Cartilage damage is the key pathological mechanism in the progressive development of osteoarthritis(OA). Slowing down cartilage damage and accelerating cartilage repair are strategies for effective treatment of OA. Acupuncture and moxibustion therapies are widely used in relieving symptoms of OA and have a protective effect on cartilage. In this paper

we reviewed the mechanisms of acupuncture and moxibustion underlying relieving cartilage damage from three aspects: 1) promoting chondrocyte homeostasis by inhibiting apoptosis and improving cellular autophagy

2) regulating extracellular matrix(ECM) metabolism(inhibiting decomposition and promoting synthesis) by suppressing the release of inflammatory factors and the activity of proteolytic enzymes

and 3) improving OA microenvironment by reducing the number of macrophagocyte 1(M1) and increasing the ratio of M2/M1 in the local inflammatory locus. In addition

most studies on the mechanisms of acupuncture and moxibustion underlying remission of OA focus on the improvement of pathological changes

such as joint histopathology

cartilage morphology

synovial inflammatory reaction and infiltration

subchondral bone remodeling

etc.

thus

the exact functions of acupuncture and moxibustion in ameliorating cartilage injury remain unknown. In view of the important role of mitochondrial dysfunction in promoting OA development and cartilage damage and the current use of tissue engineering methods of chondrocytes and mesenchymal stem cells to repair articular cartilage injury

it is highly recommended that future studies should pay more attention to these aspects.