Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs

Elaine V. Dinwiddie; Aaron Rendahl; Stan Veytsman; Guillaume Ragetly; Albert C. Lynch; Brianna Miniter; Ron Ben-Amotz

doi:10.1371/journal.pone.0255388

Peer Review History

Original SubmissionJuly 7, 2020
4 Sep 2020 Decision Letter - Simon Clegg, Editor PONE-D-20-20573 Retrospective evaluation of post-operative complications of elbow arthrodesis (EA) in dogs: 22 cases (2009-2019) PLOS ONE Dear Dr. Dinwiddie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Many thanks for submitting your manuscript to PLOS One Your manuscript was reviewed by two experts in the field, and they have suggested some revisions be made to it prior to acceptance. If you could make these revisions, and write a response to reviewers, it will greatly expedite revision upon resubmission I wish you the best of luck with your revisions Hope you are keeping safe and well in these difficult times Thanks Simon ============================== Please submit your revised manuscript by Oct 19 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Simon Clegg, PhD Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This case series reports the outcomes of elbow arthrodesis in 22 dogs. It is the largest series of its kind, and the manuscript also provides an update on the techniques as the previous largest case series was published decades ago. The authors are commended for collating the cases at multiple institutions, as well as attempting to obtain long term (albeit verbal) follow-up. There is potentially publishable material here, but several major flaws must be addressed: - While the content of the manuscript was generally straight-forward, the scientific writing style needs much improvement, particularly pertaining to grammar. The authors should consider having the paper professionally edited prior to the next submission. - There are many problems with sentence structure (too numerous to highlight every one), and anthropomorphisms (e.g. a group of dogs cannot report complications lines 36,179,183...). - Additionally, it is not appropriate to report 'rates', 'common/uncommon' occurrences, and '%' when case numbers are so low (e.g. line 226 the most common major complication was pin migration (2/4)). Simply report the numbers as they are. - There are over-reaching and misleading conclusions, which could be attributed to the lack of relevant data. Most importantly: reporting that most dogs had 'good to excellent quality of life' and 'high satisfaction' as one of the most relevant findings is highly misleading for this population. Indeed, most of the dogs had moderate or severe lameness on long term follow-up. The most striking case in point: (line 264-265)- one dog required a mobility cart due to lack of any weight-bearing on the arthrodesis limbs, yet the owners report good satisfaction and quality of life from the arthrodesis!! The authors should consider classifying outcomes as "full", "acceptable", "unacceptable" (per Cook et al., Vet Surg 2010) based on the questionnaire results. For instance, this reviewer would suggest outcomes of dogs with 'moderate' or 'severe' overall limb disability would be 'unacceptable'. Note that, per Cook et al Vet Surg 2010, it is possible to have a satisfied owner yet an unacceptable outcome. On a similar note- how is it possible to diagnose a 'mechanical' lameness by telephone conversation? - The case numbers within groups are too low to draw any major conclusions from comparisons between groups - e.g. only 3 dogs with ESF had follow-up. Therefore, 'recommendations' (e.g. cannot recommend ESF) should be tempered. - While the manuscript title suggests the case series focuses on complications, there is a clear intent to report overall outcomes as well. Therefore, 1) the title must be adjusted, and 2) more information regarding outcomes should be provided; namely- (when) was union of the arthrodesis documented for each case? Specific comments: Line 43: Conclusions: major complication rate was high for all groups. Why single out ESF if final result not obviously different? Line 51-53: not sure how this is a ‘paradigm’; suggest deleting this sentence. Paragraph starting line 65: Please report how many cases of elbow arthrodesis have been previously described. This will give better context for the relevance of this manuscript. Line 86: why exclude these methods? Line 120: What were the outcomes of the non-grafted cases? Grafting is a fundamentally important aspect of arthrodesis Line 137-138: Provide the scales for satisfaction (excellent, good, fair, poor) Line 154: please ensure none of the cases have been described in other papers; or otherwise disclose the information Line 159-165: Redundant statements (already mentioned in the methods); delete Line 172: Carpal valgus?? Line 178-186: all redundant information as these values are provided later in the results again Table 2 is not easy to read; consider revising to chart form. Line 244 vs line 253: range is 1-9 years yet 2 dogs were euthanized < 1 year postoperatively? Line 285-288: cut and pasted out of results; please rephrase Line 291-295: it is hard to agree with the logic here based on the data provided (i.e. that minor complications will lead to major complications). Paragraph starting line 296: this paragraph should discuss SSI occurrence for all groups, yet only ESF is discussed. Line 311: How is it known that the lameness was mechanical, since outcomes were defined by telephone conversations with owners?. There is no mention of circumduction in the results? Paragraph starting line 321: Is this supposed to be the limitations paragraph? There are many more limitations than the variable approaches taken i.e. incomplete/inaccurate records, lack of veterinarian assessed follow-up, highly heterogenous population etc etc. Paragraph starting line 333: The arguments here are based on extremely weak data. Indeed, from the table, it is not obvious that older animals had more complications or poorer outcomes. Line 348: If you are recommending a validated assessment, why was one not used?? Line 258: "Good use of the operated limb" in the 'majority of patients' is simply not true; 10/14 dogs had moderate or severe limb disability; only 2/14 dogs did not have lameness at walk and run Line 359-360: Where in the results is this shown? i.e. that ESF group had lacked improvement post-operatively and had lowest satisfaction (2 out of 3 owners were actually satisfied)? Please consider adding a paragraph in the discussion on the paradox between satisfied owners vs lack of good limb use. One possibility is that the owners were simply happy that their dog was not amputated. Reviewer #2: I think that this study has potential for publication as it is a nice series of reports on elbow arthrodesis in dogs, which is an under reported area, and this is a nice and fairly large study for this area. It is nice that it is multi centred too and the authors deserve a lot of credit for it. It is a nice study, and a nice paper with some good results, but I think that some are unclear and in some places, over interpreted. I struggled to follow certain parts of it as it was quite contradictory. For example, how can dogs have an excellent quality of life, yet be moderate to severely lame? Including one which had a mobility cart? The two seem somewhat contradictory to me. I think I understand what you mean, but I think it needs some quantification. I think I would also be tempted to edge on the side of caution with your conclusions, as although numbers are relatively large for this field, overall they are quite small. The title is also a little misleading (wrong word but couldn’t think up a better one). You have a lot on clinical final outcomes, so that maybe better in the title too? Line 54-57- its not the patients which have the difficult choices to make- it’s the owners! Line 66- up to 100% means very little, can you be more specific? Line 85- how was quality of life assessed? Line 86- why were these methods excluded? Is there a specific reason? Line 106- . In total, twenty-two EA procedures were included in this study (Add in comma) Line 120- can you mention the outcomes of the cases? Particularly the grafts as these can sometimes be tricky to take Line 135-139- these are quite open, subjective categories to ask. Were there scales used? If so, please include them Some of the results are included already above, please consider revising I struggled to follow table 2- this may be easier as a figure, or with more explanation. Line 255- again it would be nice to know how the quality of life was judged Line 285-288 is better in results, and used here to discuss prevalence etc Line 291- is a major complaint not just a progression of a minor one? I can see what you are saying here but its unclear. Perhaps a major complaint masks a minor? Line 303- To the authors knowledge, there is no published infection rate of (add in comma) Line 311- hpw do you know that it is mechanical lameness? Unlikely that the owner would pick this up. Line 321- the limitations are far greater than those explained, including inaccurate records, different vets, poor follow up etc Line 333- I have concerns about some of the arguments here as the data isn’t that strong- maybe have a read over it and consider rewording it? Line 358- good use of the limb seems in direct opposition to some of what you have said previously? Line 359- isn’t the ESF group the lowest improvement group post op? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. 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Revision 1
17 Jun 2021 Author Response Response to reviewers: Thank you both for taking the time to review, and comment about our manuscript. We hope that with this version all comments were addressed. Please let us know if any additional changes are needed. Sincerely Dr. Dinwiddie and authors Reviewer #1: While the content of the manuscript was generally straight-forward, the scientific writing style needs much improvement, particularly pertaining to grammar. The authors should consider having the paper professionally edited prior to the next submission. -The manuscript has been re-written and professionally edited by experienced authors multiple times prior to re-submission making direct correction to grammar, sentence structure, and writing style. Additionally, it is not appropriate to report 'rates', 'common/uncommon' occurrences, and '%' when case numbers are so low (e.g. line 226 the most common major complication was pin migration (2/4)). Simply report the numbers as they are. -The sentence structures of the manuscript have been addressed to reflect numbers simply as reported. There are only 2 previously reported articles regarding EA which have are referenced in the manuscript. This lack of information regarding EA is noted starting in line 66 There are over-reaching and misleading conclusions, which could be attributed to the lack of relevant data. Most importantly: reporting that most dogs had 'good to excellent quality of life' and 'high satisfaction' as one of the most relevant findings is highly misleading for this population. Indeed, most of the dogs had moderate or severe lameness on long term follow-up. The most striking case in point: (line 264-265)- one dog required a mobility cart due to lack of any weight-bearing on the arthrodesis limbs, yet the owners report good satisfaction and quality of life from the arthrodesis!! The authors should consider classifying outcomes as "full", "acceptable", "unacceptable" (per Cook et al., Vet Surg 2010) based on the questionnaire results. For instance, this reviewer would suggest outcomes of dogs with 'moderate' or 'severe' overall limb disability would be 'unacceptable'. Note that, per Cook et al Vet Surg 2010, it is possible to have a satisfied owner yet an unacceptable outcome. On a similar note- how is it possible to diagnose a 'mechanical' lameness by telephone conversation? -The conclusions have been edited to reflect that while arthrodesis can be achieved via multiple fixation methods, care should be taken in performing this procedure because all fixation groups had complications. Over-reaching statements have been removed and/or edited to reflect that. In addition, we have added statements discussing Cook et al’s paper reflecting that there was case with satisfied owners yet unacceptable outcome (lines 395-399). Statements were also added to discuss mechanical lameness at 8 week surgical rechecks (lines 202-208) and that while mechanical lameness is expected, without physical exams, it is not possible to confirm that the lameness is indeed mechanical in nature (lines 355-367) The case numbers within groups are too low to draw any major conclusions from comparisons between groups - e.g. only 3 dogs with ESF had follow-up. Therefore, 'recommendations' (e.g. cannot recommend ESF) should be tempered. -Statements singling out any one type of fixation have been removed as all types of fixations had complications. While the manuscript title suggests the case series focuses on complications, there is a clear intent to report overall outcomes as well. Therefore, 1) the title must be adjusted, and 2) more information regarding outcomes should be provided; namely- (when) was union of the arthrodesis documented for each case? -Title has been edited Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in dogs: 22 cases (2009-2019) In addition, we have added dialogue regarding post-operative evaluations as well as information regarding arthrodesis union (lines 161-162) Line 43: Conclusions: major complication rate was high for all groups. Why single out ESF if final result not obviously different? -Statements regarding conclusions have been edited to reflect that while complication rates were high for all fixation types, arthrodesis is achievable in all fixation types as well (lines 46-47) Line 51-53: not sure how this is a ‘paradigm’; suggest deleting this sentence. -sentence deleted Paragraph starting line 65: Please report how many cases of elbow arthrodesis have been previously described. This will give better context for the relevance of this manuscript. -Paragraph starting line 63 discusses infrequency of EA reporting to give relevance of this manuscript (One paper written in the last 10 years) Line 86: why exclude these methods? -the methods of fixation that the authors wished to include in this study were bone plate and ESF which are the most common. Any other form was eliminated for continuity purposes and so that the categories of EA could be maintained. -Cases included were those with EA performed by plate fixation or ESF and reflected in the abstract lines 26-30 Line 120: What were the outcomes of the non-grafted cases? Grafting is a fundamentally important aspect of arthrodesis -Paragraph starting line 163 discussed outcome of non-grafted cases Line 137-138: Provide the scales for satisfaction (excellent, good, fair, poor) -Scales have been added for all evaluations (surgical and owner) in lines 92-103 Line 154: please ensure none of the cases have been described in other papers; or otherwise disclose the information -None of these cases have been previously reported. The other 2 papers regarding EA are referenced in the manuscript Line 159-165: Redundant statements (already mentioned in the methods); delete -Redundant information and statement have been removed and/or edited Table 2 is not easy to read; consider revising to chart form. -Table 2 was revised into individual tables (Table 2, 3, and 4) to reflect responses to individual fixation types. The owners responses to the question on the left hand is written next to the possible options in parentheses to the right Line 244 vs line 253: range is 1-9 years yet 2 dogs were euthanized < 1 year postoperatively? -range was updated to reflect correct time frame (7 months-9 years) Line 285-288: cut and pasted out of results; please rephrase -redundant information was removed and results section restated Line 291-295: it is hard to agree with the logic here based on the data provided (i.e. that minor complications will lead to major complications). -Paragraph has been re-written to discuss infection associated with these fixations as we cannot conclude that one minor complication leads to a major. Discussion thus surrounds the SSI portion of complications in paragraph starting 331 Paragraph starting line 296: this paragraph should discuss SSI occurrence for all groups, yet only ESF is discussed. -Paragraph starting 331 edited to discusses SSI. In all forms of EA fixation, not just ESF Line 311: How is it known that the lameness was mechanical, since outcomes were defined by telephone conversations with owners?. There is no mention of circumduction in the results? -Information regarding surgical evaluation at 8 weeks post operatively has been added to include mechanical lameness as well as circumduction (lines 63-68). Mechanical lameness is expected with this procedure; however, without performing PE, we cannot confirm that on long term evaluations with the owners via phone call if the lamenesses were indeed mechanical. This is reflected in discussion starting lines 355-360. Paragraph starting line 321: Is this supposed to be the limitations paragraph? There are many more limitations than the variable approaches taken i.e. incomplete/inaccurate records, lack of veterinarian assessed follow-up, highly heterogenous population etc etc. -Limitations paragraph has been re-written to reflect a more conclusive list starting line 406 Paragraph starting line 333: The arguments here are based on extremely weak data. Indeed, from the table, it is not obvious that older animals had more complications or poorer outcomes. -Paragraph was removed as argument was weak and not founded on information gathered for this manuscript Line 348: If you are recommending a validated assessment, why was one not used?? - We used a modified version of the previously reported questionnaire as a means to keep data consistent. The other validating system (i.e. force plate analysis) would be useful post operatively, but due to the retrospective nature of this study, we could not conduct that type of analysis. Line 258: "Good use of the operated limb" in the 'majority of patients' is simply not true; 10/14 dogs had moderate or severe limb disability; only 2/14 dogs did not have lameness at walk and run -10/14 dogs had mild to moderate lameness long term which is an improvement for these patients from pre-operatively. Again, mechanical lameness is expected so we anticipate lameness with some of these cases. This should be more evident now that the Table 2 has been broken down into individual tables to reflect the long term outcome of patients. Line 359-360: Where in the results is this shown? i.e. that ESF group had lacked improvement post-operatively and had lowest satisfaction (2 out of 3 owners were actually satisfied)? -ESF group did have a good outcome which is now reflected in the ESF complications and outcome section begin line 257. Outcome for each fixation type has been re-written and added to the respective section Please consider adding a paragraph in the discussion on the paradox between satisfied owners vs lack of good limb use. One possibility is that the owners were simply happy that their dog was not amputated. -Paragraph starting 383 was added to discuss this paradox Reviewer #2: I struggled to follow certain parts of it as it was quite contradictory. For example, how can dogs have an excellent quality of life, yet be moderate to severely lame? Including one which had a mobility cart? The two seem somewhat contradictory to me. I think I understand what you mean, but I think it needs some quantification. -Paragraph starting line 383 was added to reflect that there can be pleased owners that perceive a good quality of life for their pet despite that they have an unacceptable outcome. I think I would also be tempted to edge on the side of caution with your conclusions, as although numbers are relatively large for this field, overall they are quite small. -Conclusions have been tempered and re-written to reflect the data given here, that all fixation types can result in complete arthrodesis but all groups had complications; therefore, the conclusions are merely cautionary in nature about EA as a procedure regardless of fixation type The title is also a little misleading (wrong word but couldn’t think up a better one). You have a lot on clinical final outcomes, so that maybe better in the title too? - Title has been edited Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in dogs: 22 cases (2009-2019) Line 54-57- its not the patients which have the difficult choices to make- it’s the owners! -The Abstract and Introduction have both been revised and include discussion of treatment of cases with end stage elbow disease and what options are available for owners. Line 85- how was quality of life assessed? -Quality of life was one of the long term questionnaire questions and a subjective measurement by the owners meant for them to assess how their pet was doing at that point long term (Table 2, 3, 4). Line 86- why were these methods excluded? Is there a specific reason? -The line was re-written- the cases included were cases that had EA performed by either LCP, DCP, or ESF. Line 106- . In total, twenty-two EA procedures were included in this study (Add in comma) -The manuscript was professionally edited again and hopefully addressed most of the grammatical errors. This sentence was re-written with the comma added Line 120- can you mention the outcomes of the cases? Particularly the grafts as these can sometimes be tricky to take -Case outcomes have been included in the paragraph regarding each respective fixation type (i.e. DCP complications and outcome). Table 2 had been broken down to reflect each fixation type, so are now Table 2, Table 3, Table 4. In addition, images of each fixation type have been included as well. Some of the results are included already above, please consider revising -The materials/methods and results sections have been revised to better include information in correct sections. I struggled to follow table 2- this may be easier as a figure, or with more explanation. -Table 2 was broken down to reflect owner responses to individual fixation types and are now Table 2, Table 3, Table 4 Line 291- is a major complaint not just a progression of a minor one? I can see what you are saying here but its unclear. Perhaps a major complaint masks a minor? -Both major and minor complications have been revised in both Table 1 as well as the text to better clarify what is minor vs major. Line 303- To the authors knowledge, there is no published infection rate of (add in comma) -This paragraph has been edited to discuss infection in all types of fixation not only ESF in paragraph beginning 331 Line 311- hpw do you know that it is mechanical lameness? Unlikely that the owner would pick this up. - Statements were added to discuss mechanical lameness at 8 week surgical rechecks (lines 202-208) and that while mechanical lameness is expected, without physical exams, it is not possible to confirm that the lameness is indeed mechanical in nature (lines 355-367) Line 321- the limitations are far greater than those explained, including inaccurate records, different vets, poor follow up etc -The paragraph regarding limitations has been edited and includes more limitations than previously discussed. This is discussed in paragraph starting at line 406 Line 333- I have concerns about some of the arguments here as the data isn’t that strong- maybe have a read over it and consider rewording it? -The discussion portion was re-written to take into consideration that due to the low numbers of cases, some overarching conclusions couldn’t be made. This paragraph was reworded with specific changes to the arguments. Line 359- isn’t the ESF group the lowest improvement group post op? -The ESF group had the most complications associated with it but only 1 patient had low improvement. This section was re-written to reflect complications and outcome for ESF lines 258-294 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0255388.r002
6 Jul 2021 Decision Letter - Simon Clegg, Editor PONE-D-20-20573R1 Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs PLOS ONE Dear Dr. Ben-Amotz, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Many thanks for submitting your manuscript to PLOS One It was reviewed by two experts in the field as reviewed the original submission, and they have recommended some further modifications be made prior to acceptance I therefore invite you to make these changes and to write a response to reviewers which will expedite revision upon resubmission I wish you the best of luck with your modifications Hope you are keeping safe and well in these difficult times Thanks Simon ============================== Please submit your revised manuscript by Aug 20 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Simon Clegg, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the revisions, the manuscript is improved. General comments: - Do not use the word ‘patient’ unless referring to human subject. Use ‘dog’ or ‘case’ instead. - Delete all % values- the numbers are too small in this study. - The results and discussion are very lengthy and could be condensed further. Specific comments: Line 36,37: “Complications were reported in X/X, Y/Y, and Z/Z for the DCP, LCP, and ESF groups, respectively” Do not jumble methods with results in abstract – i.e. move sentence on line 37 to methods area Abstract conclusion: Yes it can be done, but persistent lameness is expected and complication rate is high. Line 54: amputation is a radical surgical intervention – delete ‘amputation’ Line 63: Do not begin sentence with acronym Line 64: what is meant by ‘the most recent literature’? Line 70: Something is missing between the last two paragraphs of the introduction. Need to provide some comment about advent of new implants i.e. locking plates that might influence success rates. Line 78: acronym not used for EA Line 93: Outcome was based on evaluations/radiographs at what minimum time frame? Line 97: the time range provided belongs in the results. Line 134: why 9/9? The number of cases is already listed above Tables 2-4 should be combined Discussion: First paragraph: Need to explicitly state that, while persistent lameness was typical, lameness had improved. Line 333: Do not report % - numbers are too small therefore % are misleading. Line 359: Was mechanical in nature Line 375: A little too speculative; consider deleting this paragraph (manuscript is already very long) Line 391-393: this needs to be stated in the results Line 398-404: Consider deleting from “To increase the accuracy…” to the end of the paragraph. Reviewer #2: I wish to thank the authors for making the previously suggested modifications. I have read the manuscript, and although it reads well, I still have a few minor comments to address prior to acceptance. These are listed below, but I don’t expect to see the manuscript again prior to acceptance so I want to wish you all the best with your future research. Please note that these are only suggestions and I shall not be disappointed if they are not actioned. Within the abstract, is it possible to have both the n and a % value? So lines 40. 41 and 42 Line 110- there is only 21 here, not the 22 which were included, Can you please add in the 22nd? Line 116- again there are only 20 here, can you add in the other two please? Line 143- completed, the bone graft (reword) Line 144- grafted, an autogenous …(reword) Line 153- screws rather than screw Line 165- did not receive a bone graft (reword) Line 179- non union, and deep SSI (reword) Line 228- screw, and humeral fissure (reword) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0255388.r003
Revision 2
12 Jul 2021 Author Response Response to reviewers: Thank you both again for taking the time to review, and comment on our manuscript. We hope that with this version all comments were addressed. This manuscript is required to obtain ACVS credentials by August 1, 2021. Please let us know if any additional changes are needed prior to acceptance. Sincerely, Dr. Dinwiddie and authors Reviewer #1: Thank you for the revisions, the manuscript is improved. General comments: Do not use the word ‘patient’ unless referring to human subject. Use ‘dog’ or ‘case’ instead. -The term ‘patient’ was replaced with either dog or case throughout the manuscript Delete all % values- the numbers are too small in this study. -Percentage values were removed from the manuscript with the exception of the discussion of infection rates for this study. The statement of “small sample size” was added to the discussion paragraph to specifically recall that sample size plays a factor in these infection rates The results and discussion are very lengthy and could be condensed further. -Both the results and discussion have had portions removed or revised to condense the material. Specific comments: Line 36,37: “Complications were reported in X/X, Y/Y, and Z/Z for the DCP, LCP, and ESF groups, respectively” -This line has been reworded as suggested above Do not jumble methods with results in abstract – i.e. move sentence on line 37 to methods area -Sentence removed from abstract and stated within methods section Abstract conclusion: Yes it can be done, but persistent lameness is expected and complication rate is high. -The concluding sentences were combined to read better Line 54: amputation is a radical surgical intervention – delete ‘amputation’ -‘amputation’ was deleted Line 63: Do not begin sentence with acronym -Changed EA to Elbow Arthrodesis Line 64: what is meant by ‘the most recent literature’? -Defined and edited to say ‘in the past 10 years of literature’ Line 70: Something is missing between the last two paragraphs of the introduction. Need to provide some comment about advent of new implants i.e. locking plates that might influence success rates. -Added paragraph addressing available implants Line 78: acronym not used for EA -Changed elbow arthrodesis to ‘EA’ Line 93: Outcome was based on evaluations/radiographs at what minimum time frame? -Added ‘average of 9 weeks post operatively’. The full timeframe range is stated in the results section Line 97: the time range provided belongs in the results. -Moved timeframe to results section Line 134: why 9/9? The number of cases is already listed above -Removed ‘9/9’ and replaced with ‘all cases’ Tables 2-4 should be combined -The tables have been combined into a single Table 2 and references within the manuscript edited to reflect the change Discussion: First paragraph: Need to explicitly state that, while persistent lameness was typical, lameness had improved. -Added sentence to state that lameness had improved in 9/14 cases Line 333: Do not report % - numbers are too small therefore % are misleading. -Percentages have been removed Line 359: Was mechanical in nature -edited sentence to say ‘was mechanical in nature’ Line 375: A little too speculative; consider deleting this paragraph (manuscript is already very long) -paragraph was removed Line 391-393: this needs to be stated in the results -This sentence was moved to the results and reworded to be included in the Discussion Line 398-404: Consider deleting from “To increase the accuracy…” to the end of the paragraph. -This section has been removed along with the references that were stated in the section Reviewer #2: I wish to thank the authors for making the previously suggested modifications. I have read the manuscript, and although it reads well, I still have a few minor comments to address prior to acceptance. These are listed below, but I don’t expect to see the manuscript again prior to acceptance so I want to wish you all the best with your future research. Please note that these are only suggestions and I shall not be disappointed if they are not actioned. Within the abstract, is it possible to have both the n and a % value? So lines 40. 41 and 42 -The percentages have been removed Line 110- there is only 21 here, not the 22 which were included, Can you please add in the 22nd? -This sentence is correct in that there were only 21 dogs- but one case had bilateral elbows operated making it 22 total procedures Line 116- again there are only 20 here, can you add in the other two please? -Recounted all patients and appropriately categorized. Number is now 22 including the bilateral case Line 143- completed, the bone graft (reword) -Did not add the word ‘the’ Line 144- grafted, an autogenous …(reword) -Added the word ‘an’ Line 153- screws rather than screw -Edited to make word plural Line 165- did not receive a bone graft (reword) -Added ‘a’ Line 179- non union, and deep SSI (reword) -Added ‘and’ Line 228- screw, and humeral fissure (reword) -Added ‘and’ Attachments Attachment Submitted filename: Response to Reviewers (2).docx https://doi.org/10.1371/journal.pone.0255388.r004
16 Jul 2021 Decision Letter - Simon Clegg, Editor Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs PONE-D-20-20573R2 Dear Dr. Ben-Amotz, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Simon Clegg, PhD Academic Editor PLOS ONE Additional Editor Comments: Many thanks for resubmitting your manuscript to PLOS One As you have addressed all the comments and the manuscript reads well, I have recommended it for publication You should hear from the Editorial Office shortly. It was a pleasure working with you and I wish you the best of luck for your future research Hope you are keeping safe and well in these difficult times Thanks Simon https://doi.org/10.1371/journal.pone.0255388.r005
Formally Accepted
21 Jul 2021 Acceptance Letter - Simon Clegg, Editor PONE-D-20-20573R2 Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs Dear Dr. Ben-Amotz: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Simon Clegg Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0255388.r006

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