Acupuncture is a medical procedure that involves the stimulation of points on or below the skin to achieve therapeutic effects. Acupuncture has been recommended in a variety of conations including musculoskeletal conditions, behavior modification, gastrointestinal disorders, and cancer. The objective of this review is to investigate the evidence for efficacy of acupuncture for musculoskeletal conditions in dogs. The following databases were searched for any controlled trials investigating acupunctures efficacy in musculoskeletal conditions: MEDLINE, CAB Direct, AGRICOLA, CINAHL, TOXNET, Science.gov, Web of Science. Eligible studies were randomized control trials or non-randomized controlled trials that investigated the efficacy of acupuncture in any musculoskeletal condition. Mixed effects meta-analyses and GRADE assessments were conducted on seven outcomes selected post-hoc. All of the GRADE assessments indicate low confidence in the effect estimates due to limited numbers of trials, high risk of bias, and confidence intervals that cross both no effect and appreciable benefit. There is a need for several well-designed and reasonably similar studies focusing on the most common clinical uses of veterinary acupuncture in order to establish its efficacy.