Prevalence and mechanisms of anterior cruciate ligament tears in military personnel: A cross-sectional study in Iran

Seyyed-Mohsen Hosseininejad; Mohammad Kazem Emami Meybodi; Mehdi Raei; Alireza Rahimnia

doi:10.1371/journal.pone.0303326

Peer Review History

Original SubmissionMay 23, 2023
28 Jul 2023 Decision Letter - Amit Joshi, Editor PONE-D-23-13460Anterior Cruciate Ligament Tear in the Iranian Military Setting; the Injury Prevalence and MechanismPLOS ONE Dear Dr. Rahimnia, 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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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 2. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ Additional Editor Comments: dear author. our reviewer have suggested some correction on your manuscript. kindly address ech point. [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: No Reviewer #2: No ****** 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: 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: Reviewer’s Comments Anterior Cruciate Ligament Tear in the Iranian Military Setting; the Injury Prevalence and Mechanism Comments for the Author Line 22 The introduction lacks a scientific rationale for this study. Line 23 The author should provide a specific hypothesis. Line 33 Could all the patients in this study recall the mechanism of injury? E.g., Fall with the knee in valgus position. Line 35 Difference between military exercises and athletic exercise? Line 42 Could you please elaborate the prevention strategies this study has helped to develop? Line 82 Please mention the rationale for excluding the chronic injury. Line 85 Clinical and imaging findings for ACL tear have inter- observer and intra- observer variability. If only those patients taken for arthroscopic surgery were studied and intraoperative findings considered the gold standard, the results would be more reproducible. Line 98 Clinical and imaging findings with respect to chondral and meniscus injuries have inter- observer variability. Line 128 Please define the military exercise. Line 176 Please clarify the similarities and differences between the military and sports activities. Line 216 This study does not determine the exact measures to prevent an injury to ACL. Line 192 The author has assumed that none of the patients were exposed to warm-up exercises. Line 194 A gender sub-analysis could give a better insight. Line 194 Besides the mechanism of injury, there are other anatomical factors responsible for ACL injury. Please clarify how these factors have been matched. Earlier studies have concluded even more detailed mechanisms of injury and prevention strategies. Please elaborate what this study adds extra to the existing knowledge related to the topic. Reviewer #2: Authors should be congratulated for such a nice work. It definitely has scientific merit and will be an interesting topic for readers. However, here are some suggestions: introduction section: please incorporate paragraphs 1 and 2 to shorten the introduction section and make the background information more relevant. line 57-59 can be deleted because it is not contributing much to the flow of writing. methodology section: 1. Please mention the sample size calculation and sampling technique in detail (provide formula). 2. Please mention whether or not the normality of the data set was tested? 3. Please justify the use of statistical test based on the normality of the data. Consult statistician. 4. Please revise the statement mentioned in line 85/86, as it is confusing that you enrolled 285 or 402 patients. Better to mention it in the result section with flow of participants. 5. As it is a cross-sectional descriptive analytical study, providing confidence intervals would be better. 6. You have mentioned that you included patients with knee complaints with pain, giving away, and locking. Did that mean all patients had locking symptoms? please clarify. Result section: 1. please avoid explanation of the study findings. for e.g. significantly lower. Please provide study findings as it is and explain them in the discussion section. All the tables are self-explanatory, so, limited writing is sufficient. In addition, please provide which test was done to calculate p value in all 4 table legends. Discussion section: it is weak and can be improved significantly by careful writing and direct comparison with previous study findings. 1. Please follow simple rule of academic writing that 1 paragraph should evaluate 1 outcome. Use format of breaking sentence, data, evaluation, analysis with relevant previous study findings, reflection (if applicable), and closing sentence. 2. Please do not create new information which was not mentioned in the objective and methodology. for eg., correlation (in line 194), I did not find anywhere it was mentioned. 3. please delete line 156-164 as these statements are general remarks. Can be used in introduction section though. 4. please compare and contrast your findings with specific studies rather than in general with multiple citations. conclusion: please delete line 213-215, as it is not in the scope of the study. instead, it would be better to write the implications of the findings. for eg. such prevalence of ACL injury would..... ****** 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: Subhash Regmi ******** [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/. 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Revision 1
23 Feb 2024 Author Response Dear Editor, Thank you for evaluating my work. The following comments have been check and edited in the manuscript file. Line 22 the introduction lacks a scientific rationale for this study. Edited Line 23 The author should provide a specific hypothesis. Edited Line 33 Could all the patients in this study recall the mechanism of injury? E.g., Fall with the knee in valgus position. Yes, as our sample included acute and new cases with knee injury they could recall. Line 35 Difference between military exercises and athletic exercise? Added and Defined in the methods Line 42 Could you please elaborate the prevention strategies this study has helped to develop? As mentioned in discussion and conclusion: The findings on mechanisms and prevalence of injury may help develop ACL injury prevention programs that may minimize the occurrence of such injuries in the military setting. Line 82 Please mention the rationale for excluding the chronic injury. The most important rationale was the recall bias which may occur with a longer time since injury. Other reasons include narrowing diagnosis and associated injuries. Line 85 Clinical and imaging findings for ACL tear have inter- observer and intra- observer variability. If only those patients taken for arthroscopic surgery were studied and intraoperative findings considered the gold standard, the results would be more reproducible. Yes, right, we did all investigation by one person to reduce any bias and error but included all injured knees in the study. Line 98 Clinical and imaging findings with respect to chondral and meniscus injuries have inter- observer variability. This also had been investigated by the same person. Line 128 Please define the military exercise. Defined previously Line 176 Please clarify the similarities and differences between the military and sports activities. As mentioned, both activities-as mentioned the examples- are the same in terms of magnitude of activity the difference are in kind of activity like combat and sport activities ,etc. Line 216 This study does not determine the exact measures to prevent an injury to ACL. as we discussed, our study provided data on knowing mechanism and prevalence of the injury which could be taken into account for neutralizing the associated factors of injury or decrease chance of getting injured. Line 192 The author has assumed that none of the patients were exposed to warm-up exercises.no we mean that although participants will get involve in warm-up exercise before actual activity, at the beginning of the actual and main activity, there would be a greater chance of injury as the body system has just faced real and serious activity, physiologically. Line 194 A gender sub-analysis could give a better insight. Yes, it was better if more extensive literature were available. we tried to elaborate it anyway. Line 194 Besides the mechanism of injury, there are other anatomical factors responsible for ACL injury. Please clarify how these factors have been matched. Actually our study was a cross sectional analytic study and we did not do any classic matching. Earlier studies have concluded even more detailed mechanisms of injury and prevention strategies. Please elaborate what this study adds extra to the existing knowledge related to the topic. We conducted the study in a referral military Iranian hospital which no previous data have been reported.so geographically; our data will help know regional data. Reviewer #2: Authors should be congratulated for such a nice work. It definitely has scientific merit and will be an interesting topic for readers. However, here are some suggestions: introduction section: please incorporate paragraphs 1 and 2 to shorten the introduction section and make the background information more relevant. line 57-59 can be deleted because it is not contributing much to the flow of writing. Edited methodology section: 1. Please mention the sample size calculation and sampling technique in detail (provide formula). According to the type 1 error value and accuracy equal to 5%, as well as considering the value of 50% for the percentage of knee ligament damage (in order to estimate the maximum sample size), at least 384 people should be examined in this study. In this research, the researcher studies about 402 patient by Census sampling in which 285 patients had ACL injury and included for analysis. 2. Please mention whether or not the normality of the data set was tested? Yes did in SPSS. 3. Please justify the use of statistical test based on the normality of the data. Consult statistician. Checked. 4. Please revise the statement mentioned in line 85/86, as it is confusing that you enrolled 285 or 402 patients. Better to mention it in the result section with flow of participants. Edited 5. As it is a cross-sectional descriptive analytical study, providing confidence intervals would be better. 6. You have mentioned that you included patients with knee complaints with pain, giving away, and locking. Did that mean all patients had locking symptoms? please clarify. No, any of the symptoms could be a presenting symptoms. Result section: 1. please avoid explanation of the study findings. for e.g. significantly lower. Please provide study findings as it is and explain them in the discussion section. All the tables are self-explanatory, so, limited writing is sufficient. In addition, please provide which test was done to calculate p value in all 4 table legends. - Chi-squared test was done to calculate p value Discussion section: it is weak and can be improved significantly by careful writing and direct comparison with previous study findings. Edited : 1. Please follow simple rule of academic writing that 1 paragraph should evaluate 1 outcome. Use format of breaking sentence, data, evaluation, analysis with relevant previous study findings, reflection (if applicable), and closing sentence. 2. Please do not create new information which was not mentioned in the objective and methodology. for eg., correlation (in line 194), I did not find anywhere it was mentioned. It is mentioned in Table 1 and paragraph 1 in result. 3. please delete line 156-164 as these statements are general remarks. Can be used in introduction section though. 4. please compare and contrast your findings with specific studies rather than in general with multiple citations. conclusion: please delete line 213-215, as it is not in the scope of the study. Instead, it would be better to write the implications of the findings. for eg. such prevalence of ACL injury would..... .edited. Alireza Rahimnia Regards, September 27, 2023 Attachments Attachment Submitted filename: reply to comments.docx https://doi.org/10.1371/journal.pone.0303326.r002
12 Apr 2024 Decision Letter - Luciana Labanca, Editor PONE-D-23-13460R1Prevalence and Mechanisms of Anterior Cruciate Ligament Tears in Military Personnel: A Cross-Sectional Study in IranPLOS ONE Dear Dr. Rahimnia, 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. Some minor comments which need to be addressed are reported below. Please submit your revised manuscript by May 27 2024 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: 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, Luciana Labanca 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. Additional Editor Comments: Lines 21-23. The meaning of the first sentence of the abstract is not clear. Please rephrase it. Line 90. Please, move the approval number after the name of the Institution providing the approval. Line 96. There are two dashes which should be removed. Line 121. Please change ; with . Line 125. Please change ; with . Line 149. Remove one of the dashes Line 254. In addition Line 263. Since you did not assess and reported other kind of injuries, I suggest to change in “…the ACL injury is one the most common knee injuries.” [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 #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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #2: (No Response) ****** 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: Yes: Subhash Regmi ******** [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.0303326.r003
Revision 2
22 Apr 2024 Author Response Dear Editor-in-chief Thank you for evaluating my work. All the helpful comments were reviewed and edited in the text as follows: The reference list is correct and in sync with the text. Lines 21-23. The meaning of the first sentence of the abstract is not clear. Please rephrase it. It is checked and revised. Line 90. Please, move the approval number after the name of the Institution providing the approval. Checked , edited. Line 96. There are two dashes which should be removed. Edited. Line 121. Please change ; with . changed. Line 125. Please change ; with . changed Line 149. Remove one of the dashes. Removed. Line 254. In addition. Edited. Line 263. Since you did not assess and reported other kind of injuries, I suggest to change in “…the ACL injury is one the most common knee injuries.” Edited. Regards, Monday, April 22, 2024 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303326.r004
24 Apr 2024 Decision Letter - Luciana Labanca, Editor Prevalence and Mechanisms of Anterior Cruciate Ligament Tears in Military Personnel: A Cross-Sectional Study in Iran PONE-D-23-13460R2 Dear Dr. Rahimnia, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Luciana Labanca Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0303326.r005
Formally Accepted
14 May 2024 Acceptance Letter - Luciana Labanca, Editor PONE-D-23-13460R2 PLOS ONE Dear Dr. Rahimnia, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 Dr. Luciana Labanca Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303326.r006

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