Introduction: The aim of this systematic review was to assess the efŞcacy of Saline load tests (SLTs) toevaluate extension of periarticular wounds into capsule in emergent settings.Methods: We systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosingpenetrating 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 sensitivitiesranging between 91% and 99% depending on the size of the laceration. A SLT of 30 mL in the ankle yieldssensitivities ranging from 95% to 99% in assessing joint penetration. A SLT of 45 mL in the elbow yields asensitivity of 95% in assessing joint penetration. The addition of methylene blue does not change thesensitivity 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 studiesare required to make deŞnitive recommendations. In addition, more studies will be needed on jointsother than the knee, pediatric patients, and the use of methylene blue dye in conjunction with SLT.Level of evidence: Level II, Diagnostic study.
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1. Terry Canale S. Campbell's Operative Orthopaedics. 10th ed. Boston, MA: CV Mosby; 2003.
2. Patzakis MJ, Dorr LD, Ivler D, Moore TM, Harvey Jr JP. The early management of open joint injuries. A prospective study of one hundred and forty patients. J Bone Jt Surg Am Vol. 1975;57(8):1065e1070.
3. Collins DN, Temple SD. Open joint injuries. Classification and treatment. Clin Orthop Relat Res. 1989;(243):48e56.
4. Konda SR, Howard D, Davidovitch RI, Egol KA. The saline load test of the knee redefined: a test to detect traumatic arthrotomies and rule out periarticular wounds not requiring surgical intervention. J Orthop Trauma. 2013;27(9): 491e497.
5. Konda SR, Davidovitch RI, Egol KA. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J Orthop Trauma. 2013;27(9):498e504.
6. Konda SR, Davidovitch RI, Egol KA. Open knee joint injuriesean evidence-based approach to management. Bull Hosp Jt Dis. 2014;72(1):61e69.
7. Nord RM, Quach T, Walsh M, Pereira D, Tejwani NC. Detection of traumatic arthrotomy of the knee using the saline solution load test. J Bone Jt Surg Am Vol. 2009;91(1):66e70.
8. Keese GR, Boody AR, Wongworawat MD, Jobe CM. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J Orthop Trauma. 2007;21(7):442e443.
9. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.
10. Metzger P, Carney J, Kuhn K, Booher K, Mazurek M. Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies. J Orthop Trauma. 2012;26(6):347e349.
11. Tornetta 3rd P, Boes MT, Schepsis AA, Foster TE, Bhandari M, Garcia E. How effective is a saline arthrogram for wounds around the knee? Clin Orthop Relat Res. 2008;466(2):432e435.
12. Haller JM, Beckmann JT, Kapron AL, Aoki SK. Detection of a traumatic arthrotomy in the pediatric knee using the saline solution load test. J Bone Jt Surg Am Vol. 2015;97(10):846e849.
13. Bariteau JT, Blankenhorn BD, Digiovanni CW. Evaluation of saline load test for simulated traumatic arthrotomies of the ankle. Injury. 2013;44(11): 1498e1501.
14. Feathers T, Stinner D, Kirk K, et al. Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies. J Trauma. 2011;71(5):E110eE113.
15. Voit GA, Irvine G, Beals RK. Saline load test for penetration of periarticular lacerations. J Bone Jt Surg Br Vol. 1996;78(5):732e733.
16. Goddard NJ, Gosling PT. Intra-articular fluid pressure and pain in osteoarthritis of the hip. J Bone Jt Surg Br Vol. 1988;70(1):52e55.
17. Beck M, Siebenrock KA, Affolter B, Notzli H, Parvizi J, Ganz R. Increased intraarticular pressure reduces blood flow to the femoral head. Clin Orthop Relat Res. 2004;(424):149e152.
18. Ninomiya JT, Dean JC, Goldberg VM. Injury to the popliteal artery and its anatomic location in total knee arthroplasty. J Arthroplast. 1999;14(7): 803e809.
19. Raskind JR, Marder RA. Arthroscopic versus open debridement of penetrating knee joint injuries. Iowa Orthop J. 1993;13:121e123.