-->PONE-D-25-39091-->-->High-intensity eccentric hip abductor strength training improves dynamic knee valgus in a task-dependent manner in asymptomatic young women: a pilot study-->-->PLOS ONE

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[ÁF, PI, and BG was supported by the Ildikó Kriszbacher scholarship, University of Pécs. BS was supported from EKÖP-24-4-I-PTE-379, funded by the Ministry of Culture and Innovation, National Fund for Research, Development and Innovation, under the University Research Grant Programme EKÖP-24-1. For the remaining authors none were declared.].

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Reviewer #1: Yes

Reviewer #2: Partly

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Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1: This is an automated report for PONE-D-25-39091. This report was solicited by the PLOS One editorial team and provided by ScreenIT.

ScreenIT is an independent group of scientists developing automated tools that analyze academic papers. A set of automated tools screened your submitted manuscript and provided the report below. Each tool was created by your academic colleagues with the goal of helping authors. The tools look for factors that are important for transparency, rigor and reproducibility, and we hope that the report might help you to improve reporting in your manuscript. Within the report you will find links to more information about the items that the tools check. These links include helpful papers, websites, or videos that explain why the item is important. While our screening tools aim to improve and maintain quality standards they may, on occasion, miss nuances specific to your study type or flag something incorrectly. Each tool has limitations that are described on the ScreenIT website. The tools screen the main file for the paper; they are not able to screen supplements stored in separate files. Please note that the Academic Editor had access to these comments while making a decision on your manuscript. The Academic Editor may ask that issues flagged in this report be addressed. If you would like to provide feedback on the ScreenIT tool, please email the team at ScreenIt@bih-charite.de. If you have questions or concerns about the review process, please contact the PLOS One office at plosone@plos.org.

Reviewer #2: Hello to all authors,Was this pilot study conducted to assess participants’ acceptance of the protocol, to evaluate the validity of measurement tools, or to estimate the dropout rate for a future main study?

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Reviewer #2: Yes: Dr. Mohadeseh AshrafizadehDr. Mohadeseh Ashrafizadeh

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Submitted filename: report_10.1101+2025.09.11.25332758.pdf

-->PONE-D-25-39091R1-->-->High-intensity eccentric hip abductor strength training improves dynamic knee valgus in a task-dependent manner in asymptomatic young women: a pilot study-->-->PLOS One

Dear Dr. Fésüs,

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 02 2026 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.. 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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-->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 . 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..

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Mário Espada, PhD

Academic Editor

PLOS One

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Congratulations on your work.

Please revise the manuscript in light of the reviewers' minor suggestions.

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Reviewer #2: (No Response)

Reviewer #3: (No Response)

Reviewer #4: (No Response)

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Reviewer #3: Yes

Reviewer #4: Partly

**********

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

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: (No Response)

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Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

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Reviewer #2: (No Response)

Reviewer #3: Reviewer Comments on Manuscript PONE-D-25-39091

Title: High-intensity eccentric hip abductor strength training improves dynamic knee valgus in a task-dependent manner in asymptomatic young women: a pilot study

Journal: PLOS ONE

Reviewer’s Assessment: Major Revisions Recommended

General Overview:

This pilot study investigates a relevant and timely research question: whether the mode of hip abductor strength training (eccentric vs. concentric) differentially affects dynamic knee valgus (DKV) and jump performance in asymptomatic young women. The study is well-motivated, highlighting the often-overlooked eccentric control function of the hip abductors. The use of an isokinetic dynamometer for precise, maximal-effort training and testing is a significant strength. The findings that eccentric training was superior in reducing DKV during a single-leg countermovement jump (SLCMJ) but not during a drop landing are novel and interesting. However, several methodological ambiguities, statistical reporting issues, and overinterpretations in the discussion need to be addressed before the manuscript is suitable for publication.

Major Concerns:

Participant Selection and DKV Quantification:

The inclusion criterion of "presence of DKV subjectively evaluated by a physiotherapist using the single leg squat test" is a major methodological weakness. Subjective visual assessment is known to have limited reliability. To strengthen the study's validity, the authors should provide data on the inter- or intra-rater reliability of this assessment. Furthermore, since baseline DKV values were subsequently measured with 3D motion capture, why were these objective data not used as the primary inclusion criterion? A minimum threshold of DKV (e.g., >10°) would have created a more homogeneous and relevant sample.

Ecological Validity of the Training Intervention:

While the use of an isokinetic dynamometer allows for excellent experimental control, its ecological validity is a concern. Training the hip abductors in a side-lying, non-weight-bearing position is quite different from the functional, weight-bearing context in which DKV occurs (e.g., jumping and landing). The authors should discuss this as a key limitation. The impressive strength gains (20-42%) may be specific to this testing/training apparatus and may not fully translate to the coordinated, multi-joint control required during the SLCMJ and landing tasks.

Statistical Analysis and Interpretation:

Interaction Effects: The key finding of a significant group-by-time interaction for DKV during the SLCMJ (p < 0.05) is well-presented. However, the interpretation of the non-significant interaction for DKV during the landing task (p > 0.05) needs to be more nuanced. The paper states "eccentric vs. concentric training reduced DKV in single leg CMJ more than in single leg drop landing." This is accurate, but it should be emphasized that the training did not differentially affect the landing task. The discussion should explore potential reasons for this task-dependent adaptation more deeply.

Correlation Analysis: The lack of correlation between strength gains and DKV reduction is a critical finding that challenges the study's primary hypothesis. The current discussion offers plausible reasons (e.g., timing of activation vs. maximal strength, differential muscle usage). This section should be expanded, as it points toward neuromuscular control rather than raw strength being the primary driver of the observed improvements. The authors should consider whether the sample size (n=20) was sufficient to detect a moderate correlation, and note this as a limitation for the correlation analysis.

Clarity of Methods - Work Equilibration:

The description of equating mechanical work between groups needs clarification. The authors state that concentric subjects performed an additional 5th set to match the work of the eccentric subjects. This implies that the training stimulus was not identical in volume. It also suggests that the "maximal effort" in the concentric group's 5th set may have been performed under significant fatigue. Please provide more detail on the timing of this 5th set and how the total work was calculated and matched session-by-session.

Minor Concerns:

Terminology and Grammar:

"Dynamic knee valgus": This term is correctly used, but the manuscript would benefit from a brief operational definition early in the methods (e.g., "defined as the frontal plane projection angle...").

"countermovement jump": Please ensure this term is consistently capitalized (CMJ) after its first use, as it appears in lowercase in several places (e.g., Abstract line 40, Results line 256).

Abstract Line 37: "dynamic knee valgus" should be capitalized as "Dynamic knee valgus" to start the sentence.

Data Presentation:

Table 2: The table is very dense. Consider splitting the ANOVA results into a separate table or using symbols (e.g., *, †) directly in the table to denote significant main effects and interactions for easier readability. The column headers for the ANOVA results are also difficult to follow.

Specific Discussion Points:

Lines 307-310: The statement regarding the lack of effects in previous studies should be tempered. The current study uses a different population, training method (isokinetic), and outcome measure, making direct comparisons difficult.

Conclusion: The conclusion in the abstract and main text ("improves dynamic knee valgus and vertical jump performance") is too broad. It should specify that it improves DKV in a task-dependent manner (favoring SLCMJ) and improves jump performance similarly to concentric training.

Questions for the Authors:

What was the rationale for choosing a 4-week intervention? Was a power analysis conducted to determine the sample size of 20, and if so, what was the expected effect size for the primary outcome (DKV change)?

Were the participants blinded to their group allocation (eccentric vs. concentric)? If not, how might this have influenced the results?

Could the "task-dependent" improvement in the SLCMJ be partially explained by a learning effect specific to the jump task, given that the training did not involve a similar plyometric movement?

Reviewer #4: I suggest softening the conclusions and avoiding statements that imply injury-prevention benefits. Considering the pilot design, the small sample size, the use of DKV as a surrogate outcome, and the lack of muscle activation measures, the results should be interpreted as suggestive findings showing a task-specific effect on DKV rather than evidence of reduced ACL injury risk.

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Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes: Seham Abdallah ElazabSeham Abdallah Elazab

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High-intensity eccentric hip abductor strength training improves dynamic knee valgus in a task-dependent manner in asymptomatic young women: a pilot study

PONE-D-25-39091R2

Dear Dr. Ádám Fésüs,

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.

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