Objective: This meta-analysis aims to assess the clinical efficacy of opposing needling for treating knee osteoarthritis (KOA) in athletes, focusing on pain management, mobility improvement, and overall recovery, which are critical for maintaining athletic performance. Methods: A systematic search was conducted across several databases including China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang Data Knowledge Service Platform, VIP Database for Chinese Technical Periodicals, PubMed, Web of Science, Cochrane Library, and EMBASE. Randomized controlled trials (RCTs) were selected based on strict inclusion and exclusion criteria. Data extraction and quality assessment were performed, followed by a meta-analysis using Revman 5.4 and Stata 14.0 software. Results: The meta-analysis revealed a higher clinical efficacy rate in the opposing needling group compared to the control group (RR=1.18, 95%CI [1.12,1.25], P<0.0001). Significant improvements were also observed in pain reduction, as indicated by lower VAS scores (MD=-1.31, 95%CI [-1.70, -0.93], P<0.0001), and in functional mobility, as reflected by improved WOMAC scores (MD=-10.17, 95%CI [-13.64, -6.69], P<0.0001). However, the differences in Lysholm scoring, which relates specifically to knee stability and function in sports, did not show statistical significance (MD=18.37, 95% CI [-1.02, 37.75], P=0.06), potentially due to limited studies focusing on this outcome. Conclusion: Opposing needling is an effective and reliable intervention for managing KOA in athletes. It shows significant advantages in enhancing clinical outcomes, reducing pain, and improving stiffness and daily activities compared to other treatments. Given its benefits in promoting quicker recovery and maintaining athletic performance, opposing needling therapy is recommended for broader clinical application in sports medicine.