Saline injection as a treatment for chondral injuries and osteoarthritis?
Saline knee injections can be an effective treatment for articular cartilage injuries in the knee.
Joint injections have been widely used in football medicine over the last few decades. Steroid injections, visco-supplementation and more recently platelet rich plasma (PRP) have all been used to treat joint disease. This is despite the lack of good quality evidence to show that these treatments are effective. In some situations, particularly following the use of corticosteroid, these injections may have negative effects on the joint. Studies that have investigated these treatment options have frequently used normal saline as a placebo control. Based on the results of a recent study it is possible that saline may be an effective treatment in its own right.
In a meta-analysis published in the American Journal of Sports Medicine, 1076 patients from 13 studies were reviewed to quantify a possible therapeutic effect of intra-articular saline in knee osteoarthritis (OA).1 Patient-reported outcomes were assessed before the injection and at 3 and 6 months after the injection. Pain scores from the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were collected. At 3 months after saline injection there was a significant improvement in VAS pain scores. Both scores were significantly improved at 6 months’ post-injection.
The results of this study are intriguing. It supports the idea that saline knee injections can achieve a clinically significant result in patients with known osteoarthritis. This may be an effective, safe and cheap method of improving a player’s symptoms (if other options like rest, altered loading and strength training are not effective). If you are faced with a patient with difficult ongoing knee pain, this could be simple, effective and low risk treatment option.