Three hundred and six patients with knee osteoarthritis (OA) were randomized to receive 20 treatment sessions (3 times/week) of crossbow needling, a traditional Chinese medicine technique or conventional acupuncture for the relief of pain, and improvement in function and quality of life. The primary outcome of interest was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes of interest included the Japanese Orthopaedic Association (JOA) knee score, the Lysholm knee score, pain on a Visual Analog Scale (VAS), and the Short-Form 36 (SF-36) quality of life questionnaire. Outcomes were assessed at 46, 62, and 77 days after initiation of treatment. The crossbow needling group reported significantly favourable WOMAC scores at all time-points compared to the acupuncture group. Lysholm knee scores, JOA scores, VAS pain scores, and SF-36 scores were not significantly different between groups at 46 and 62 days, but were significantly in favour of the crossbow needling group at 77 days. The crossbow needling group reported a higher incidence of red and itchy skin at the knee joint.