The originator of the biologic concept of Continuous Passive Motion (CPM) is Dr Robert B. Salter, CC, MD, MS, FRCSC, a pioneer in the field of orthopaedic surgery who served as Chief of Orthopaedic Surgery at Toronto’s Hospital for Sick Children for over ten years followed by surgeon in chief for 10 years and University professor for 20 years.
Dr. Salter has published more than 150 articles as well as a major textbook, Diseases of the Musculoskeletal System. His honours include the 1969 Gairdner International Award for Medical Science for his contributions to the understanding of cartilage degeneration and growth disturbance of the epiphyseal plate, induction into the Canadian Medical Hall of Fame, and the 1997 F.N.G. Starr Award, which is the highest award the CMA can bestow upon a member.
Recognized as a world-renowned surgeon, teacher, and scientist, Dr. Salter now serves as the surgeon-in-chief emeritus and senior orthopaedic surgeon emeritus at the Hospital for Sick Children. In 2006 he was named a Giant of basic research by the University of Toronto.
In 1994, Dr. Salter published The Physiologic Basis of Continuous Passive Motion for Articular Cartilage Healing and Regeneration, in which he presented an overview of the first 23 years of basic research on the biologic concept of CPM and the first 15 years of his experience with the clinical application of CPM to a variety of disorders and injuries.Basic Premises and Hypotheses of CPM
With these premises in mind, Dr. Salter hypothesized that continuous passive motion should have the following effects on synovial joints:
Overview, Results, and
Conclusions of Basic Research
Dr. Salter and a succession of Basic Research Fellows have conducted experimental investigations in both adult and adolescent rabbits on the effects of CPM on full and partial-thickness defects, intra-articular fracture, acute septic arthritis, intra-articular fluid pressures, clearance of hemarthrosis, wound healing, muscle atrophy, immobilization, tendon and ligament healing, autogenous and allogenic intra-articular periosteal grafts, and chondral shaving and subchondral abrasion.
This basic research led Dr. Salter to the conclusions that CPM:
In 1978, Dr. Salter began to apply CPM to patients following procedures such as ORIF of intra-articular, metaphyseal, and diaphyseal fractures, surgical release of extra-articular joint contractures, arthrotomy and incision with drainage for acute septic arthritis, synovectomy, biologic resurfacing, ligamentous repair and reconstruction, tendon repair, tibial osteotomy, and total joint replacement.
Results from these clinical applications include: CPM is well tolerated, maintenance of an increased ROM, normal wound healing, absence of complications, and shortened period of hospitalization and rehabilitation.