Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

Youssef Rahou-El-Bachiri, Marcos J Navarro-Santana, Guido F Gómez-Chiguano, Joshua A Cleland, Ibai López-de-Uralde-Villanueva, César Fernández-de-Las-Peñas, Ricardo Ortega-Santiago, Gustavo Plaza-Manzano, Youssef Rahou-El-Bachiri, Marcos J Navarro-Santana, Guido F Gómez-Chiguano, Joshua A Cleland, Ibai López-de-Uralde-Villanueva, César Fernández-de-Las-Peñas, Ricardo Ortega-Santiago, Gustavo Plaza-Manzano

Abstract

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain.

Methods: Several electronic databases were searched for randomized controlled trials where at least one group received dry needling for knee pain. Studies had to include human subjects and collect outcomes on pain and pain-related disability in musculoskeletal knee pain. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated.

Results: Ten studies (six patellofemoral pain, two knee osteoarthritis, two post-surgery knee pain) were included. The meta-analysis found moderate effect sizes of dry needling for reducing pain (SMD -0.53, 95% CI -0.87 to -0.19) and improving related disability (SMD -0.58, 95% CI -1.08 to -0.09) as compared to a comparison group at short-term. The main effect was observed for patellofemoral pain (SMD -0.64, 95% CI -1.17 to -0.11). No significant effects were observed at mid- or long-term follow-ups. The risk of bias was generally low, but the heterogenicity and the imprecision of the results downgraded the level of evidence.

Conclusion: Low to moderate evidence suggests a positive effect of trigger point dry needling on pain and related disability in patellofemoral pain, but not knee osteoarthritis or post-surgery knee pain, at short-term. More high-quality trials investigating long-term effects are clearly needed.

Keywords: Dry needling; knee pain; meta-analysis; musculoskeletal pain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow diagram.
Figure 2
Figure 2
Plots of risk of bias of the included studies.
Figure 3
Figure 3
Comparison (standardized mean difference) between the effects of dry needling versus a comparative group on knee pain intensity at (A) short- (B) mid- and (C) long-term. The area of each square is proportional to the study’s weight in the meta-analysis. The horizontal bars represent the confidence intervals of the between-groups difference of the study. The diamond represents the overall meta-analyzed measure of effect (SMD) and the lateral points indicate the confidence intervals for this estimate.
Figure 4
Figure 4
Comparison (standardized mean difference) between the effects of dry needling versus a comparative group on pain-related disability at (A) short- (B) mid- and (C) long-term. The area of each square is proportional to the study’s weight in the meta-analysis. The horizontal bars represent the confidence intervals of the between-groups difference of the study. The diamond represents the overall meta-analyzed measure of effect (SMD) and the lateral points indicate the confidence intervals for this estimate.

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