Objective To analyze the clinical efficacy of small needle knife combined with acupuncture and moxibustion in the treatment of knee osteoarthritis. Methods We selected 100 patients with knee osteoarthritis admitted to our hospital from January 2023 to January 2024, and divided them into the control group (50 cases, with conventional treatment) and the observation group (50 cases, with small needle knife combined with acupuncture and moxibustion) according to the random number table. We compared and evaluated the clinical treatment effects of the two groups, such as the osteoarthritis index, knee joint range of motion, pain score, knee joint function score and inflammatory factor level. Results The improvement of osteoarthritis index and pain score in observation group was better than that in control group, the levels of transforming growth factor-β, basic fibroblast growth factor and insulin-like growth factor in observation group were higher than those in control group, the level of interleukin-1 was lower than that in control group, and the knee function score and mobility after treatment were higher than those in control group (P<0.05). Conclusions In the treatment of knee osteoarthritis patients with small needle knife combined with acupuncture and moxibustion and moxibustion, obvious effects have been achieved, which can significantly reduce the pain of patients, improve the functional level of patients' knee joints, and improve the range of motion of knee joints. It has high application value.