Enthesis

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Enthesis
Joint.svg
Typical joint
Identifiers
TH H3.03.00.0.00034
Anatomical terminology

The enthesis (plural entheses) is the connective tissue which attaches tendons or ligaments to a bone. [1]

Contents

There are two types of entheses: fibrous entheses and fibrocartilaginous entheses. [2] [3]

In a fibrous enthesis, the collagenous tendon or ligament directly attaches to the bone.

In a fibrocartilaginous enthesis, the interface presents a gradient that crosses four transition zones: [4]

  1. Tendinous area displaying longitudinally oriented fibroblasts and a parallel arrangement of collagen fibres
  2. Fibrocartilaginous region of variable thickness where the structure of the cells changes to chondrocytes
  3. Abrupt transition from cartilaginous to calcified fibrocartilage—often called 'tidemark' or 'blue line'
  4. Bone

Clinical significance

A disease of the entheses is known as an enthesopathy or enthesitis . [5]

Enthetic degeneration is characteristic of spondyloarthropathy and other pathologies.

The enthesis is the primary site of disease in ankylosing spondylitis.

Society and culture

Bioarchaeology

Entheses are widely recorded in the field of bioarchaeology, in which the presence of anomalies at these sites, called entheseal changes, has been used to infer repetitive loading to study the division of labour in past populations. [6] Several different recording methods have been proposed to record the variety of changes seen at these sites. [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] Previous studies have shown that, whichever recording method is used, certain entheseal changes occur more frequently in older individuals. [18] [8] [19] [20] [21] Moreover, research demonstrates that diseases, such as ankylosing spondylitis and calcific tendinitis, [22] also have to be taken into consideration. Nevertheless, experimental studies relying on virtual anthropological methods of analysis (e.g.,"Validated Entheses-based Reconstruction of Activity" 1.0 and 2.0 [15] [16] [23] ) have demonstrated how loading history (physical activity) can increase the relative three-dimensional (3D) size of muscle attachment sites [24] [25] [26] [27] and their subtle surface changes. [16]

History

"Enthesis" is rooted in the Ancient Greek word, "ἔνθεσις" or "énthesis," meaning “putting in," or "insertion." This refers to the role of the enthesis as the site of attachment of bones with tendons or ligaments. Relatedly, in muscle terminology, the insertion is the site of attachment at the end with predominant movement or action (opposite of the origin). Thus the words (enthesis and insertion [of muscle]) are proximal in the semantic field, but insertion in reference to muscle can refer to any relevant aspect of the site (i.e., the attachment per se, the bone, the tendon, or the entire area), whereas enthesis refers to the attachment per se and to ligamentous attachments as well as tendinous ones.

See also

References

  1. ↑ "enthesis". Medcyclopaedia. GE. Archived from the original on 2012-02-05.
  2. ↑ Thomopoulos S, Birman V, Genin G, eds. (2012). Structural Interfaces and Attachments in Biology. New York: Springer. ISBN   9781461433163.
  3. ↑ Rothrauff BB, Tuan RS (January 2014). "Cellular therapy in bone-tendon interface regeneration". Organogenesis. 10 (1): 13–28. doi:10.4161/org.27404. PMC   4049890 . PMID   24326955.
  4. ↑ Genin GM, Thomopoulos S (May 2017). "The tendon-to-bone attachment: Unification through disarray". Nature Materials. 16 (6): 607–608. Bibcode:2017NatMa..16..607G. doi:10.1038/nmat4906. PMC   5575797 . PMID   28541313.
  5. ↑ Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S (April 2006). "Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load". Journal of Anatomy. 208 (4): 471–490. doi:10.1111/j.1469-7580.2006.00540.x. PMC   2100202 . PMID   16637873.
  6. ↑ Jurmain R, Cardoso FA, Henderson C, Villotte S (2011-01-01). Grauer AL (ed.). A Companion to Paleopathology. Wiley-Blackwell. pp. 531–552. doi:10.1002/9781444345940.ch29. ISBN   9781444345940.
  7. ↑ Hawkey DE, Merbs CF (1995-12-01). "Activity-induced musculoskeletal stress markers (MSM) and subsistence strategy changes among ancient Hudson Bay Eskimos". International Journal of Osteoarchaeology. 5 (4): 324–338. doi:10.1002/oa.1390050403. ISSN   1099-1212.
  8. 1 2 Henderson CY, Mariotti V, Pany-Kucera D, Villotte S, Wilczak C (2013-03-01). "Recording Specific Entheseal Changes of Fibrocartilaginous Entheses: Initial Tests Using the Coimbra Method". International Journal of Osteoarchaeology. 23 (2): 152–162. doi:10.1002/oa.2287. hdl: 10316/44423 . ISSN   1099-1212. S2CID   145571511.
  9. ↑ Henderson CY, Mariotti V, Pany-Kucera D, Villotte S, Wilczak C (2016-09-01). "The New 'Coimbra Method': A Biologically Appropriate Method for Recording Specific Features of Fibrocartilaginous Entheseal Changes" (PDF). International Journal of Osteoarchaeology. 26 (5): 925–932. doi:10.1002/oa.2477. hdl: 10316/44421 . ISSN   1099-1212.
  10. ↑ Mariotti V, Facchini F, Belcastro MG (June 2004). "Enthesopathies--proposal of a standardized scoring method and applications". Collegium Antropologicum. 28 (1): 145–159. PMID   15636072.
  11. ↑ Mariotti V, Facchini F, Giovanna Belcastro M (March 2007). "The study of entheses: proposal of a standardised scoring method for twenty-three entheses of the postcranial skeleton". Collegium Antropologicum. 31 (1): 291–313. PMID   17598416.
  12. ↑ Villotte S. "Practical protocol for scoring the appearance of some fibrocartilaginous entheses on the human skeleton".
  13. ↑ Villotte S, Castex D, Couallier V, Dutour O, Knüsel CJ, Henry-Gambier D (June 2010). "Enthesopathies as occupational stress markers: evidence from the upper limb". American Journal of Physical Anthropology. 142 (2): 224–234. doi:10.1002/ajpa.21217. PMID   20034011.
  14. ↑ Villotte S, Assis S, Cardoso FA, Henderson CY, Mariotti V, Milella M, et al. (June 2016). "In search of consensus: Terminology for entheseal changes (EC)" (PDF). International Journal of Paleopathology. 13: 49–55. Bibcode:2016IJPal..13...49V. doi:10.1016/j.ijpp.2016.01.003. hdl:10316/44443. PMID   29539508. S2CID   3902457.
  15. 1 2 Karakostis, Fotios Alexandros; Lorenzo, Carlos (2016). "Morphometric patterns among the 3D surface areas of human hand entheses" . American Journal of Biological Anthropology. 160 (4): 694–707. doi:10.1002/ajpa.22999. PMID   27166777.
  16. 1 2 3 Karakostis, Fotios Alexandros (2025-04-16). "Introducing "Validated entheses-Based reconstruction of activity 2.0" (VERA 2.0): Semi-automated 3D analysis of bone surface changes". PLOS ONE. 20 (4): e0321479. Bibcode:2025PLoSO..2021479K. doi: 10.1371/journal.pone.0321479 . ISSN   1932-6203. PMC   12002543 . PMID   40238840.
  17. ↑ Karakostis, Fotios Alexandros; Hotz, Gerhard; Scherf, Heike; Wahl, Joachim; Harvati, Katerina (May 2018). "A repeatable geometric morphometric approach to the analysis of hand entheseal three-dimensional form" . American Journal of Physical Anthropology. 166 (1): 246–260. doi:10.1002/ajpa.23421. ISSN   0002-9483. PMID   29399778.
  18. ↑ Cardoso FA, Henderson C (2013-03-01). "The Categorisation of Occupation in Identified Skeletal Collections: A Source of Bias?". International Journal of Osteoarchaeology. 23 (2): 186–196. doi:10.1002/oa.2285. hdl: 10316/21142 . ISSN   1099-1212.
  19. ↑ Michopoulou E, Nikita E, Valakos ED (December 2015). "Evaluating the efficiency of different recording protocols for entheseal changes in regards to expressing activity patterns using archival data and cross-sectional geometric properties". American Journal of Physical Anthropology. 158 (4): 557–568. doi: 10.1002/ajpa.22822 . PMID   26239396.
  20. ↑ Milella M, Giovanna Belcastro M, Zollikofer CP, Mariotti V (July 2012). "The effect of age, sex, and physical activity on entheseal morphology in a contemporary Italian skeletal collection". American Journal of Physical Anthropology. 148 (3): 379–388. doi:10.1002/ajpa.22060. PMID   22460619.
  21. ↑ Henderson CY, Mariotti V, Santos F, Villotte S, Wilczak CA (2017-06-20). "The new Coimbra method for recording entheseal changes and the effect of age-at-death". BMSAP. 29 (3–4): 140–149. doi:10.1007/s13219-017-0185-x. hdl: 10316/44430 . ISSN   0037-8984. S2CID   29420179.
  22. ↑ Henderson CY (March 2013). "Do diseases cause entheseal changes at fibrous entheses?". International Journal of Paleopathology. 3 (1): 64–69. Bibcode:2013IJPal...3...64H. doi:10.1016/j.ijpp.2013.03.007. hdl: 10316/44415 . PMID   29539362. S2CID   3916560.
  23. ↑ Karakostis, Fotios Alexandros (May 2023). "Statistical protocol for analyzing 3D muscle attachment sites based on the "Validated Entheses-based Reconstruction of Activity" (VERA) approach". International Journal of Osteoarchaeology. 33 (3): 461–474. doi: 10.1002/oa.3196 . ISSN   1047-482X.
  24. ↑ Karakostis FA, Jeffery N, Harvati K (November 2019). "Experimental proof that multivariate patterns among muscle attachments (entheses) can reflect repetitive muscle use". Scientific Reports. 9 (1) 16577. Bibcode:2019NatSR...916577K. doi:10.1038/s41598-019-53021-8. PMC   6851080 . PMID   31719626.
  25. ↑ Karakostis FA, Wallace IJ, Konow N, Harvati K (December 2019). "Experimental evidence that physical activity affects the multivariate associations among muscle attachments (entheses)". The Journal of Experimental Biology. 222 (Pt 23): jeb213058. doi:10.1242/jeb.213058. PMC   6918778 . PMID   31712353.
  26. ↑ Castro AA, Karakostis FA, Copes LE, McClendon HE, Trivedi AP, Schwartz NE, Garland T (February 2022). "Effects of selective breeding for voluntary exercise, chronic exercise, and their interaction on muscle attachment site morphology in house mice". Journal of Anatomy. 240 (2): 279–295. doi:10.1111/joa.13547. PMC   8742976 . PMID   34519035.
  27. ↑ Karakostis, Fotios Alexandros; Wallace, Ian J. (2023-01-31). "Climbing influences entheseal morphology in the humerus of mice: An experimental application of the VERA methodology". American Journal of Biological Anthropology. 181: 130–139. doi: 10.1002/ajpa.24700 . ISSN   2692-7691. S2CID   256486347.

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