• Daniel D Bohl, Rachel M Frank, Simon Lee, Kamran S Hamid, George B Holmes, and Johnny Lin.
• 1 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
• Foot Ankle Int. 2018 Jun 1; 39 (6): 736-740.

BackgroundThe saline load test has been used to evaluate for traumatic arthrotomy in orthopedics. The purpose of this study was to determine the volume of saline required to detect traumatic arthrotomy of the ankle.MethodsForty-two patients undergoing elective ankle arthroscopy were prospectively enrolled. For each patient, a standard 4-mm anteromedial portal was established. Next, an 18-gauge needle was inserted at the site of the anterolateral portal. Sterile saline was slowly injected through the needle until saline extravasated from the anteromedial portal. Saline volumes at the time of extravasation were recorded and analyzed.ResultsThe saline volume required to achieve extravasation ranged from 0.2 to 60.0 mL. The median saline volume required to achieve extravasation was 9.7 mL (interquartile range, 3.8-29.6 mL); however, 5 of 42 patients required volumes between 50.0 and 60.0 mL. A total of 50.0 mL was required to achieve 90% sensitivity, 55.0 mL to achieve 95% sensitivity, and 60.0 mL to achieve 99% sensitivity.ConclusionsThe previously recommended 30 mL of saline required to reliably detect traumatic arthrotomy of the ankle may be too small a volume.Clinical RelevanceThe present study suggests that clinicians should attempt to inject 60 mL of saline to effectively rule out a traumatic arthrotomy injury. Because of the study's methods involving an anteromedial arthrotomy with anterolateral saline injection, these findings may be most valid for arthrotomies on the medial side of the ankle.

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