Saline injection as a treatment for chondral injuries and osteoarthritis?

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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.

To learn more about the assessment and management of knee injuries complete the relevant modules in the FIFA Diploma in Football Medicine.

References

1 Saltzman BM, Leroux T, Meyer MA et al. The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee Osteoarthritis: A Meta-analysis of Evidence Level 1 Studies. Am J Sports Med 2017 (45) 11, 2647-2653.

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Zaza Telia
26 January 2018 11:57

I wonder if there have been done meta-analyses of this trials and if yes, what is the heterogenity? Show us the Forest Plot. Is there any systematic review done by Chochrane?

Tarek Hadla, MD
09 February 2018 13:12

Hi,
Pretty interesting and worth looking at further.
Sincerely,

Dr VOUNDI VOUNDI Junior
11 February 2018 8:17

Hi,
I’m quite perplexed on why are NSAID’s not applied to relief the symptoms of O.A. which are generally of traumatic causes?
I’m sure corticosteroids could have that negative effect from their immunosuppressif properties.
But how saline injection do work?

Adamu Mohammed MAGAJI
24 February 2018 17:54

The results is quite probable, after all; saline is a near physiological solution devoid of many factors, enzymes, vitamins, minerals and hormones! It would be nice to study the effects of adding some growth factors like colony stimulating factors to saline in recent knee injuries!

Bangoura
09 October 2018 14:32

L arthrose en générale la gonarthrose ou la gonarthrose en particulier demande un suivi très sérieux pour des personnes atteintes. Elle est L apanage des personnes âgées. Le traitement à long terme nécessite des infiltrations intra articulaires. C est des traitements très efficaces.
Les produits généralement utilisés sont
LES CORTICOSROIDES
LA VISCOSUPLEMENTATION
LES PLASMAS
L utilisation des corticoïdes à des avantages et des inconvénients
Dans les inconvénients les infiltrations intra articulaires mal faits entraînent une fragilité voir une rupture des tendons et des ligaments la destruction du cartilage.
L utilisation des solutions salines apporte très peu de resultar

Zaza Telia
26 January 2018 11:57

I wonder if there have been done meta-analyses of this trials and if yes, what is the heterogenity? Show us the Forest Plot. Is there any systematic review done by Chochrane?

Mark Fulcher
31 January 2018 10:39
Reply to  Zaza Telia

Thanks for the feedback. This is a metanalysis – but no there is no Cochrane review nor is there any more definitive data. I like the article though. Quite thought provoking however – in an injury where there are very limited good quality treatment options.

Keita cosgrove
Keita cosgrove
23 November 2019 9:39

I suffered from severe soreness in my right knee and swollen joints which eventually developed into such a painful condition, I could not lift my leg or put weight on it to walk. After trying several treatments, I finally went to a care clinic where x-rays showed advanced Arthritis/OA. My condition worsened with severe pains and stiffness, so a friend introduced me to Herbal Health Point (ww w. herbalhealthpoint. c om) and their Arthritis Formula treatment protocol, I immediately started on the treatment, few weeks into the treatment the pain and stifness were completely gone and I had regained complete use of… Read more »