This research highlight offers compelling scientific support for using fire needling (FN) acupuncture as a treatment for knee osteoarthritis (OA), focusing on both pain relief and crucial cartilage protection. A study conducted on rats with induced OA (MIA model) found that the FN group, treated at common knee acupoints like Xuehai (SP 10) and Zusanli (ST 36), demonstrated significant post-treatment improvements. Assessments using micro-CT and histology confirmed improved bone structure and density. Critically, the treatment inhibited cartilage degeneration, supported by enhanced OARSI scores. Mechanistically, FN acupuncture reduced key pro-inflammatory proteins (MMP9 and MMP13) while increasing beneficial Type II collagen (COL2). Furthermore, improvements were observed in synovial inflammation and subchondral bone structure. Behavioral tests confirmed these findings, showing enhanced weight-bearing ability and improved pain thresholds. The study concludes that FN acupuncture provides a scientific basis for this traditional technique, making it a valuable therapeutic option for managing painful and often recalcitrant joint disorders.