Joint Contractures

Joint contractures are well known to the orthopaedic community but less so to other medical fields and to the general population. Neither the pathophysiology nor the prevention and treatment of this often crippling affliction have received the attention they deserve. Joint contractures not only restrict mobility, they also have a devastating effect on the quality of life of a large number of patients by preventing them from performing daily activities such as dressing, eating and walking independently. Due to lack of awareness and insufficient research, treatment options for contractures have improved little in the past century. Recovery of joint motion remains very limited. Stretching of the joint with adjuvant heat and with functional bracing or casting is resource-intensive and prolonged, and the outcome usually falls short of patients' expectations. One roadblock to progress is our lack of a basic scientific understanding of the pathogenetic processes-a lack of knowledge on which to base therapy. How do cells react to decreased joint mobility? How are these reactions translated into changes in cellular expression? What are the main biochemical pathways and key mediators of change in the joint capsule and overlying tissues that lead to limitation in range of motion? It is not a lack of investigative tools that keeps us from making breakthroughs. Researchers are, in fact, beginning to use such tools to investigate the molecular mechanisms, genes and pathways that lead to structural and mechanical changes in other bone and joint conditions, so why not do the same for contractures? Research on joint contractures requires better integration, collaboration and coordination: (1) We should be integrating data from patients, from families, from therapists, and from the physicians who deal on a daily basis with the serious consequences of joint contractures. Since contractures arise during the course of many different disorders-Alzheimer's disease, cerebral palsy, diabetes, muscular dystrophy, spinal cord injury, ALS-the associations and support groups for these disorders should be made aware of how severely joint contractures can affect their constituent members' quality of life; (2) Collabora-tion is needed among scientists in fields as diverse as epidemiology, medicine, molecular biology, engineering and genetics: the lock that prevents us from understanding and curing joint contracture is not going to open with just one key; and (3) Coordination could lead to a concerted group effort to advance research by means of large-scale multi-center, multi-pronged investigations. In 2005, clinicians and scientists met in Montreal for the first international research conference on joint contractures. The goal at that meeting was to increase the awareness and knowledge of ongoing research in this area. This symposium includes selected papers from that meeting, with some additional invited papers. These contributions reflect the spectrum of current knowledge and research directions in the field of joint contractures-starting with an historical paper, followed by epidemiological, mechanical and kinetic results, and finishing with applications from molecular biology, gene expression and genetic research. It is our hope the knowledge gained through this symposium will serve as a useful reference for both practitioner and researcher. We hope to see, in the not-too-distant future the direct results of studies now underway: explanations of the pathophysiology of contractures, identification of preventive regimens to block the development of joint contractures in populations at risk, and completion of therapeutic trials aimed at reversing established contractures. Most importantly, we hope to see epidemiological studies confirming the quality of life of patients affected by this devastating joint problem has been improved. Guy Trudel, MD, MSc The Bone and Joint Laboratory and The Division of Physical Medicine and Rehabilitation The University of Ottawa Ottawa, Ontario, Canada Odette Laneuville, PhD The Department of Biochemistry, Microbiology and Immunology The University of Ottawa Ottawa, Ontario, Canada Hans K.