Myofascial Trigger Point–Augmented Acupuncture vs Conventional Acupuncture for Early- to Mid-Stage Knee Osteoarthritis: A Randomized Clinical Trial [Response to Letter]

We thank Xu and Zhou for their thoughtful comments on our randomized clinical trial.1,2 We would like to clarify three issues concerning myofascial trigger point (MTrP) characterization, gait terminology, and sample-size estimation.First, our trial was designed to evaluate the incremental effect of adding individualized MTrP-targeted needling to an otherwise identical conventional acupuncture regimen in patients with early-to mid-stage knee osteoarthritis.The presence of an MTrP was therefore not an eligibility criterion.For participants in the MTrP-augmented group, clinicians received standardized training in the prespecified identification criteria and 4-grade tenderness scale.Before the first treatment, two trained physicians separately assessed candidate peri-knee sites, primarily in the vastus medialis and gastrocnemius, and measured pressure pain threshold.Three grade 3 or 4 sites with the greatest tenderness were selected, photographed, and documented, and the same sites were treated throughout all 10 sessions.All participants assigned to the MTrP-augmented group had at least three sites meeting these criteria; therefore, no participant was treated at fewer than three qualifying sites.Systematic MTrP mapping was performed for treatment selection in the augmented group rather than as a baseline phenotyping procedure in both groups.Consequently, MTrP number and muscle distribution were not collected as comparative baseline variables in the conventional acupuncture group.We agree that this prevents a formal comparison of baseline MTrP burden between groups and should be considered when interpreting MTrP-specific findings.Second, we appreciate the authors' observation regarding the gait-phase terminology.After rechecking the original device output and dataset, we confirmed that the variable reported as "single-leg support time" corresponds to the stance phase of the analyzed limb rather than to the biomechanically defined single-limb support period.The gait-analysis device used in our study reports the relevant variables in Chinese, and during preparation of the English-language manuscript, the Chinese term corresponding to the stance/support phase was translated imprecisely as "single-leg support time."The device-derived gait cycle was partitioned into stance phase and swing phase, which together constitute 100% of the gait cycle.This explains both their complementary values and their equal-and-opposite longitudinal changes.The issue therefore concerns terminology rather than the original device output, numerical values, or statistical calculations; the effect estimates, confidence intervals, and P values remain unchanged.