Fourteen randomized controlled trials involving 1186 patients with knee osteoarthritis (KOA) were included. Patients were randomized to receive Fu’s subcutaneous needling (FSN) or routine acupuncture therapy (RAT), which included manual acupuncture, electroacupuncture, or transcutaneous electrical acupoint stimulation. The primary outcomes of interest were total efficacy rate, pain measured using the Visual Analog Scale, and knee function assessed using Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Secondary outcomes included synovial inflammatory cytokines (IL-6 and TNF-α) and adverse events. Follow-up durations ranged from 10 days to 3 months, depending on the individual trial. Overall, the results of the study revealed that Fu’s subcutaneous needling was associated with significantly greater pain reduction, improved knee function, and reduced inflammatory markers compared with routine acupuncture therapy, with no clear safety signal. These findings suggest Fu’s subcutaneous needling may provide superior short-term symptomatic benefit in knee osteoarthritis.