Eighteen randomized controlled trials involving 1,432 patients with knee osteoarthritis were included in this systematic review and meta-analysis comparing acupuncture with moxibustion versus standard treatments. Pooled outcomes of interest included pain scores (VAS), WOMAC pain, stiffness, physical function, overall efficacy, and adverse events. Acupuncture combined with moxibustion significantly improved VAS pain scores and WOMAC outcomes, particularly in mid-term (6–60 weeks) and long-term (>60 weeks) assessments, and exhibited fewer adverse events compared to control treatments. These findings indicate that acupuncture combined with moxibustion offers a safe and effective treatment alternative for patients with knee osteoarthritis, especially beneficial in the longer term.