Peer Review History
Original SubmissionFebruary 10, 2023 |
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PONE-D-23-03456Effect of Intramedullary Nail Stiffness on Load-sharing in Tibiotalocalcaneal Arthrodesis: A Patient-Specific Finite Element StudyPLOS ONE Dear Dr. Carpenter, 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. Please submit your revised manuscript by May 04 2023 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:
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Additional Editor Comments: According to reviewers opinion the paper needs major revision. The details you can read in the opinions. You can submit the corrected version within 45 days. [Note: HTML markup is below. Please do not edit.] 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: Partly Reviewer #2: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ********** 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: Yes 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: Dear authors, I have found this article very interesting, well-written, and well-structured. I am sending you the following major issues that, by my understanding, should be considered: 1. Regarding the FE models, the information is insufficient for reproducibility (unless the source ABAQUS files are supplied along with the publication). 2. The description of the FEM boundary conditions should be explained in more detail in the article, as in the text and graphically. 4. It is said that the mesh convergence and validation were reported in [31], but this reference does not explicitly show the validation but only comments on it. Could you please extend the explanation? 3. Please explain why linear tetrahedral elements have been used instead of higher-order ones. Also, reference [31] does not specify which element order was used and shows some artificial bending due to using tetrahedral finite elements. Could parabolic elements or finer meshes have fixed the problem? Is this problem also present in the current simulations? 4. The thermal contraction of the resorption zone introduces fictitious (tensile) stresses. How can you analyze the load-sharing behavior when fictitious stresses are involved? Please quantify such stresses and explain why they are neglectable or do not affect the calculation of the resultant forces. 5. Given that the equivalent von Mises stress is signless and more related to shear than normal stresses, why is it the only stress used? Maximum/minimum normal stresses or principal stresses arrow maps would be much more helpful in understanding the system’s mechanics and appropriate for analyzing the stresses in the bone. Moreover, these other stresses allow for distinguishing between tensile and compressive stresses, while von Mises hides this aspect. Also, it can help to quantify and understand the magnitude of the fictitious resorption stresses. On the other hand, the following minor issues can be considered: 6. A reference for the friction coefficient value of 0.1 between the nail body and the surrounding bone would be necessary. 7. Which friction coefficient value is used for the contact between the nail and the nail body? 8. Why “stress heat map” instead of simply “stress map”? Sincerely Reviewer #2: PONE-D-23-03456 Effect of Intramedullary Nail Stiffness on Load-sharing in Tibiotalocalcaneal Arthrodesis: A Patient-Specific Finite Element Study Terrill et al. Comments to Authors: In this manuscript, the authors built a finite element hindfoot model to determine the influence of different intramedullary nails used for tibiotalocalcaneal arthrodesis on the amount of bone load-sharing with and without different bone resorption depths. Overall, the manuscript is well written, but there are some concerns related to the boundary conditions of the model and its ability to appropriately investigate the devices of interest. Introduction Lines 48-50, Page 3: A clear and concise explanation of “dynamization of the arthrodesis construct’ should be included prior to or within this sentence to help explain this concept before moving on. Lines 52-57, Page 3: You state that important factors are maximizing bone-to-bone contact across the fusion site and minimizing micromotion of the joint for proper fusion. You also mention that the device should be rigid to prevent excessive bending and torsional moments at the TTC complex. How does bone-to-bone contact changes with these different devices? How does the micromotion change? Lines 64-66, Page 4: The language should change here to emphasize the comparison of different IM nails here because some of the authors of this manuscript have previously published at least one other study quantifying the load-sharing of arthrodesis devices and bone at the fusion sit, as I understand it. Lines 78-80, Page 4: For (1), be more specific. The authors are not testing a hypothesis for any material implemented. They are testing a hypothesis for two specific materials. Define ‘high stiffness’. Why not just stick to the second part of the hypothesis? The introduction leads into the second part of the hypothesis, but the first part seems out of place or at least not supported in the Introduction. Method Lines 99-100, Page 5: The study is interesting, but the single, healthy subject used to develop the finite element model without experimental validation limits the impact. Lines 112-113, Page 5: Why not demonstrate the influence of different IM nails with varying material properties, since only one subject was used to develop a single finite element model? In the previous study by the authors, they vary the effect of bone modulus and demonstrate changes. How does the comparison in this manuscript of the different IM nails changes in relation to the bone modulus, and does the positive effect of the dynamization decrease with different bone quality? Lines 129-130, Page 6: Why not demonstrate the influence from different IM nails with different alignment? How sensitive are the results to changes in position and alignment of the device? Lines 132-135, Pages 6-7: Where does the coefficient of friction value come from? Lines 132-135, Pages 6-7: Is the bone-nail interface perfect? Is that realistic? What implications are there for modeling the IM nails this way? This model representation negates the ability of the device to settle with further loading and potentially change the results. This should probably be mentioned in the Discussion. Lines 135-136, Page 7: Do you mean frictionless here? The language used in this sentence does not make this clear. Lines 142-143, Page 7: I would refer to this as ‘simulated resorption behavior’ because the representation of resorption is simplified. Lines 164-166, Page 8: I am confused by the loading applied. How can you apply this load to just the distal end of the calcaneus where the IM nail was implanted and call it ‘gait loading’? What about during toe-off when the ground reaction force is being applied to the forefoot, which wasn’t modeled? Also, why weren’t the off axis loads applied to assess the complexity of loads during stance? The loading does not seem physiologic if all the load is always applied to the distal calcaneus near the IM nail implanted. Results Lines 197-198, Page 9: Change ‘no gait loading’ and ‘peak gait load’ to ‘unloaded’ and ‘peak compressive load’. This manuscript may be basing the compressive force off of the ground reaction forces during gait, but they are only being applied as a range of axial compressive loads. They do not replicate the loads under walking conditions, as these would be more complex. Lines 201-210, Page 10: Why focus on reporting absolute values? Since you only have one subject without any experimental validation, the analysis should consist of relative comparisons between the different nails. There is no ability to determine if these values are correct, or that they represent the values that would be demonstrated in others. Lines 205-206, Page 10: Why did you compare 400 to 500N? If you can’t achieve 500N with the NiTi nail, then why not just compare each to 400N? I understand that the differences found between the two are vast, even with this discrepancy, but the inconsistency in methodology doesn’t make sense. Lines 217-224, Pages 10-11: The simulations seem to be quasistatic and not dynamic, so I’m not sure why two cycles of gait loading were performed. It seems like the axial load was just varied. Were dynamic simulations performed and acceleration of loading during walking included? Lines 232-234, Page 11: It is not clear where at ‘toe-off’ you are referring to make this calculation. Lines 253-264, Page 12: I like the sensitivity analysis of simulated bone resorption in this study. Why not just focus on this aspect? Since this is one model of a single foot without experimental validation, the sensitivity of different amounts of bone resorption is more interesting and impactful than the earlier analysis. Discussion Lines 310-313, Page 14: Can you really say that this is dynamic compressive loading? It is not clear from the methods that you can. It appears you applied different values of compressive load near the site of the nail. Lines 313-315, Page 14: I would use ‘suggest’ instead of ‘exhibit’ here. The language is a little strong for an analysis with one model. Lines 369-372, Page 17: Why not include more specimens then to present results in light of different subject variability in bone material properties, geometry, alignment, etc.? Lines 372-374, Page 17: This is true, but the finite element model would be more impactful with some level of experimental validation and then use this to even extrapolate predictions of stress. ********** 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. 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 #1: No 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.
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Revision 1 |
PONE-D-23-03456R1Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: a patient-specific finite element studyPLOS ONE Dear Dr. Carpenter,Please insert comments here and delete this placeholder text when finished. Be sure to: Please submit your revised manuscript by Jun 29 2023 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:
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: https://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, Pawel Klosowski, D.Sc. 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. [Note: HTML markup is below. Please do not edit.] 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: All comments have been addressed Reviewer #2: (No Response) ********** 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: Yes Reviewer #2: Partly ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ********** 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: (No Response) Reviewer #2: PONE-D-23-03456.R1 Effect of Intramedullary Nail Stiffness on Load-sharing in Tibiotalocalcaneal Arthrodesis: A Patient-Specific Finite Element Study Terrill et al. Comments to Authors: Response to Author Responses to Reviewers Although the authors state that their methodology allows them to isolate the effects of the IM nails with their one subject, which is true, it still does not eliminate the need to perform the same analysis in other subject models to support their conclusions. A repeated-measures analysis with multiple subject models does not prevent an investigation to isolate the effects of IM nails. In fact, I think it is important to analysis different aspects that these nails will encounter as a part of a sensitivity analysis in order to say anything valuable about the results. If multiple models generated with different geometry and bone material properties could exhibit the behavior that the authors have stated, then this would improve the impact of their analysis. The problem with this study is that the authors have only found that one subject had the effects they describe, where we don't know whether this is the case with other subjects or with other conditions that are possible like malalignment or reduced bone density. This should at least be addressed further in the limitation section as this is more work, but these details may influence their conclusions. Introduction Lines 81-86, Page 4: Include background information and rationale within the earlier paragraphs of the Introduction for evaluating nails with bone resorption modeled. There was no mention of bone resorption until the objective and hypothesis. Please elaborate to prepare the reader for the objective and hypothesis. Methods Line 182, Page 9: Change “peak gait load” to “peak compressive load.” You are applying a compressive force from a value extracted from the ground reaction force and applied to the opening of the implanted nail. You are not representing gait loading. Change this throughout the manuscript. Line 182-184, Page 9: Do you mean “vertical ground reaction force”? Is that where you are getting this value? Same for Lines 187-188. Results Lines 242-244, Page 12: Two cycles of gait loading? This is confusing because these are quasistatic simulations. Do you mean that you are running multiple simulations or steps while varying the compressive load applied? If so, clarify as such within the results (even though this is more of a method detail). ********** 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 #1: No 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.
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Revision 2 |
Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: a patient-specific finite element study PONE-D-23-03456R2 Dear Dr. Carpenter, 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, Pawel Klosowski, D.Sc. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: |
Formally Accepted |
PONE-D-23-03456R2 Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: a patient-specific finite element study Dear Dr. Carpenter: 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 Prof. Pawel Klosowski Academic Editor PLOS ONE |
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