OBJECTIVE:To investigate the possible advantages of acupotomy over sodium hyaluronate injection for the treatment of knee osteoarthritis (KOA).METHODS:Twenty rabbits were divided randomly into four groups (n =5 in each):a control group,model group,acupotomy group,and sodium hyaluronate injection group.The model,acupotomy,and sodium hyaluronate groups underwent anterior cruciate ligament transection plus partial medial meniscectomy.Sodium hyaluronate injection and acupotomy were administered to the respective groups from weeks 5 to 8,and samples of the tibial plateau and medial condyle of the femur were collected in week 9.Vascular endothelial growth factor (VEGF) expression was assessed in cartilage and subchondral bone by immunohistochemical staining.RESULTS:Articular cartilage degeneration was less pronounced in the acupotomy compared with the model and sodium hyaluronate groups.VEGF expression levels in cartilage and subchondral bone were increased in the model group compared with the control group (P ＜ 0.01),and acupotomy had a more pronounced therapeutic effect than sodium hyaluronate injection (P ＜ 0.01).CONCLUSION:Acupotomy and sodium hyaluronate injection may both reduce degeneration in the cartilage and subchondral bone in KOA based on the results from a rabbit model,but acupotomy improved the histopathology and reduced the VEGF content more effectively than sodium hyaluronate injection,probably by reducing venous stasis and intraosseous pressure.Acupotomy may improve KOA by lowering VEGF.