 He started his career in the youth system at Leyton Orient, making his debut at the age of sixteen in a 3–0 defeat to Huddersfield Town in September 2003.He scored his first goal for the club in a Football League Trophy tie against future club Woking on 28 September 2004.Despite starting as a central midfielder, Saah was converted to a central defender and won praise for his displays deputising for first team regulars John Mackie and Gabriel Zakuani during the 2005–06 promotion season to League One.