PONE-D-24-25139Effects of virtual reality technology on anterior cruciate ligament reconstruction: A systematic review and meta-analysisPLOS ONE

Dear Dr. Qian,

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Academic Editor

PLOS ONE

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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: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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

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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

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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: The manuscript presents a systematic review and meta-analysis of the effects of virtual reality technology (VRT) on anterior cruciate ligament (ACL) reconstruction rehabilitation. The study design, objectives, and methodology are clearly stated, and the results section provides a summary of the findings. However, there are several areas where the manuscript could be improved to enhance clarity, precision, and adherence to best practices in scientific reporting.

1. The abstract should succinctly summarize the novel findings and their implications, such as “This study is the first to systematically compare VRT with traditional therapy, providing evidence for the integration of VRT in post-ACLR rehabilitation protocols.”

2. The introduction should clearly state the gap in knowledge that the study addresses. Add a sentence that highlights the lack of consensus on the use of VRT in ACLR rehabilitation, emphasizing the study's contribution to filling this gap.

3. Clarify the time frames mentioned in this section. It is unclear what is meant by “more than one week” and “one week after surgery.” Specify the exact time points to avoid ambiguity.

4. The sensitivity analysis is well-conducted. However, it would be helpful to explain why the study by Gsangaya et al. had such a significant impact on the overall results. Consider adding a sentence or two discussing possible reasons.

5. The publication bias section is concise. However, it would be useful to mention the number of studies included in the Egger's test and the effect size.

6. The discussion should provide a more comprehensive synthesis of the findings in relation to existing literature. Discuss the mechanisms behind the observed effects, the clinical implications, and potential future research directions. Also, consider mentioning the limitations of the study and how they might affect the interpretation of the results.

7. Some of the statements in the manuscript are not clearly expressed and the quality of the language needs to be improved. Such as:

Current: This study aimed to examine the effects of VRT on rehabilitation following ACLR. The findings will help inform decisions regarding the use of VRT in clinical settings.

Revision Suggestion: This study aimed to evaluate the effects of virtual reality technology on rehabilitation following ACLR, providing insights for its application in clinical settings.

Current: After a selection process, six randomised controlled studies including a total of 387 patients who underwent ACL repair were considered.

Revision Suggestion: Following a rigorous selection process, six randomized controlled trials involving a total of 387 patients who underwent ACL reconstruction were included.

Current: The results indicate that VRT had a significant positive effect on various measures.

Revision Suggestion: The findings demonstrate that VRT significantly enhances knee function, walking ability, gait function, and knee muscular strength post-ACLR.

8. Ensure consistent use of terms (e.g., always use “virtual reality technology (VRT)” after its first mention).

9. Ensure that all references cited in the text are included in the reference list and vice versa. Double-check the formatting of the references to ensure consistency and adherence to the journal's style guide.

Reviewer #2: Title: really poor and scarce

Abstract

Report clear purpose and hypothesis if any

Design: ok

Objectives:any hypothesis

Methods: report keywords added

Results: too many numbers. hard to read

Conclusions: coherent

Introduction

Little bit too long

Please focus on the topic of your paper

Report current evidences and what are the controversies in literature

Explain the rationale for your study

finish with aim and hypothesis

methods

improve inclusion and exclusion criteria

results

little bit too long

discussion

start with main findings of your paper

report what is new and what this paper add to Current literature

explain how this study can help in clinical daily practice

improve limitations

conclusions

coherent

references

add following

D'Ambrosi R, Hewett TE. Validity of Material Related to the Anterior Cruciate Ligament on TikTok. Orthop J Sports Med. 2024 Feb 22;12(2):23259671241228543. doi: 10.1177/23259671241228543. PMID: 38405012; PMCID: PMC10893838.

D'Ambrosi R, Milinkovic DD, Abermann E, Herbort M, Fink C. Quality of YouTube Videos Regarding Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft Is Unsatisfactory. Arthroscopy. 2024 Aug;40(8):2236-2243. doi: 10.1016/j.arthro.2024.01.002. Epub 2024 Jan 6. PMID: 38185185.

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Reviewer #1: No

Reviewer #2: No

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Effectiveness of virtual reality technology in rehabilitation after anterior cruciate ligament reconstruction: A systematic review and meta-analysis

PONE-D-24-25139R1

Dear Dr. Qian,

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.

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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:

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: All comments have been addressed

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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: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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

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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

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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: all queries have been answered in full so the article deserve to be considered for publication in the journal

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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

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