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Congratulations on the Acceptance!
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
No comment.
No comment.
No comment.
Please address the final minor revisions requested by Reviewer 2
Language is now clear, in adequate English, but I still notice some issues:
- Now that images showing the ORIF technique were provided, it is clear that when the authors use the term "hollow nail" they are actually referring to cannulated screws. Please correct. On that same note, in the title, the term "intramedullary nail" seems very inadequate.
- Some minor issues with the use of articles when not needed (e.g. "the knee function", "the postoperative functional recovery"). Also:
Line 111: "positive outcome on the posterior knee drawer test" -> positive posterior knee drawer test.
Line 170: "joint strangulation"-> joint restraining
Line 295: after you state several limitations of ORIF, you say "consequently" you have consistent outcomes. Please correct.
Finally, the authors seem to have not made the previously suggested corrections in the abstract, only in the body of the article.
- In Materials and Methods, itens 1 and 2 in exclusion criteria don't need to be mentioned, since they have already been left out because of the inclusion criteria (you exclude from what's been included).
- Also in Materials and Methods, throughout the whole section, the present tense was used (e.g. "Both patient groups engage in knee function exercises"). Please change to past tense.
- In Discussion, you only describe Meyers and McKeever types I to III, leaving out type IV (which you mentioned earlier in Materials and Methods.
- Tables 2 and 3 still seem innacurate. Both have the same title ("Lysholm knee scoring indicators before and after surgery for the patients"), with different data. Seems to me each of them is showing indicators before and after for each one of the tecnhiques, so title would contain the tecnhique, and columns would be "before" and "after". But please clarify.
Considering the design, all the data and statistical analysis provided, and after corrections in the connection between the hypothesis, the experiment and the answers, the findings of the study seem valid and benefical to the literature.
Thanks to the authors for the study, which compares two important and useful techhniques in the treatment of PCL avulsion fractures in terms of clinical results, providing information to help knee trauma surgeons take management decisions in this scenario.
Good
Good
Good
Thank you for considering the suggestions. The manuscript has improved substantially: congratulations to the authors!
Please address the comments of the reviewers in a comprehensive revision
This manuscript is clear in terms of data, material, and language. Each section is well-organized and cohesive. The figures are of good quality. The rationale of the study is described with adequate information, but it would be beneficial to explain why you chose a nail over other implants. For in-text citations and reference style, please confirm and check the author guidelines.
The study design and methods are clearly defined, and the aim of the study is well explained. What is your strategy to prevent bias and ensure that the baseline data is homogeneous?
All data have been presented well.
a. Based on research by Qi H, Lu Y et al., a hook plate provides a better outcome than a hollow screw, as also noted by Deng W, Li Y, Wu S, et al. with the Locking Compression Hook Plate (LCHP). Why did you choose Intramedullary Nail Fixation over this technique? This is not discussed in the manuscript.
b. Provide the rationale for the chosen arthroscopic technique.
c. What about the Tight-Rope technique in arthroscopy?
d. The advantages and disadvantages of both ORIF and arthroscopic surgery should be explained in a separate table.
e. The running head should represent both treatment options.
f. It would be beneficial to include more figures of the arthroscopic view.
5. Confidential Notes to the Editor
In my opinion, this study is interesting and contributes valuable insights into treatment options for PCLTAF. I recommend accepting this retrospective study with minor revisions.
- I suggest the English language is reviewed, as the phrasing used sometimes in the text makes comprehension difficult. Some examples include lines 104-105, 124, 125, 128, 154, 184, 190-191, 198-199 and 243-244.
- In the Introduction, regarding the risks and benefits of both ORIF and arthroscopy, the risk of damage to neurovascular structures is mentioned for ORIF, but not for arthroscopy. This risk is worth mentioning, and neglecting to do so might convey the idea that it is not present in the arthroscopic technique. See: James et al (J Knee Surg. 2021;34(06), 587–591. doi:10.1055/s-0041-1723016).
Also, lines 71-72 and 81-82 repeat the same information.
- In Methods, there were no figures depicting the ORIF technique. It would be interesting to add images, in order to help the reader understand the method (as was done for the arthroscopy technique). For instance, when you mention "hollow nails", it's not clear what device exactly you are referring to (cannulated screws? In that case, I suggest reviewing the term). Illustrations would help clarify that.
In the description of the operative technique for the ORIF, you mention a "modified medial approach", without further detail (vertical incision? Inverted L-shaped incision?). Considering the lack of illustrations, it can become confusing for the reader.
- In Results, there seems to be a mistake with Tables 2 and 3. Their titles indicate they compare results before and after surgery for each technique separately (Table 2 for arthroscopic group, Table 3 for ORIF group), but both tables show columns named "Arthroscopy group" and "ORIF group".
Also in Results, you mention VAS score, although it wasn't at all mentioned as one of the parameters to be assessed in Methods.
- As minor details: in Table 1, waiting time before surgery should have its time unit (days) specified. Also, Lysholm score parameters should be identified as such.
The objective of the study was defined as follows: "This study aimed to compare the clinical outcomes of arthroscopic fixation and ORIF(...)". This is a little too broad, and it might be better to specify what clinical outcomes are being assessed (VAS, Lysholm).
- In the Conclusion, you state the arthroscopic technique has "the potential to significantly expedite fracture healing rates in PCLTAF patients". That was never a part of your original question, nor it was shown in Results.
You also state the arthroscopic technique "exhibits a certain level of safety when applied to adolescents", but then again, this was never mentioned in your research question nor tested/supported by your results.
The article shows an interesting retrospective comparison between two PCL reconstruction techniques, with an adequate experimental design.
On the other hand, there seems to be some confusion in the connection between the researchers' objectives, results, and conclusions.
Those should be addressed, along with the other inconsistencies, before publication.
Review
Many thanks to the authors for having presented a so interesting original article about “A retrospective study: Clinical Outcomes of Arthroscopic Suture Fixation Combined with Loop Plate vs. Posterior Approach Open Reduction and Intramedullary Nail Fixation for Treating Tibial Avulsion Fractures of the Posterior Cruciate Ligament”.
Before resubmitting the revision version of the article, please read the editorial rules carefully, and check other editorial aspects, such as text justification at the head (lacking), etc. The language is no good, hence the manuscript needs to be corrected by a person of English mother tongue.
Title and Abstract
The title and abstract cover the main aspect of the work.
The abstract is well structured, and it contains the main information of the study.
Key words
Please provide them in alphabetic order.
Please add some words like knee injury, knee instability.
Background
The introduction clearly identifies the problem addressed in the manuscript and how the most optimal surgical strategy remains a subject of debate.
This section is well structured and well written.
Please improve this section by explaining the different surgical approaches to achieve secure fixation of the avulsed fragment.
Methods
This section contains enough information to understand and possibly repeat the study.
The distribution in age is too wide, the two groups are too different in size and there is no itemized the distribution of the different types of fracture according to Meyers and McKeever classification.
This should be reported as limitation of the study.
In this section, inclusion and exclusion criteria are indicated and well explained.
It is also indicated who approved the study, the setting and the relevant dates, and all the main scoring system the authors refer to in the paper.
All the information is structured into different sub-paragraphs, which is quite convenient to search data among the paper.
However, it does not reflect the Strobe Statement-Checklist for cohort studies as it does not mention any bias or possible potential confounders. Please, rewrite this section.
Statistical analysis
The statistical analysis is appropriate to the research. It is described the software and the parameters calculation, but not who performed the analysis.
Please provide this information: an independent statistician or the same authors?
Results
The results presented are quite complete, reflecting the MM section.
This section is structured in paragraphs so, it quite easy to read and every aspect is well illustrated.
The results are reproducible and reflective of clinical expectations.
Table 2 and 3 help to summarize and read all the results.
Discussion
This section analyzes quite thoroughly every aspect of the matter, but it is not very organized.
The length and content of the discussion communicates the main information of the paper. The discussion does not explain the results relative to prior publication for each aspect of the topic
The paper recognizes the limitations of the manuscript, these limitations are well illustrated; but there is no reference to how the research can continue in the future.
Conclusions
The conclusions only reflect and refer to the results of the study.
The conclusion provides a clear summary of the main points, but it is almost a list of conclusions rather than a wise illustration of the main conclusions of this study.
This section is quite outlined, but not developed in depth. Please improve this section and add some future possible development in the matter.
Review
Many thanks to the authors for having presented a so interesting original article about “A retrospective study: Clinical Outcomes of Arthroscopic Suture Fixation Combined with Loop Plate vs. Posterior Approach Open Reduction and Intramedullary Nail Fixation for Treating Tibial Avulsion Fractures of the Posterior Cruciate Ligament”.
Before resubmitting the revision version of the article, please read the editorial rules carefully, and check other editorial aspects, such as text justification at the head (lacking), etc. The language is no good, hence the manuscript needs to be corrected by a person of English mother tongue.
Title and Abstract
The title and abstract cover the main aspect of the work.
The abstract is well structured, and it contains the main information of the study.
Key words
Please provide them in alphabetic order.
Please add some words like knee injury, knee instability.
Background
The introduction clearly identifies the problem addressed in the manuscript and how the most optimal surgical strategy remains a subject of debate.
This section is well structured and well written.
Please improve this section by explaining the different surgical approaches to achieve secure fixation of the avulsed fragment.
Methods
This section contains enough information to understand and possibly repeat the study.
The distribution in age is too wide, the two groups are too different in size and there is no itemized the distribution of the different types of fracture according to Meyers and McKeever classification.
This should be reported as limitation of the study.
In this section, inclusion and exclusion criteria are indicated and well explained.
It is also indicated who approved the study, the setting and the relevant dates, and all the main scoring system the authors refer to in the paper.
All the information is structured into different sub-paragraphs, which is quite convenient to search data among the paper.
However, it does not reflect the Strobe Statement-Checklist for cohort studies as it does not mention any bias or possible potential confounders. Please, rewrite this section.
Statistical analysis
The statistical analysis is appropriate to the research. It is described the software and the parameters calculation, but not who performed the analysis.
Please provide this information: an independent statistician or the same authors?
Results
The results presented are quite complete, reflecting the MM section.
This section is structured in paragraphs so, it quite easy to read and every aspect is well illustrated.
The results are reproducible and reflective of clinical expectations.
Table 2 and 3 help to summarize and read all the results.
Discussion
This section analyzes quite thoroughly every aspect of the matter, but it is not very organized.
The length and content of the discussion communicates the main information of the paper. The discussion does not explain the results relative to prior publication for each aspect of the topic and should be integrated by other different experiences quoting:
• https://pubmed.ncbi.nlm.nih.gov/31755217/
• https://pubmed.ncbi.nlm.nih.gov/31821294/
The paper recognizes the limitations of the manuscript, these limitations are well illustrated; but there is no reference to how the research can continue in the future.
Conclusions
The conclusions only reflect and refer to the results of the study.
The conclusion provides a clear summary of the main points, but it is almost a list of conclusions rather than a wise illustration of the main conclusions of this study.
This section is quite outlined, but not developed in depth. Please improve this section and add some future possible development in the matter.
References
The references are relevant to the study and in the correct style.
The references are not up to date. Hence, delate those before 2013 if not essential, replacing them with newer ones and integrating them as suggested previously.
Competing interest
The authors' competing interests does not raise any concerns about the validity of the study.
Concerns
The paper does not raise any concerns.
Tables and Figures
The number and quality of tables and figures are appropriate to transmit the main information of the paper, but it could be good to include images of control X-Rays after ORIF surgery and image of control X-Rays at 1- and 3-months post-operative.
.
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