Introduction:
Knee osteoarthritis (KOA) is a common chronic degenerative disease in middle-aged and elderly people, characterized by joint pain, functional impairment, and abnormal joint alignment. Knee joint resistance rotation therapy, a traditional Chinese medicine massage technique, has been reported to have clinical benefits, but research on its effects and mechanisms in regulating joint alignment and knee temperature is limited. The aim of the study was to observe the effects of knee joint resistance rotation therapy compared with conventional massage on pain, function, joint alignment, and joint temperature in patients with KOA, and to explore its clinical effects and possible mechanisms of action.

Material and methods:
A single-blind, randomized controlled trial was conducted, including 40 patients with knee osteoarthritis (KOA) who visited the outpatient department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2020 to July 2021. They were randomly divided into a treatment group (resisted knee rotation) and a control group (routine massage), with 20 patients in each group. Both groups received treatment twice a week for a total of 3 weeks. Pain intensity was assessed using the Visual Analogue Scale (VAS) before and after treatment, joint function was assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), joint alignment was assessed by measuring the angle between the tibial articular surface and the long axis of the femur using X-ray, and temperature changes in different areas of the knee joint were detected using infrared thermography.

Results:
Ultimately, 34 patients (19 in the treatment group and 15 in the control group) completed the study (6 dropped out, dropout rate 15%). After treatment, VAS scores in both groups were significantly lower than before treatment (treatment group: 5.21 ±1.72 vs. 1.26 ±1.10, p < 0.001; control group: 5.20 ±1.61 vs. 1.73 ±1.03, p < 0.001), but the difference between the groups was not statistically significant (MD = –0.47, 95% CI: –1.22 to 0.28, p = 0.212). Both groups showed significant improvements in KOOS scores across dimensions such as pain, symptoms, and activities of daily living compared to pre-treatment levels (p < 0.05). Furthermore, the treatment group had lower reported scores than the control group for pain (8.63 ±3.70 vs. 11.80 ±3.12, MD = –3.17, 95% CI: –6.02 to –0.32, p = 0.012), activities of daily living (10.53 ±5.58 vs. 15.00 ±6.20, MD = –7.47, 95% CI: –12.56 to –0.38, p = 0.034), and total score (48.21 ±15.96 vs. 60.33 ±8.68, MD = –12.12, 95% CI: –22.01 to –2.23, p = 0.012). After treatment, the angle between the tibial articular surface and the long axis of the femur increased significantly from baseline in the treatment group compared to before treatment (98.10 ±2.56 vs. 99.78 ±2.45, p = 0.046), while there was no statistically significant difference in the control group (p > 0.05). After treatment, the temperature in multiple areas of the anterior and posterior knee joint was significantly lower in the treatment group compared to before treatment (p < 0.05), while there was no statistically significant difference in temperature in the control group (p > 0.05).

Conclusions:
Knee joint resistance rotation therapy may improve pain, joint function, joint alignment, and knee temperature in patients with knee arthritis (KOA). Although some KOOS outcomes favored this therapy over conventional massage, the between-group difference in VAS scores was not statistically significant.