Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction

Joseph B. Kahan; Patrick Burroughs; Logan Petit; Christopher A. Schneble; Peter Joo; Jay Moran; Maxwell Modrak; William Mclaughlin; Adam Nasreddine; Jonathan N. Grauer; Michael J. Medvecky

doi:10.1371/journal.pone.0294964

Peer Review History

Original SubmissionMay 22, 2023
28 Jul 2023 Decision Letter - Hassan Zmerly, Editor PONE-D-23-15574Subsequent Surgical Rates of Meniscus Repair with and without Anterior Cruciate Ligament ReconstructionPLOS ONE Dear Dr. Medvecky, 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 Sep 11 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. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. [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: Yes Reviewer #2: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Yes Reviewer #2: No ****** 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: No ****** 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: Thank you for a study with a pertinent question, large database, and a sound discussion. Questions: 1. For secondary knee surgery procedure codes used to query for second surgeries within 2 years, did you consider looking for cartilage-injury treatment codes, like chondroplasty, microfracture, osteochondral grafting (autograft and allograft)? Those can be considered to be associated with meniscal repair failures along with the secondary procedures you chose to query. Also, revision ACL reconstruction? It seems unusual that among the sub-cohort of 1006 patients who underwent ACL reconstruction there were no re-tears for whom a revision ACL reconstruction was performed. If you decided against querying for those codes, would be interested in your reasoning. 2. Would there be a way to add a figure and some discussion on age-specific rates of second surgeries (and types)? There might be some interesting findings there. Since you did a nice job showing age distribution of all patients and those with 2 year follow up in Figure 2, I thought it would be possible to also show results distribution by age, and was hoping to see that. Thank you! Reviewer #2: I would first thank the author for this manuscript, however few comments need to be considered 1- The title of the article is misleading and needs to be reconsidered, I understood the purpose of the study after I read the abstract. eg, The need for subsequent surgery after arthroscopic meniscal repair with or without ACL reconstruction OR The failure rates after meniscal repair surgery with or without ACL reconstruction. 2- Linguistic review is needed 3- The author should avoid abbreviations like ACLr and needs to clarify it in abstract. 4- Line 55 - 75 need to be clarified. How many intervals did the author reported the outcome. 5- Significant drop of the study population, why is that? 6- Table 1 is not really adding to the paper and instead the authors could have mentioned the techniques used for meniscal repair in their population. 7- I understood that you measured the outcomes in two cohorts, while the second cohort is understood to be at 2 years, what was the follow up interval of the larger cohort? 8- Line 179 - Between 1-9 patient had TKA. this is weak point of the study. why you are not precise? ****** 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: Yes: Aissam Elmhiregh ******** [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.0294964.r001
Revision 1
6 Sep 2023 Author Response Ref.: Ms. No. PONE-D-23-15574 Journal: PLOS ONE Title: Rates of subsequent surgeries after meniscus repair with and without anterior cruciate ligament reconstruction Dear Reviewers, We thank the PLOS ONE reviewers for their insightful comments, which have helped to make the manuscript better. We have included an itemized list with our responses to all the reviewers’ comments on how we have altered the manuscript text to address these concerns. Reviewer Responses Reviewer #1 Thank you for a study with a pertinent question, large database, and a sound discussion. Questions: 1. For secondary knee surgery procedure codes used to query for second surgeries within 2 years, did you consider looking for cartilage-injury treatment codes, like chondroplasty, microfracture, osteochondral grafting (autograft and allograft)? Those can be considered to be associated with meniscal repair failures along with the secondary procedures you chose to query. Thank you for this comment. We had considered adding cartilage-injury treatment codes as secondary surgeries, but due to the increase in noise in the dataset from addition of each additional CPT code, the research team made a decision to focus secondary procedures to those directly related to the index procedure (repeat meniscal surgery) or definite end point (arthroplasty) as this would provide the cleanest results from this particular dataset. Also, revision ACL reconstruction? It seems unusual that among the sub-cohort of 1006 patients who underwent ACL reconstruction there were no re-tears for whom a revision ACL reconstruction was performed. If you decided against querying for those codes, would be interested in your reasoning. This is absolutely a limitation of this study, and a statement has been added to the discussion section expanding on this point. Revision ACL reconstruction is a valuable point to consider, but when the CPT code was added, an error occurred for the ACLr cohort as the initial inclusion criteria query had only pulled ACLr reports for the index procedure. This consideration that our subsequent revision rates may be an underestimate and does not apply to patients undergoing revision ACL reconstruction has been clarified. 2. Would there be a way to add a figure and some discussion on age-specific rates of second surgeries (and types)? There might be some interesting findings there. Since you did a nice job showing age distribution of all patients and those with 2 year follow up in Figure 2, I thought it would be possible to also show results distribution by age, and was hoping to see that. Thank you! We agree this is an interesting point and had attempted to subcategorize the secondary surgeries, but given the HIPAA restrictions on reporting database categorization data with <10 patients, the precise reporting of age-specific rates was not available for secondary analysis as described in the manuscript. Reviewer #2 I would first thank the author for this manuscript, however few comments need to be considered 1- The title of the article is misleading and needs to be reconsidered, I understood the purpose of the study after I read the abstract. eg, The need for subsequent surgery after arthroscopic meniscal repair with or without ACL reconstruction OR The failure rates after meniscal repair surgery with or without ACL reconstruction. Thank you for this comment. The title of the manuscript has been revised to: Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction. This better clarifies the purpose of this study. 2- Linguistic review is needed We appreciate this comment and have combed through the manuscript for linguistic review 3- The author should avoid abbreviations like ACLr and needs to clarify it in abstract. The abbreviation has been clarified in the abstract 4- Line 55 - 75 need to be clarified. How many intervals did the author reported the outcome. Thank you, the mean and range of overall follow up has been included 5- Significant drop of the study population, why is that? As described in the methods and limitations, performing statistics with a large database requires stringent inclusion criteria. One such inclusion criteria was to ensure at least 2 year follow up, which will knowingly reduce the study population if their surgery was within 2 years, changed insurance, or were lost to follow up within 2 years. While this purposefully reduces the study population, the statistics performed within this sub-population is much more accurate. 6- Table 1 is not really adding to the paper and instead the authors could have mentioned the techniques used for meniscal repair in their population. We appreciate the reviewer’s comment. However, given this is a database study, the primary method of identifying meniscal repairs is via CPT codes. Unfortunately this means that the techniques used by surgeons is unavailable, as this is a national administrative database analysis and not a chart review study 7- I understood that you measured the outcomes in two cohorts, while the second cohort is understood to be at 2 years, what was the follow up interval of the larger cohort? Thank you for this point – we have included the follow up interval within the abstract and the results section for the overall cohort as a mean of 13 years (1.5-24 years) 8- Line 179 - Between 1-9 patient had TKA. this is weak point of the study. why you are not precise? Thank you for this comment. As is described in the next sentence, national policy on privacy (HIPAA) prevents reporting of database study results of <10 patients, as there is potential to be deemed identifiable. Thus database studies by convention commonly report “less than 10” for such results. Attachments Attachment Submitted filename: Reviewer Responses.docx https://doi.org/10.1371/journal.pone.0294964.r002
13 Nov 2023 Decision Letter - Hassan Zmerly, Editor Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstructionDear Dr. Michael MedveckyWe are 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,Hassan Zmerly, MD PhDAcademic Editor, PLOS ONE https://doi.org/10.1371/journal.pone.0294964.r003
Formally Accepted
16 Nov 2023 Acceptance Letter - Hassan Zmerly, Editor PONE-D-23-15574R1 Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction Dear Dr. Medvecky: 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 customercare@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 Professor Hassan Zmerly Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0294964.r004

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