Robert Salter, CC, OOnt, MD, FRSC, FRCSC, FACS

Hospital for Sick Children Research Institute Senior Scientist Emeritus

University of Toronto Professor Emeritus Surgery



Brief Biography

During the past 22 centuries the traditionally accepted and enforced treatment for diseased and injured joints was immobilization. Yet the potential for joint cartilage to heal or to regenerate is notoriously limited. In 1970, at The Hospital for Sick Children and the Research Institute Dr. Robert Salter concluded from his previous 15 years of research that immobilization was very harmful to joints and furthermore, that immobilization did not stimulate joint cartilage either to heal or to regenerate. Consequently he originated the revolutionary biological concept of continuous passive motion (CPM) of joints.

In 35 experimental investigations at Sick Kids he has demonstrated that CPM for four weeks has a remarkably beneficial effect on the healing and regeneration of joint cartilage. For example, in a periosteal graft in the knee joint of the rabbit, CPM causes the osteoblasts (that are destined to produce bone) to change their phenotypic expression to become chondroblasts that produce articular cartilage rather than bone.

Since 1978 (after the first eight years of basic research) Dr. Salter began to apply CPM to the care of human patients while continuing this research. John Saringer, a mechanical engineer and researcher from U of T began working with Dr. Salter to produce CPM machines for all the synovial joints of the body. As of 2005 it has been estimated that 8 million patients worldwide have been treated by CPM.

Research Interests
  • Healing and regeneration of articular cartilage, ligaments, tendons and bones under the influence of continuous passive motion (CPM)
  • Animal Models
  • Clinical Studies re: CPM
Research Activities

Basic research on the effects of continuous passive motion on a variety of experimental models of disorders and injuries of musculoskeletal tissues.

The effects of continuous passive motion compared to immobilization on healing and regeneration in the following experimental models of disorders and injuries of musculoskeletal tissues in an animal model:

  • Full Thickness Defects of Articular Cartilage
  • Intra-articular Fractures
  • Septic Arthritis
  • Tendon Injuries
  • Ligament Injuries
  • Biological Resurfacing of Major Defects in Articular Cartilage - Autogenous and Allograft Periosteum
  • Chondral Shaving and Chondroabrasion
  • An Antigen - Induced Model of Rheumatoid Arthritis
  • Osteocartilaginous Allografts
Select Publications

Salter RB. An overview of Continuous Passive Motion (CPM). Historical Background the limited potential of articular cartilage to heal or to regenerate. Folia Traumatologica Lovaniesia. pp 29-37. ISNB 90-803-659-9-8, 2003.

Salter RB. Epipyseal Plate Injuries. Folia Traumatologica Lovaniensia pp 46-56 ISNB 90-803-659-9-8, 2003.

Salter RB. The biological concept of Continuous Passive Motion (CPM) of joints for the healing and regeneration of articular cartilage, Ligaments and tendons. The 20th Anniversary of the Death of Sir John Chamley. Vol: After Chamley. Ch 15 Mc Millan & Co. Preston, United Kingdom, 2002.

Salter RB. Textbook of Disorders and Injuries of the Musculoskeletal System: An Introduction of Orthopaedics Fractures and Joint Injuries, Rheumatology, Metabolic Bone Disease, and Rehabilitation - Third Edition - 687 pages 1,360 Illustrations. Baltimore. Williams and Wilkins, 1999.

Salter RB. Promotion of surgical research among students and residents. p.290 In (eds)Wamock GH, Tator CH: Surgical Research in Canada: Synopsis of a Consensus Conference. Canadian Journal of Surgery. Vol. 41, No 4. P.p. 289, August, 1998.

Babyn PS, Kim HK, Gahunia HK, Lemaire C, Salter RB, Fornasier V, Pritzker KPH. MRI of the cartilaginous epiphysis of the femoral head in the piglet hip after ischemic damage. JMRI 8: 717-723, 1998.

Kim HK, Kerr RG, Turley CB, Evans PJ, Jay V, Salter RB. The effects of postoperative continuous passive motion on peripheral nerve repair and regeneration. An experimental investigation in rabbits. Journal of Hand Surgery, 23: 594-597, 1998.

van Susante JL, Buma P, Kirn HK, Salter RB. Traumatic heterotopic bone formation in the quadriceps muscle. No progression by continuous passive motion in rabbits. Acta Orthopaedics Scandinavica, 67: 450-454, 1996.

Epps HR, Salter RB. Orthopaedic conditions of the cervical spine and shoulder. Pediatric Clinics of North America, 43: 919-931, 1996.

Kim KW, Cruz TF, Salter RB. The effects of continuous passive motion and immobilization on synovitis and cartilage degradation in antigen-induced arthritis. Journal of Rheumatology, 22(9), 1995.

Williams JM, Moran M, Thornor EJ-MA, Salter RB. Continuous passive motion stimulates repair of rabbit knee articular cartilage after matrix proteoglycan loss. Clinical Orthopaedics & Related Research, 304: 252-262, 1994.

Kreder HJ, Moran ME, Keeley FW, Salter RB. Biological resurfacing of major joint defects with cryopreservation allogenic periosteum. Clinical Orthopaedics and Related Research, 300: 288-296, 1994.