The human muscle-tendon junction. A morphological study during normal growth and at maturity

A Comprehensive Review of Muscle-Tendon Junction: Structure, Function, Injury and Repair

The muscle-tendon junction (MTJ) is a highly specific tissue interface where the muscle's fascia intersects with the extracellular matrix of the tendon. The MTJ functions as the particular structure facilitating the transmission of force from contractive muscle fibers to the skeletal system, enabling movement. Considering that the MTJ is continuously exposed to constant mechanical forces during physical activity, it is susceptible to injuries. Ruptures at the MTJ often accompany damage to both tendon and muscle tissues. In this review, we attempt to provide a precise definition of the MTJ, describe its subtle structure in detail, and introduce therapeutic approaches related to MTJ tissue engineering. We hope that our detailed illustration of the MTJ and summary of the representative research achievements will help researchers gain a deeper understanding of the MTJ and inspire fresh insights and breakthroughs for future research.

Design and bioprinting for tissue interfaces

Tissue interfaces include complex gradient structures formed by transitioning of biochemical and mechanical properties in micro-scale. This characteristic allows the communication and synchronistic functioning of two adjacent but distinct tissues. It is particularly challenging to restore the function of these complex structures by transplantation of scaffolds exclusively produced by conventional tissue engineering methods. Three-dimensional (3D) bioprinting technology has opened an unprecedented approach for precise and graded patterning of chemical, biological and mechanical cues in a single construct mimicking natural tissue interfaces. This paper reviews and highlights biochemical and biomechanical design for 3D bioprinting of various tissue interfaces, including cartilage-bone, muscle-tendon, tendon/ligament-bone, skin, and neuro-vascular/muscular interfaces. Future directions and translational challenges are also provided at the end of the paper.

Effects of mutant lamins on nucleo-cytoskeletal coupling in Drosophila models of LMNA muscular dystrophy

The nuclei of multinucleated skeletal muscles experience substantial external force during development and muscle contraction. Protection from such forces is partly provided by lamins, intermediate filaments that form a scaffold lining the inner nuclear membrane. Lamins play a myriad of roles, including maintenance of nuclear shape and stability, mediation of nuclear mechanoresponses, and nucleo-cytoskeletal coupling. Herein, we investigate how disease-causing mutant lamins alter myonuclear properties in response to mechanical force. This was accomplished via a novel application of a micropipette harpooning assay applied to larval body wall muscles of Drosophila models of lamin-associated muscular dystrophy. The assay enables the measurement of both nuclear deformability and intracellular force transmission between the cytoskeleton and nuclear interior in intact muscle fibers. Our studies revealed that specific mutant lamins increase nuclear deformability while other mutant lamins cause nucleo-cytoskeletal coupling defects, which were associated with loss of microtubular nuclear caging. We found that microtubule caging of the nucleus depended on Msp300, a KASH domain protein that is a component of the linker of nucleoskeleton and cytoskeleton (LINC) complex. Taken together, these findings identified residues in lamins required for connecting the nucleus to the cytoskeleton and suggest that not all muscle disease-causing mutant lamins produce similar defects in subcellular mechanics.

The Influence of Growth, Maturation and Resistance Training on Muscle-Tendon and Neuromuscular Adaptations: A Narrative Review

The purpose of this article is to provide an overview of the growth, maturation and resistance training-related changes in muscle-tendon and neuromuscular mechanisms in youth, and the subsequent effect on performance. Sprinting, jumping, kicking, and throwing are common movements in sport that have been shown to develop naturally with age, with improvements in performance being attributed to growth and maturity-related changes in neuromuscular mechanisms. These changes include moderate to very large increases in muscle physiological cross-sectional area (CSA), muscle volume and thickness, tendon CSA and stiffness, fascicle length, muscle activation, pre-activation, stretch reflex control accompanied by large reductions in electro-mechanical delay and co-contraction. Furthermore, a limited number of training studies examining neuromuscular changes following four to 20 weeks of resistance training have reported trivial to moderate differences in tendon stiffness, muscle CSA, muscle thickness, and motor unit activation accompanied by reductions in electromechanical delay (EMD) in pre-pubertal children. However, the interaction of maturity- and training-related neuromuscular adaptions remains unclear. An understanding of how different neuromuscular mechanisms adapt in response to growth, maturation and training is important in order to optimise training responsiveness in youth populations. Additionally, the impact that these muscle-tendon and neuromuscular changes have on force producing capabilities underpinning performance is unclear.

In the human, true myocutaneous junctions of skeletal muscle fibers are limited to the face

Within the panniculus carnosus‐associated skeletal muscles in the human, the palmaris brevis and the platysma showed myotendinous/myofascial junctions with clear distance to the corium and the specific connection collagen type XXII. The orbicularis oris muscle, in contrast, contained bundles of striated muscle fibers reaching the corium at two distinct levels: the predominant inner ending was connected to the elastic network of the inner corium and the outer ending was within the more superficial collagen network. At both locations, the striated muscle fibers showed brush‐like cytoplasmic protrusions connecting a network which was not oriented toward the muscle fibers. Collagen type XXII was not present.

The Influence of Growth and Maturation on Stretch-Shortening Cycle Function in Youth

Hopping, skipping, jumping and sprinting are common tasks in both active play and competitive sports. These movements utilise the stretch-shortening cycle (SSC), which is considered a naturally occurring muscle action for most forms of human locomotion. This muscle action results in more efficient movements and helps optimise relative force generated per motor unit recruited. Innate SSC development throughout childhood and adolescence enables children to increase power (jump higher and sprint faster) as they mature. Despite these improvements in physical performance, the underpinning mechanisms of SSC development during maturational years remain unclear. To the best of our knowledge, a comprehensive review of the potential structural and neuromuscular adaptations that underpin the SSC muscle action does not exist in the literature. Considering the importance of the SSC in human movement, it is imperative to understand how neural and structural adaptations throughout growth and maturation can influence this key muscle action. By understanding the factors that underpin functional SSC development, practitioners and clinicians will possess a better understanding of normal development processes, which will help differentiate between training-induced adaptations and those changes that occur naturally due to growth and maturation. Therefore, the focus of this article is to identify the potential underpinning mechanisms that drive development of SSC muscle action and to examine how SSC function is influenced by growth and maturation.

Structural remodeling of unweighted soleus myotendinous junction in monkey

This study describes the morphology of the soleus myotendinous junction (MTJ) in the Rhesus monkey. Ultrastructural observations revealed a structural complexity that probably reflects functional adaptations. We also studied ultrastructural modifications of the MTJ in response to 14 days of hypokinesia and microgravity (Bion 11 mission). The reduced limb mobility of the animals, placed in a safety seat aboard the satellite, induced a sarcolemmal remodeling that was enhanced by the microgravity conditions. Signs of MTJ remodeling such as alterations of contractile apparatus and myofilament-anchoring structures, T-tubule dilation, and autophagic vacuoles could be ascribed to the microgravity.

Anatomie und Verhalten von Sehnen und Bändern

Tendons and ligaments are mainly composed of type I collagen fibers surrounded by a mesh of loose connective tissue. The whole tendon transmits forces from muscle to bone. However, it also shows viscoelastic behavior such as creep or stress relaxation. Tendons respond dynamically to physical activity. Release of neurotransmitters and growth factors, as well as cell communication between tenocytes by gap junctions, initiate a cascade of transcriptions and metabolic alterations leading to enhanced activity of synthetic and degrading enzymes to ensure optimal functional adaptation of extracellular tissue. Tendons and ligaments vary greatly in shape, length, and composition. Especially where they are subject to compression, they are fibrocartilaginous. Loss of vasculature may explain the high incidence of pathological alterations in these areas. The aging tendon is characterized by a reduced ability to adapt to force transmission. Inactivity markedly decreases collagen turnover soon leading to reduced stress resistance. Counteracting these phenomena requires a full understanding of the physiological processes during mechanical loading.

Is the histomorphological concept of the female pelvic floor and its changes due to age and vaginal delivery correct?

AIMS

To compare the histomorphology of pelvic floor specimens of 94 female cadavers, ten male cadavers, and 24 female symptomatic patients who underwent pelvic floor surgery, and to evaluate the association of age, parity, and sex to myogenic and/or neurogenic changes to the levator ani muscle (LAM).

METHODS

The pelvic floor was biopsied at the pubococcygeus, the iliococcygeus and the coccygeus muscle. After staining, signs for myogenic/neurogenic changes to the muscle were evaluated (fibrosis, variation in fiber diameter, centralization of nuclei, small angulated fibers, and type grouping). To identify the intact neuromuscular junction stainings with NCAM (neuronal cell adhesion molecule) and acetylcholinesterase (ACE) were used.

RESULTS

A significant influence of age and parity on the histomorphological criteria of myogenic cell-damage was shown in this study. Although these criteria were found even in young nulliparous women, there was a significant increase in older or parous women with at least one vaginal delivery. We failed to demonstrate significant changes between the nulliparous LAM, the male LAM, and the LAM from women with prolapse and incontinence. None of the specimen showed any obvious evidence of neuropathy.

CONCLUSIONS

We have evaluated histological criteria adapted from the examination of limb muscles in the LAM of nulliparous young women. "Myogenic changes" seem to be a normal finding in the LAM. The increase of these changes with aging and parity points to mechanical stress to the LAM as the most plausible causative factor. We propose that further studies using histomorphological techniques of the pelvic floor muscle in nulliparous and parous women should clarify the potential role of our histological findings.

Characterization of Fxr1 in Danio rerio; a simple vertebrate model to study costamere development

The X-linked FMR1 gene, which is involved in the fragile X syndrome, forms a small gene family with its two autosomal homologs, FXR1 and FXR2. Mouse models for the FXR genes have been generated and proved to be valuable in elucidating the function of these genes, particularly in adult mice. Unfortunately, Fxr1 knockout mice die shortly after birth, necessitating an animal model that allows the study of the role of Fxr1p, the gene product of Fxr1, in early embryonic development. For gene function studies during early embryonic development the use of zebrafish as a model organism is highly advantageous. In this paper the suitability of the zebrafish as a model organism to study Fxr1p function during early development is explored. As a first step, we present here the initial characterization of Fxr1p in zebrafish. Fxr1p is present in all the cells from zebrafish embryos from the 2/4-cell stage onward; however, during late development a more tissue-specific distribution is found, with the highest expression in developing muscle. In adult zebrafish, Fxr1p is localized at the myoseptum and in costamere-like granules in skeletal muscle. In the testis, Fxr1p is localized in immature spermatogenic cells and in brain tissue Fxr1p displays a predominantly nuclear staining in neurons throughout the brain. Finally, the different tissue-specific isoforms of Fxr1p are characterized. Since the functional domains and the expression pattern of Fxr1p in zebrafish are comparable to those in higher vertebrates such as mouse and human, we conclude that the zebrafish is a highly suitable model for functional studies of Fxr1p.

Compartmental fasciotomy and isolating a muscle from neighboring muscles interfere with myofascial force transmission within the rat anterior crural compartment

Muscles within the anterior crural compartment (extensor digitorum longus, EDL; tibialis anterior, TA; and extensor hallucis longus, EHL) and within the peroneal compartment were excited simultaneously and maximally. All muscles were kept at constant length with the exception of EDL, for which muscle length was changed by moving its proximal tendon. Active and passive force was measured at proximal as well as distal EDL tendons and at the combined distal tendons of TA and EHL (TA+EHL). In the initial experimental condition, a difference (F(proximal) > F(distal)) in EDL force, amounting to 0-14% of proximal force, was confirmed for most EDL lengths. This is interpreted as a clear proof of extramuscular myofascial force transmission, as no significant EDL length effects could be shown on TA+EHL force. Repeated measurements were confirmed to cause marked changes of both proximal and distal length-force characteristics, such as a shift of the whole ascending limb of the active curve, including optimum length, to higher lengths without decreasing optimum force, and decreasing active force at low lengths (by approximately 57%). Repeated measurements also lowered proximal and distal EDL passive force (by up to 35%). The proximo-distal difference in passive as well as active EDL force was decreased, but persisted. At most lengths, this difference for active force amounted to a constant fraction (14%) of proximal force. TA+EHL force was not affected significantly. Subsequently, acute effects of experimental surgical alterations were studied: The first manipulation was full lateral fasciotomy of the anterior crural compartment that caused a further decrease in active force at the proximal EDL but not at the distal EDL tendon. Passive forces showed no further significant changes. The proximo-distal EDL active force difference decreased to 0-5% of proximal force. After fasciotomy, TA+EHL force increased by 30%. This was interpreted as evidence of increased intramuscular and decreased extramuscular myofascial force transmission. The second manipulation was full isolation of EDL from TA+EHL, but not from extramuscular connective tissues, which caused a further decrease of the EDL proximo-distal force differences, indicating a stiffening effect of the presence of TA+EHL on the extramuscular matrix. For EDL active force the difference was no longer significantly different from zero. In contrast, for EDL passive force the proximo-distal force difference persisted. It is concluded that extramuscular myofascial force transmission is an important feature of the anterior crural compartment. The magnitude of this force transmission requires that it be considered in analysis of muscular function.

The cell and developmental biology of tendons and ligaments

We have sought to create, for the first time in a single comprehensive review, a modern synthesis of opinion on the cell, developmental, and molecular biology of tendons, ligaments, and their associated structures (tendon sheaths, vinculi, and retinacula). Particular attention has been paid to highlighting new data on the early development of tendons, the signaling molecules involved in their patterning, and the diversity of specialized regions (entheses, wrap-around regions, and myotendinous junctions) that characterize fully formed tendons and ligaments. We have emphasized the complexities of adult tendon and ligament cell shape and related these to their early development. The importance of gap junctions in allowing cell communication throughout an extensive extracellular matrix (ECM) has also been highlighted, particularly in relation to understanding how tendon and ligament cells respond to changes in mechanical load. Finally, we have considered the influence of growth factors and related molecules on cell proliferation and ECM synthesis.

Activity-induced fiber regeneration in rat soleus muscle

In an attempt to understand why muscle recovery is limited following atrophy due to limb immobilization, satellite cell activity and muscle fiber regeneration were analyzed in rat soleus muscles. Adult rat hindlimbs were immobilized in plaster casts for a period of two to ten weeks. Soleus muscles were examined by electron microscopy for evidence of fiber degeneration or regeneration, and to quantify satellite cell nuclei. Immunocytochemical localization of embryonic myosin was used to identify regenerating myofibers. Soleus muscle wet weight to body weight ratios for the casted muscles significantly decreased over the 10-week immobilization period. The casted muscles displayed ultrastructural evidence of minor fiber damage, including myofibrillar atrophy, Z-disc disruption, and abnormal triadic junctions. No ultrastructural evidence of regeneration was seen in the casted animals. The number of satellite cells in the casted muscles significantly decreased from 6.4% to 3. 3% by eight to 10 weeks of immobilization. Approximately 1.0% of extrafusal fibers in the control soleus muscles appeared to be regenerating since they expressed embryonic myosin and were of a small diameter, while in casted muscles, only 0.1% of the fibers were embryonic myosin-positive. Following release from immobilization, a reappearance of embryonic myosin-positive fibers was noted within four days of renewed activity. In contrast to control muscles, embryonic myosin-positive fibers in the recovery muscles included both small and large diameter fibers. Subtle changes in functional activity influence muscle damage and subsequent myofiber regeneration. Reduced activity reduces muscle fiber regeneration, while increased activity, as seen by increased hindlimb weight bearing and return to normal activity following immobilization, increase regenerating fibers and also the expression of embryonic myosin in adult fibers.

Respective effects of hindlimb suspension, confinement and spaceflight on myotendinous junction ultrastructure

This study compares the effects of 14-day confinement and spaceflight with the respective effects of 8, 18 and 29-day hindlimb suspension on rat soleus and plantaris MTJ ultrastructure. Independently of the experimental situation, greater morphological changes were observed in the soleus as compared to the plantaris MTJ. 18 days of suspension and 14 days of confinement resulted in ultrastructural modifications of the digit-like processes in the soleus MTJ. Additional changes were observed in the myofibrils, microtendon and tendon after 29 days of suspension and 4 days of spaceflight. These results emphasize the influence of the intensity and duration of the muscle loading on the MTJ ultrastructure.

Basal lamina development in chicken muscle spindles

The development of basal laminas was examined in immunohistochemical sections of chicken leg muscle spindles from embryonic day (E) 13 to 8 weeks postnatal. Fragments of basal laminas as seen with immunostaining for isoforms of laminin were already observed in E6 muscles. When clusters of intrafusal myotubes were first recognized at E13-14, they were surrounded by basal laminas which were incomplete both in terms of coverage and molecular composition. More mature basal lamina tubes individually enclosed young myofibers at E18. After afferents made contact with myotubes, synaptic portions of basal laminas at myosensory junctions reacted strongly with antibodies against s-laminin and chondroitin sulfate proteoglycan, while extrasynaptic portions were negative or reacted only weakly. At synaptic basal laminas of neuromuscular junctions heparin sulfate proteoglycan and s-laminin became prominent after E16. Contrary to the early presence of basal lamina proteins around intrafusal fibers, initial deposition of basal lamina proteins in the outer spindle capsule was not recognized until E17-18, and significant amounts were not detected until postnatal week 1. Unlike intrafusal basal laminas, capsular basal laminas developed no distinct specialized regions; however, molecular compositions of intrafusal and capsular basal laminas were similar.

Structure and protein composition of sites of papillary muscle attachment to chordae tendineae in avian hearts

Most cardiac myocytes transmit force across fasciae adherentes, specialized sites of cell-cell adhesion. However, some cardiac myocytes in papillary muscle terminate on collagenous connective tissue in the chordae tendineae. These papillary myotendinous junctions (MTJs) are specialized for force transmission from myocytes to extracellular matrix. In the present study, we compared structural molecules at papillary MTJs to those at fasciae adherentes and skeletal MTJs. By using indirect immunofluorescence, we found that papillary MTJs more closely resemble skeletal MTJs in their molecular composition in that they are enriched in talin, vinculin, integrin, and fibronectin. Zeugmatin and alpha-actinin, both components of fasciae adherentes, are absent from papillary MTJs. Although papillary MTJs and skeletal MTJs display strong similarities in structural protein composition, ultrastructural organization of the two junctions is different. Papillary MTJs display little folding of the junctional membrane and, according to morphological criteria, more closely resemble sites of thin filament-membrane association in smooth muscle than skeletal MTJs. Thus, papillary MTJs display a combination of structural characteristics described previously in skeletal and smooth muscles but exhibit few structural features observed previously in cardiac fasciae adherentes.

Dystrophic changes in mdx muscle regenerating from denervation and devascularization

The regenerative capacity of young mdx muscle after a denervating and devascularizing injury (DD) was examined in extensor digitorum longus (EDL) and compared with that of age-matched control mouse EDL. DD of the right EDL was produced at the age approximating the onset of dystrophy in the mdx model, and mice recovered for 2 weeks. Contralateral unoperated EDLs from mdx and control mice served as internal controls for histopathology, myofiber cross-sectional area (CSA), and ultrastructure of fiber regeneration in DD-EDL. Mdx DD-EDL were composed of small, uniformly mature myofibers with mostly peripheral nuclei. This contrasted with control DD-EDL in which fibers were centrally nucleated. In addition, the unoperated mdx EDL exhibited the central nucleation of spontaneous recovery from dystrophy. The CSA distribution of mdx DD-EDL myofibers was significantly shifted toward smaller CSA compared with unoperated mdx EDL, although mean CSA did not differ between the two mdx muscle groups. The CSA distribution of control DD-EDL was significantly different and shifted toward smaller CSA from both unoperated control EDL and from mdx DD-EDL distributions. Ultrastructural features of dystrophy were present in both mdx DD-EDL and in the unoperated mdx EDL, although they appeared more prevalent in the latter. These results suggest that short-term plasticity of mdx muscle recovery from imposed injury may be greater than that of normal muscle in establishing a regenerating fiber population.

In vitro attachment of skeletal muscle fibers to a collagen gel duplicates the structure of the myotendinous junction

The myotendinous junction (MTJ) and its associated cells and connective tissue are important structures involved in transmission of contractile force from skeletal muscle to tendon. A model culture system was developed to investigate the formation of the MTJ and its attachment to collagen fibers. Skeletal muscle cells were cultured in a well modeled from two layers of a native gel of type I collagen. Muscle cells cultured in this manner formed attachments to the collagen gel and developed into highly contractile multinucleated muscle fibers with the development of extensive terminal invaginations of the sarcolemma. In addition, the subsarcolemma at the ends of muscle fibers showed areas of increased electron density which corresponded well with the termini of myofibrils. The results indicate that the development of sarcolemmal invaginations at the end of a muscle fiber probably occurs intrinsically during muscle development in vivo. The direct association of collagen fibers with the basal lamina at the end of muscle fibers was only occasionally observed in culture, suggesting that other fibrils or proteins may also be involved in the attachment of collagen fibers to the basal lamina of muscle fibers at the MTJ.

Connective-tissue macromolecules in Golgi chicken tendon organs and at their interface with muscle fibers and adjoining tendinous structures

Tendon organs from leg and forearm muscles of white leghorn chickens were examined with a library of monoclonal antibodies to determine the composition of their connective-tissue framework and the types of connective-tissue macromolecules that occur at the sites where muscle fibers attach to the receptors. The capsules of the tendon organs were positive for connective-tissue macromolecules typical of basal lamina (collagen type IV, laminin, and heparin sulfate proteoglycan) and for tenascin, collagen types III and VI, and fibronectin. Connective-tissue bundles in the lumen of a receptor reacted primarily with antibodies against collagen type I and 4-chondroitin sulfate. The narrow partitions that divide each lumen into compartments stained for collagen type III. Toward its tendinous end, a receptor made few contacts with muscle fibers. Instead, the capsule and the collagenous bundles blended gradually with the intermuscular portions of tendons. At the muscular end, the connections were more complex. Muscle fibers that attached in series to tendon organs split to produce basal lamina-covered, finger-like extensions, which were separated from each other by fissures. Tongues of connective tissue containing tenascin, collagen types I and VI, and fibronectin extended into the fissures. Distally the tongues were continuous with the tenascin in the capsule and just internal to the capsule, fibronectin and basal lamina macromolecules in the capsule, and collagen type I in the collagenous bundles. The uninterrupted presence of these macromolecules around terminating muscle fibers and in the capsule and/or the intraluminal collagen bundles suggests that muscle fibers that attach in series at the muscular end exert a force during muscular contraction on the intraluminal collagen bundles and on the receptor capsule.