PMID- 28027657
OWN - NLM
STAT- MEDLINE
DCOM- 20180208
LR  - 20181202
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 45
IP  - 11
DP  - 2017 Sep
TI  - The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee 
      Osteoarthritis: A Meta-analysis of Evidence Level 1 Studies.
PG  - 2647-2653
LID - 10.1177/0363546516680607 [doi]
AB  - BACKGROUND: Intra-articular normal saline (IA-NS) injections have been utilized 
      as a placebo in a number of randomized controlled trials pertaining to the 
      management of knee osteoarthritis (OA); however, it is believed that these 
      "placebo" injections may have a therapeutic effect that has not been quantified 
      in the literature. PURPOSE: To (1) quantify the effect of IA-NS injections on 
      patient-reported outcomes (PROs) and (2) compare postinjection PROs to 
      established minimal clinically important difference (MCID) criteria to 
      demonstrate a potential therapeutic effect. STUDY DESIGN: Meta-analysis. METHODS: 
      A review was conducted to identify all randomized, placebo-controlled trials on 
      injection therapy for knee OA between 2006 and 2016. Patient demographics and 
      PROs before the injection and at 3 and 6 months after the injection were 
      collected for patients in the IA-NS injection group in each study. A 
      random-effects model was used to compare preinjection scores and scores at each 
      postinjection time point in a pairwise fashion. RESULTS: In total, there were 14 
      placebo cohorts in 13 studies that were analyzed after meeting inclusion criteria 
      for this meta-analysis. This included 1076 patients (Kellgren-Lawrence grade 
      1-4), with a weighted mean age of 62.53 years and mean body mass index of 28.67 
      kg/m(2). There was only sufficient information to perform analyses of visual 
      analog scale (VAS) pain and Western Ontario and McMaster Universities Arthritis 
      Index (WOMAC) total scores. At 3 months after the IA-NS placebo injection, there 
      was a significant improvement in VAS pain scores (mean difference [MD], 12.10 
      [95% CI, 3.27 to 20.93]; P = .007), whereas improvement in the WOMAC total scores 
      approached but did not reach statistical significance (MD, 19.75 [95% CI, -0.50 
      to 40.09]; P = .06). At 6 months, both VAS pain scores (MD, 16.62 [95% CI, 
      12.13-21.10]; P < .00001) and WOMAC total scores (MD, 11.34 [95% CI, 7.03-15.65]; 
      P < .00001) were significantly improved in comparison to preinjection values. 
      Furthermore, improvements in both the VAS pain and WOMAC total scores at 6 months 
      were clinically significant (MCID, 1.37 and 9, respectively). CONCLUSION: The 
      administration of an IA-NS placebo injection yields a statistically and 
      clinically meaningful improvement in PROs up to 6 months after the injection in 
      patients with knee OA. This observation supports the notion that the so-called 
      placebo effect for IA-NS injections achieves a clinically meaningful response in 
      patients with OA when provided during comparison studies to an active treatment 
      group (ie, hyaluronic acid).
FAU - Saltzman, Bryan M
AU  - Saltzman BM
AD  - Department of Orthopedic Surgery, Rush University Medical Center, Chicago, 
      Illinois, USA.
FAU - Leroux, Timothy
AU  - Leroux T
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Meyer, Maximilian A
AU  - Meyer MA
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Basques, Bryce A
AU  - Basques BA
AD  - Department of Orthopedic Surgery, Rush University Medical Center, Chicago, 
      Illinois, USA.
FAU - Chahal, Jaskarndip
AU  - Chahal J
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Bach, Bernard R Jr
AU  - Bach BR Jr
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Yanke, Adam B
AU  - Yanke AB
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Cole, Brian J
AU  - Cole BJ
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20161227
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
RN  - 451W47IQ8X (Sodium Chloride)
RN  - 9004-61-9 (Hyaluronic Acid)
SB  - IM
MH  - Humans
MH  - Hyaluronic Acid/therapeutic use
MH  - Injections, Intra-Articular
MH  - Ontario
MH  - Osteoarthritis, Knee/physiopathology/*therapy
MH  - Pain/etiology/prevention & control
MH  - Pain Measurement
MH  - Patient Reported Outcome Measures
MH  - Sodium Chloride/*administration & dosage
OTO - NOTNLM
OT  - arthritis
OT  - arthrocentesis
OT  - injection
OT  - knee
OT  - osteoarthritis
OT  - placebo
OT  - saline
EDAT- 2016/12/29 06:00
MHDA- 2018/02/09 06:00
CRDT- 2016/12/29 06:00
PHST- 2016/12/29 06:00 [pubmed]
PHST- 2018/02/09 06:00 [medline]
PHST- 2016/12/29 06:00 [entrez]
AID - 10.1177/0363546516680607 [doi]
PST - ppublish
SO  - Am J Sports Med. 2017 Sep;45(11):2647-2653. doi: 10.1177/0363546516680607. Epub 
      2016 Dec 27.