupuncture group (OR = 3.61, 95% CI [2.56-5.10], P < .00001).|
^Conclusion| The efficacy of blade needle treatment for KOA is superior to that of conventional acupuncture, but more high-quality studies are needed for future validation due to the low proportion of high-quality studies included and the possible bias factor.|



  * Seung Min Lee, Cham Kyul Lee, Kyung Ho Kim, Eun Jung Kim, Chan Yung Jung, Byung-Kwan Seo, Bon Hyuk Goo, Yong Hyeon Baek, Eun Yong Lee. Acupotomy for Osteoarthritis of the Knee; A Systematic Review and Meta-Analysis. J Acupunct Res. 2021;38(2):96-109. [219985]. [[https://doi.org/10.13045/jar.2020.00339|doi]]

^Purpose| The purpose of this study was to evaluate the effectiveness and safety of acupotomy for the treatment of patients with knee osteoarthritis. |
^Methods|There were 9 databases searched to retrieve randomized controlled trials until August 3, 2019 regarding acupotomy versus conventional Western medicine, conventional Western medicine treatment with and without acupotomy, and Korean medicine treatment with and without acupotomy, and meta-analysis was performed. |
^Results|Of 303 potentially relevant studies retrieved, 43 were systematically reviewed. All studies were conducted in China. Effective rate, visual analogue scale, and Western Ontario and McMaster Universities Osteoarthritis index were used as the evaluation scales. The Ashi point was selected most frequently. In all studies, the intervention group was more effective than the control group. Meta-analysis revealed that acupotomy showed statistically significant beneficial results. |
^Conclusion| Although acupotomy had a beneficial effect on knee osteoarthritis, the risk of bias of the included studies was not low. The majority of the results from the evaluation scales used were highly heterogeneous (> 50%) which reduced confidence in the estimation of effect, or had a small sample size. Further clinical research and development is required in the future. |





  * Qu B, Wu X, Liu H, Cai W, Wang G, Song H, Wang F. Meta-analysis and systematic review of acupotomy combined with puncture and moxibustion in the treatment of knee osteoarthritis. Ann Palliat Med. 2021;10(6):6637-6649. [220191]. [[https://doi.org/10.21037/apm-21-1083|doi]]

^Background|This study aimed to systematically evaluate the therapeutic effects of acupotomy combined with acupuncture and moxibustion on knee osteoarthritis (KOA), which was expected to provide a reference for clinical treatment of KOA using traditional Chinese medicine (TCM). |
^Methods| The databases PubMed, Embase, Medline, Ovid, and Springer were searched to retrieve randomized controlled trials (RCTs) on KOA treatment by acupotomy combined with acupuncture and moxibustion. The search time was set as from the date the database was established to 31 December 2020. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to conduct bias risk assessment on the included literature, and Review Manager 5.3 software was used for meta-analysis. |
^Results| A total of 10 RCTs were included in this study, including 1,073 participants. Meta-analysis results showed that compared with the control group, the clinical treatment efficiency of the experimental group was higher [mean difference (MD) =5.72; 95% confidence interval (CI): 3.39 to 9.64; Z=6.54; P<0.00001], and the postoperative visual analogue scale (VAS) scores were reduced (MD =-1.72; 95% CI: -2.41 to -1.03; Z=4.86; P<0.00001). |
^Discussion| Acupotomy combined with acupuncture and moxibustion treatment for KOA can increase clinical treatment efficiency, and relieve postoperative pain, suggesting that the combination of acupotomy, acupuncture, and moxibustion has better therapeutic effects on KOA and can be promoted clinically. |

  * Fang T, Li Q, Zhou F, Liu F, Liu Z, Zhao M, Chen M, You J, Jin Y, Xie J. Effect and safety of acupotomy in treatment of knee osteoarthritis: a systematic review and Meta-analysis. Journal of TCM. 2020;40(3):355-364.   [221075]. https://doi.org/10.19852/j.cnki.jtcm.2020.03.002

^ Objective| To evaluate the clinical efficacy and safety of acupotomy in treatment of knee osteoarthritis (OA). |
^Methods| Extensive literature searches were carried out in PubMed, EMBASE, Cochrane Library (Issue 5, 2017), Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database and Wanfang Database. All databases were retrieved from their inception until May 31, 2017. Randomized controlled trials incorporating acupotomy versus intra-articular sodium hyaluronate for knee osteoarthritis were included. According to Cochrane Reviews' Handbook (5.2), two reviewers screened each article and extracted data independently and were blinded to the findings of each reviewer. Meta-analysis was performed by the Cochrane Collaboration's RevMan 5.3 software. |
^Results| We identified **12 studies involving 1150 patients** aged between 40 and 78 years old. The pooled analysis indicated that acupotomy showed a significant improvement for short-term effect [cure rate: odds ratio (OR) = 2.04, 95% confidence interval (CI) (1.46, 2.85), P < 0.01; total effective rate: OR = 2.25, 95% CI (1.55, 3.28), P < 0.01; pain score: standard mean difference (SMD) = －1.02; 95% CI (－1.72, －0.31); P = 0.005; Western Ontario and McMaster Universities Questionnaire (WOMAC) score: SMD = －0.74; 95% CI (－1.11, －0.37); P < 0.01]; and also for long-term effect [total effective rate: OR = 2.99, 95%CI (1.88, 4.76), Z = 4.64, P < 0.01; pain score: SMD = －1.68; 95% CI (－2.14, －1.22); P < 0.001; WOMAC score: SMD = －0.91; 95% CI (－1.40, －0.41); P < 0.001]. In addition, there was no obvious difference between acupotomy group and control group in adverse events [OR = 2.13, 95%CI (0.14, 32.28), P = 0.58]. |
^Conclusion| Acupotomy is a safe and effective treatment for KOA. However, due to the methodological deficiency of the included studies, well-designed randomized controlled trials are required to further confirm the findings.|

  * Sun J, Zhao Y, Zhu R, Chen Q, Song M, Xue Z, Wang R, Chen W. Acupotomy Therapy for Knee Osteoarthritis Pain: Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:sun-213667.pdf|[213667]}}. [[https://doi.org/10.1155/2020/2168283|doi]]

^Background and Purpose|Knee osteoarthritis (OA) is a major public health problem, and currently, few effective medical treatments exist. Chinese acupotomy therapy has been widely used for the treatment of knee OA in China. We conducted this systematic review and meta-analysis to evaluate the efficacy of Chinese acupotomy in treating knee OA to inform clinical practice.|
^Methods|We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm's score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate.|
^ Results| We identified 1317 potentially relevant studies, **thirty-two** of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of **3021 knee OA patients** (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1-5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = -1.11; 95% confidence interval (CI), -1.51 to -0.71; p < 0.00001) and WOMAC pain score (MD = -2.32; 95% CI, -2.94 to -1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09-1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11-9.76; p < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61-22.89; p = 0.01) for overall pain and function. No serious adverse events were reported. |
^Conclusion|Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted. |




  * Zhang Lei, Wei Mubin, Liu Aifeng. [Meta-analysis of acupotomy versus acupuncture for knee osteoarthrits]. Tianjin Journal of Traditional Chinese Medicine. 2019;3:253-7.   [195740]. 

^Objective|To evaluate the efficacy of acupotomy for knee osteoarthritis (KOA) by Meta-analysis. |
^Methods|Randomized controlled trials about acupotomy treating KOA were indexed from CNKI, Wanfang  Date, VIP and PubMed from the begining to October2017. The literature was screened and evaluated and Review Manager 5.3 software was used for analysis. | 
^Results| The **9 RCT** were included and there were **655 patients** in total. Meta-analysis result showed that the effective rate of acupotomy therapy for KOA was higher than acupuncture. | 
^Conclusion| The efficacy of acupotomy in the treatment of KOA was positive. However, because the number of literature included in the study was small, the quality was uneven and the sample size was limited, more perfect experiments need to be designed. |




  * Liu Fu-shui, Jin De-zhong. [Acupotomy versus acupuncture for knee osteoarthritis: A meta-analysis of randomized controlled trials]. Journal of Clinical Rehabilitative Tissue Engineering Research. 2012;44:8235-823.   [186992].

^Background|Acupotomy and acupuncture are widely used in the clinical treatment of knee osteoarthritis in recent years. However, there remains no systematic review to assess the clinical effect.| 
^Objective|To professionally assess the different effects of acupotomy versus acupuncture for knee osteoarthritis.| 
^Methods|A computer-based search was conducted on the CNKI database, VIP database, Wanfang database, PubMed database and Cochrane Central Register of Controlled Trials (Issue 3, 2011). The time limitation ran from the commencement of each database to September 15, 2011. Randomized controlled trials of acupotomy in the treatment group and acupuncture in the control group were included. Data were extracted and evaluated by two reviewers independently. RevMan5. 1 software was used for Meta-analysis after the literatures were evaluated.|
^Results and conclusion|A total of **8 trials involving 654 patients** were included. The Meta-analysis showed that both curative rate and total effective rate of acupotomy for the treatment of knee osteoarthritis are higher than those of acupuncture in short term. It showed effects as follows respectively: OR=4. 27, 95%CI (2. 32-7. 85); OR=3. 01, 95% I (1. 77-5. 14). **Acupotomy is more effective than acupuncture in the treatment of knee osteoarthritis in short term**. However, due to low quality of included studies and there are no reports on the adverse events, further well-designed randomized controlled trials with high quality are still needed to evaluate the beneficial effects of acupotomy.|

==== Talalgies ====


Zhou Meng-Yuan,  Luo Zheng-Jie , Hu Xuan-Ming , Chen Zhao-Ming. [Meta-analysis of Therapy Comparison of Acupotomy Versus Block Therapy for Heel Pain]. Chinese Journal of Basic Medicine in TCM. 2019;25(9):1280.   {{:medias securises:acupuncture:evaluation:rhumatologie - orthopedie:zhou-202950.pdf|[202950]}}.  
^Methods| A computer-based research was conducted on PubMed database, Cochrane Library database, CNKI database, VIP database and Wanfang database of the clinical literature about randomized clinical trials (RCTs) of needle knife and block therapy for HP. Data were extracted and evaluated by two reviewers independently, and then cross check date with each other. The final data is imported into the software for Meta-analysis. | 
^Results| Totally 9 RCTs involving 937 cases were included. The Mets-analysis showed that there was no significant difference between the experimental group and the control group for the short-term in the total effective rate and cure rate; The total effective rate and cure rate of the experimental group were higher than that of the control group for the long-term, The pain of the experimental group was lower than that of the control group for the short-term and long-term. | 
^Conclusion|Acupotomy therapy is a safe and effective treatment for HP. The effect of acupotomy therapy and block therapy for the HP are similar for the short-term, but the longterm efficacy of acupotomy therapy is than the block therapy, and the pain degree of acupotomy group is lower than the  block therapy group, the acupotomy therapy is more suitable for clinical application. |