Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature

Introduction: The aim of this systematic review was to assess the efficacy of Saline load tests (SLTs) to evaluate extension of periarticular wounds into capsule in emergent settings.

Methods: We systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle.

Results: The SLT values to determine knee arthrotomies vary from 73.8 mL to 194 mL with sensitivities ranging between 91% and 99% depending on the size of the laceration. A SLT of 30 mL in the ankle yields sensitivities ranging from 95% to 99% in assessing joint penetration. A SLT of 45 mL in the elbow yields a sensitivity of 95% in assessing joint penetration. The addition of methylene blue does not change the sensitivity of the SLT.

Conclusion: Several studies have demonstrated the utility of the SLT as a diagnostic modality for penetrating joint injuries. However, the literature analyzed in this study was inconclusive and more studies are required to make definitive recommendations. In addition, more studies will be needed on joints other than the knee, pediatric patients, and the use of methylene blue dye in conjunction with SLT.

Level of evidence: Level II, Diagnostic study.