20 randomized controlled trials comparing electropuncture against analgesia in patients with knee osteoarthritis were included in this systematic review and meta-analysis. Outcomes of interest included pain on a Visual Analog Scale (VAS), overall effective rate, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and activity subscales. A subgroup analysis of the type of drugs used, waveform, number of acupoints, age, and frequency of treatment was also conducted. Overall WOMAC scores, stiffness, and overall effective rate favored the electroacupuncture group. WOMAC pain, activity, and VAS pain scores were similar between the two groups. Subgroup analyses by type of drug found electroacupuncture to provide significantly greater pain relief than both meloxicam and diclofenac sodium. Similarly, when 6 or more acupoints were used and patients aged <70 years, electroacupuncture provided significantly greater pain relief. The subgroup analyses of age (>70 years) and treatment frequency (every day) found that EA provided significantly better WOMAC scores.