Efficacy of Thread-Embedding Acupuncture Using the Longitudinal Oblique Technique From BL40 Toward BL57 on KOOS Scores and Joint Range of Motion in Knee Osteoarthritis

Inclusion Criteria: * Male and female patients aged 51 to 70 years. * Clinically and radiologically diagnosed with bilateral knee osteoarthritis according to ACR (American College of Rheumatology) criteria. * Kellgren-Lawrence grade II or III knee osteoarthritis. * NRS (Numeric Rating Scale) score \>3 during activity (activities of daily living or light exercise). * Body Mass Index (BMI) ≥18.5 kg/m². * Knee functional limitations assessable via the KOOS. * Ability to understand and complete the KOOS questionnaire. MMSE score \>23 (normal or no significant cognitive impairment). * Willingness to complete the study and sign the informed consent form. Exclusion Criteria: * History of knee surgery such as total knee replacement, arthroscopy, or ligament reconstruction. * Inflammatory joint disease or autoimmune conditions (e.g., rheumatoid arthritis, gouty arthritis, spondyloarthritis, or lupus arthritis) assessed via clinical symptoms and/or radiological findings. * Presence of a tumor, wound, or local infection at the injection site. * History of peripheral vascular disease, DVT/thromboembolism, aneurysm or pseudoaneurysm, or coagulation/bleeding disorders. * Presence of a blood disorder or use of blood thinners (combination antiplatelet or anticoagulant therapy) with an INR ≤ 2.0; history of spontaneous bleeding, thrombocytopenia, or coagulation disorders. * Uncontrolled diabetes mellitus or severe systemic disease with a random blood glucose (RBG) level ≥200 mg/dL (measured via capillary blood using a glucometer). Random blood glucose (RBG) level ≥200 mg/dL in non-diabetic patients (measured via capillary blood using a glucometer for all study participants). * History of keloids. * Routine use of steroids or NSAIDs, or use of topical analgesics prior to therapy and during the study period. * Not currently receiving intra-articular knee injections (corticosteroids or hyaluronic acid) and has not received them in the last 3 months. * Presence of a Baker's cyst in the popliteal fossa, identified during physical examination. * Patients currently undergoing physiotherapy or who have undergone it within the last month. * Prior receipt of thread-embedding acupuncture therapy in the knee area or at acupuncture points BL40-BL57 within the last 6 months, or other forms of acupuncture within the last 2 weeks. * History of hypersensitivity or allergic reactions to polydioxanone (PDO) threads or procedure needle materials (e.g., stainless steel).