Acupuncture; cannot recommend
We cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee.

Rationale
There were five high- and five moderate- strength studies that compared acupuncture to comparison groups receiving non-intervention sham, usual care, or education. The five moderate-strength studies were included because they reported outcomes that were different than the high-strength evidence. High-strength studies included: Berman et al, 61 Suarez-Almazor et al.,62 Weiner et al.,63 Williamson et al.64 and Taechaarpornkul et al.65 Moderate-strength studies included: Sandgee et al.,66 Vas et al.,67 Witt et al.68 and Berman et al.69 The majority of studies were not statistically significant and an even larger proportion of the evidence was not clinically significant. Some outcomes were associated with clinical- but not statistical- significance. The strength of this recommendation was based on lack of efficacy, not on potential harm.

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