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Home , Enthesis, Fibrocartilage

Journal of Rawalpindi Medical College (JRMC); 2015;19(3):258-259

Original Article Thickness of Tidemark in at Distal Epiphyseal Attachment of Quadriceps and Semimembranosus Tendon

Tahzeeb-Ul-Hassan1, Amer Qayum1, Tassaduq Hussain 2 1.Department of Anatomy, Rawalpindi Medical College Rawalpindi;2.Central Park Medical College, Lahore.

Abstract interface. Microscopically it has four zones. These include pure or tendon, uncalcified Background: To compare width of zone of fibrocartilage, calcified fibrocartilage and . Zones tidemark at distal attachment of quadriceps tendon of uncalcified fibrocartilage and calcified fibrocartilage and semimembranosus tendon by routine histology are collectively called enthesis fibrocartilage.3-6 in view of their role as mechanical barrier and site Enthesis fibrocartilage reduces wear and tear and for osteoarthritic live degenerative changes. forms one of the protective devices. Enthesis Methods: The specimens of right sided distal fibrocartilage is also the site of pathological changes attachment of quadriceps tendon on patella and during ankylosis spondylitis and semimembranosus tendon on tibia were collected spondyloarthopathies. The layers of calcified and from 20 male cadavers of adult age not beyond 40 uncalcified fibrocartilage at an enthesis are separated years from autopsy room, within 24 hours of death. by calcification front called as tidemark.7,8 Although After fixation, dehydration and processing 5um tidemark separates the calcified and uncalcified serial sections were cut at 500um interval along the fibrocartilages, the collagen fibers in two layers are long axis of the . The varying thickness of continuous.9,10 The tidemark is smooth at sites with tidemark were calculated. much uncalcified fibrocartilage.5 Results: There were four zones at the attachment sites. These included (1) tendon (2) uncalcified Patients and Methods fibrocartilage, (3) calcified fibrocartilage, (4) bone. From central portion of attachment zones of The zone of uncalcified fibrocartilage was separated quadriceps tendon (group A) and semimembranosus from calcified fibrocartilage by calcification front tendon (group B), strips approximately 3mm were called tidemark. There were marked differences in taken. The specimens were taken from right sided width of zone of tidemark between quadriceps knee (devoid of gross pathological changes) of tendon and semimembranosus tendon insertion. 20 male humans not beyond 40 years old from autopsy Conclusion: The thickness of zone of tidemark is room of District Headquarter Hospital, Rawalpindi. greater in semimembranosus tendon than The specimen were fixed in 10% neutral buffered quadriceps tendon. As quadriceps tendon is strong formalin, decalcified in 2% nitric acid (end point being extensor with greater mobility and exert more force determined by palpation), dehydrated with graded than semimembranosus which is one of weak flexor alcohols, cleared in inhibisol and embedded in of knee , so width tidemark is more in paramat. Serial sections were cut at 5um and two semimembronosus tendon than quadriceps tendon. sections were obtained after each 500µm interval along Key Words: , Quadriceps tendon, the long axis of the tendons and stained with hematoxyline and eosin. The width of tidemark was Semimembranosus tendon, Tidemark measured with the help of ocular micrometer. The Introduction arithmetic mean of observations and standard error of The enthesis is the point of insertion of the tendon, the means were calculated. t--test was used to analyse ligament, or fascia to bone.1,2 There are the significant difference between two group A & B. two types of enthesis. Fibrous enthesis and The difference was regarded significant, if the p-value fibrocartilaginous enthesis. Fibrous enthesis is was equal to or less than 0.05. characterized by pure dense fibrous Results that links the tendon or ligament to the bone. The There were striking differences between the width of fibrocartilaginous enthesis is characterized by a zone of tidemark at insertion of quadriceps tendon transitional zone of fibrocartilage at bone-tendon and semimembranosus tendon (Table 1). The width of

258 Journal of Rawalpindi Medical College (JRMC); 2015;19(3):258-259 zone of tidemark was greater in tendon of The present study suggested that there were striking semimembranosus (mean 0.2440um ± 0.03089), i.e, it differences in the width of zone of tidemark at the exceeded the width of zone of tidemark in quadriceps epiphyseal attachment sites of quadriceps tendon and tendon. (mean 0.1167um ± 0.01234) (Table 1;Figure 1 & semimembranosus tendon. The thickness of zone of 2. tidemark was maximum in semimembranosus tendon Table 1: Comparison of width of tidemark in than quadriceps tendon. As quadriceps tendon is group A & B strong extensor, it exerts more force and mobility, so Mean Std. Std. Error tidemark is smooth and less in thickness than Group N (um) Deviation Mean semimembranosus which is one of flexor of knee joint. Tidemarks GroupA 20 0.1167 0.01234 0.00319 GroupB 20 0.2440 0.03089 0.00798 Conclusion Uncalcified 1.The thickness of tidemark was greater in fibrocartilage semimembranosus tendon than quadriceps tendon. 2.As quadriceps tendon is strong extensor with greater mobility and exerts more force so tidemark is smooth Calcified fibrocartilage and decreased in thickness than semimembranosus.

Tidemark

Bon References e 1. Dolgo-Saburoff B. Uber ursprung und insertion der Skelettmuskeln. Anat Anz 1929; 68: 8–87. Figure 1:Quadriceps tendon insertion into patella (group 2. Benjamin M, Evans EJ, Copp L. The histology of tendon attachments to bone in man. J Anat 1986;149:89-100. A), showing nuclei of (Nc) in the zone of 3. Redler I, Mow VC, Zimny ML, Mansell J. The ultrastructure and uncalcified fibrocartilage: tidemark, calcified biomechanical significance of the tidemark of articular . fibrocartilage, lamellar bone. 1040, H&E stain Clin Orthop 1975;112:357-62. 4. Havelka S and Horn V. Observations on the tidemark and Uncalcified calcified layer of articular cartilage. Biology of the fibrocartilage 1999;331-46. 5. Kumar P, Oka M, Nakamura T, Yamamuro T. Mechanical strength of osteochondral junction. Nippon Seikeigeka Gakkai Tidemark zasshi 1991;65:1070-77. 6. Lane LB and Bullough PG. Age-related changes in the thickness Calcified of the calcified zone and the number of tidemarks in adult fibrocartilage human articular cartilage. J Bone Jt Surg 1980;62B:372-75. 7. Woo S, Maynard J, Butler D, Lyon R. Ligament, tendon, and joint Bone capsule insertions to bone. American Acadamy of Orthopaedic Surgery. 1988;133-66. Figure 2: Semimembranosus tendon insertion into tibia 8. Benjamin M, Kumai T, Milz S, Boszczyk BM. The skeletal attachment of tendons–tendon ‘entheses’. Comp Biochem Physiol (group B), showing nuclei of chondrocytes (Nc) in the zone A Mol Integr Physiol 2002;133:931-45 of uncalcified fibrocartilage, tidemark, calcified 9. Lu HH and Thomopoulos S. Functional attachment of soft tissues fibrocartilage, lamellar bone. 1040, H&E stain to bone: development, healing, and tissue engineering. Annu Rev Biomed Eng 2013;15:201–26 Discussion 10. Padulo J, Oliva F, Frizziero A, Maffulli N. Muscles, and An enthesis is the attachment of tendon, ligament or Tendons Journal. Basic principles and recommendations in 7,8 clinical and field science research. MLTJ 2013;4:250–52 capsule to bone. It is also called insertional complex. 11. Lyons TJ, Stoddart RW, McClure SF. The tidemark of the Enthesis is either fibrous or fibrocartilagenous chondro-osseous junction of the normal human knee joint. J Mol depending upon the nature of tissue at tendon- Histol 2005;36:207-15. 12. Maffulli N, Reaper J, Ewen SW, Waterston SW. Chondral ligament-bone interface. Fibrous enthesis are present metaplasia in calcific insertional of the achilles at or of .9,10 tendon. Clin J Sport Med 2006;16:329-34. Fibrocartilagenous enthesis are more common than 13. Thomopoulos S, Marquez JP, Weinberger B. Collagen fiber orientation at the tendon to bone insertion and its influence on fibrous enthesis.11,12,13 This insertional complex stress concentrations. J Biomech 2006;39:1842-51. includes tendon uncalcified fibrocartilage, tidemark, 14. Toumi H, Higashiyama I, Suzuki D. Variations in human patellar 14,15,16 trabecular architecture and the structure of the proximal calcified fibrocartilage and bone itself. The layers patellar tendon enthesis. J Anat 2006;208:47-57. of calcified and uncalcified fibrocartilage at an enthesis 15. Benjamin M, Toumi H, Ralph Jr. Where tendon and ligament are separated by calcification front that is commonly meet bone: attachment sites in relation to exercise and/or mechanical load. J Anat 2006;208:471-90. called tidemark. It is an interface at which soft tissue 16. Apostolakos J, Durant JS, Alaee F, A review of the tendon-to- separate from hard ones. bone insertion. MLTJ 2014; 4(3): 333–42. .

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