Comparative analysis of isokinetic ratios between hamstrings and quadriceps in wrestlers: Resting state versus post-fatigue evaluation

Ali Tatlıcı; Ahmet Kurtoğlu; Muhammed Yılmaz; Halil Güngör; Ömer Özer; Bekir Çar; Jarosław Muracki; Robert Trybulski; Monira I. Aldhahi

doi:10.1371/journal.pone.0342975

Peer Review History

Original SubmissionNovember 11, 2025
17 Dec 2025 Decision Letter - Esedullah Akaras, Editor -->PONE-D-25-60422-->-->Comparative Analysis of Isokinetic Ratios Between Hamstrings and Quadriceps in Wrestlers: Resting State Versus Post-Fatigue Evaluation-->-->PLOS One Dear Dr. Kurtoğlu, 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 Jan 31 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. 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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: Dear Authors. Thank you for your work. I am surprised after reading your work. I live in a country which is a Trendsetting Country in wrestling. I carefully evaluated your work and have some concerns which are commented to the file. Reviewer #2: Manuscript number … Title Comparative Analysis of Isokinetic Ratios Between Hamstrings and Quadriceps in Wrestlers: Resting State Versus Post-Fatigue Evaluation Thank you for choosing me as a reviewer. General comment: Excellent work! Congratulations on a very well-written manuscript. I only have a few minor comments/suggestions. - When using abbreviations, please first provide the full term followed by the abbreviation in parentheses (e.g., functional hamstring-to-quadriceps ratio (H:QFunc) or conventional hamstring-to-quadriceps ratio (H:QConv) and then use the abbreviation throughout the manuscript. This will improve clarity and readability for all readers. - The introduction presents both ratios, but their practical differences and applications remain - It is not clear which leg was tested—was it the dominant leg? If so, please clarify how dominance was defined, as the concept of a dominant leg can vary depending on the type of motor task or movement being considered. Providing this information would improve clarity and reproducibility of the protocol. - Pre- and post-fatigue, indicating that velocities differ overall. However, this effect does not specify differences separately for pre- or post-fatigue unless the Time × Velocity interaction is significant or a simple main effects analysis is conducted. Therefore, it is recommended to perform a simple main effects or post-hoc analysis for each level of Time to clearly report how velocity changes before and after fatigue. unclear. It would be helpful if you could provide a more detailed explanation. - It may be helpful to clarify how the peak torque was determined across the three maximal repetitions—for example, whether the single highest value or an average was used. ****** -->6. 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Revision 1
7 Jan 2026 Author Response REVIEWERS’ COMMENTS AND AUTHORS’ RESPONSE Paper title: Comparative Analysis of Isokinetic Ratios Between Hamstrings and Quadriceps in Wrestlers: Resting State Versus Post-Fatigue Evaluation Revised paper title: Comparative Analysis of Isokinetic Ratios Between Hamstrings and Quadriceps in Wrestlers: Resting State Versus Post-Fatigue Evaluation Dear Editor, The authors would like to thank the reviewers for their precious time and invaluable comments. We have carefully addressed all the comments. The corresponding changes and refinements made in the revised paper are summarized in our response below. Our detailed, point-by-point responses to the reviewer comments are given below. Additionally, we have carefully revised the manuscript to ensure that the text is optimally phrased and free from typographical and grammatical errors. In the research text, corrections from the reviewer are indicated in yellow. Thank you once again for considering our work and for inviting us to submit the revised manuscript. We look forward to hearing from you. Best regards. Reviewer 1 Major comments 1. ABSTRACT Q1. Start with a background, then state the aim. A1. In line with your suggestion, background added to abstract. “Wrestling has high-intensity competitive demands, and tournament structures typically require athletes to compete in multiple matches within a single day. This results in accumulated neuromuscular fatigue that may disrupt the balance between hamstring and quadriceps strength, potentially increasing the risk of knee injuries.” Q2. The participants are very young and I do think that your results cant be interpreted for general population. Their style (Greco-Roman) must be discussed in the introductory section so that why you have considered them. A2. Approximately 60% of knee injuries have been reported to occur through non-contact mechanisms, which are commonly associated with movements that impose high loads on the knee joint, such as sudden deceleration, rapid changes of direction, and jumping–landing tasks (Belozo et al., 2024). In this context, the hamstring–quadriceps (H/Q) strength ratio is considered a critical neuromuscular factor influencing knee stability. In freestyle wrestling, frequent direct contact with the lower extremities makes it difficult to clearly distinguish whether knee injuries occur through contact or non-contact mechanisms. In contrast, Greco-Roman wrestling prohibits attacks below the waist, thereby limiting direct lower-limb contact and increasing the relative contribution of non-contact mechanisms to knee injuries. Therefore, Greco-Roman wrestlers were selected in the present study to more clearly examine fatigue-induced changes in hamstring–quadriceps strength balance. In line with your suggestion, information added to intro. “Knee injuries, especially anterior cruciate ligament injuries, are said to happen about 60% of the time in non-contact ways. These injuries are often linked with quick stops, fast turns, and jumping-landing activities that put great stress on the knee joint [8]. In this situation, the hamstring-quadriceps strength ratio is seen as an important neuromuscular factor that affects stability in the knee. In Greco-Roman wrestling, attacks below the waist are prohibited, which limits direct lower-extremity contact [9]. In contrast, freestyle wrestling allows contact with the legs and lower extremities [9], making contact-related mechanisms more prevalent. Therefore, non-contact injury mechanisms are considered more likely to contribute to knee loading patterns observed in Greco-Roman wrestling”. 2. INTRODUCTION Q3. Providing evidence of knee injuries in end-stage competition conditions or final matches can lead to a better rationale and make better sense for the issue. A3. We thank the reviewer for this valuable comment. We agree that providing evidence of knee injuries occurring during end-stage competition conditions or final matches could strengthen the rationale of the study. However, to the best of our knowledge, the existing literature does not report knee injury occurrence according to match order or tournament stage in wrestling competitions. Based on the reviewer’s suggestion, we have added a statement to the manuscript acknowledging this limitation of the current literature and clarifying the context of our study. “To the best of our knowledge, the existing literature does not report injury occurrence according to match order or tournament stage in wrestling competitions”. 3. METHODS Q4. Your participants are too young. You can interpret your results only to young Greco-Roman wrestlers. Their weight grade is controlled? A4. We thank the reviewer for this valuable comment. We agree that, due to the relatively young age of the participants, the findings of the present study should be interpreted specifically within the context of young Greco-Roman wrestlers. Based on the reviewer’s comment, we have added this point to the Limitations section, clarifying that the results should not be generalized to adult or general wrestling populations. “This study examined the effects of a fatigue-inducing protocol on the muscle strength profiles of youth Greco-Roman wrestlers”.” Thus, both fatigue and movement velocity should be considered when developing training strategies and injury prevention programs for youth Greco-Roman wrestlers”. “First, because of the relatively small sample size, these findings cannot be generalized to the greater wrestling community or athletes from other sports.” The sentence was added to methods “Weight category was not controlled as a separate analytical variable”. Although the athletes competed in different official weight categories, weight category was not controlled as a separate analytical variable because the analyses were based on within-subject comparisons between rest and post-fatigue conditions. The athletes included in this study were enrolled in state-operated national training camps organized by the Ministry of Youth and Sports and were part of structured Olympic preparation programs. Participants competed in officially regulated weight categories and were evaluated within their respective weight classes. In addition, all athletes trained and lived under standardized conditions within the same camp environment, including supervised training loads, nutrition, and recovery routines. These controlled conditions minimize potential weight- and lifestyle-related confounding factors and strengthen the internal validity of the study.” Q5. Your participants are relatively novice. It is another limitation which must be acknowledged in the limitations section A5. We thank the reviewer for this important comment. We agree that the relatively novice status of the participants represents an additional limitation of the present study. In line with the reviewer’s suggestion, this point has been acknowledged and explicitly added to the Limitations section of the manuscript. “Another limitation of this study is that the participants were relatively early in their competitive development, which may limit the generalizability of the findings to more experienced or elite adult Greco-Roman wrestlers” Q6. Add technical aspects of the device. A6. We thank the reviewer for the suggestion. The model and manufacturer details of the Cybex isokinetic dynamometer (Cybex NORM®, HUMAC, CA, USA) have already been specified in the Materials and Methods section. Q7. What do you mean standardized laboratory conditions? Please clarify A7. All measurements were conducted in the same laboratory under controlled environmental conditions, at similar times of day. The isokinetic dynamometer setup, participant positioning, warm-up protocol, and testing procedures were standardized and applied consistently for all participants by the same experienced examiner. Q8. Which leg was assessed? A8. We thank the reviewer for this comment. In accordance with the suggestion, the manuscript has been revised to clarify that all isokinetic strength assessments were performed on the dominant leg, defined as the preferred kicking leg. Q9. Provide the rationale for chosing these two velocities. A9. The angular velocities of 60°/s and 180°/s were selected as they are among the most commonly used testing speeds in isokinetic H/Q assessments and allow evaluation of muscle function under both low and moderate-velocity conditions, as reported in previous literatüre. Also, the angular velocities of 60°/s and 180°/s were selected as they are the most commonly reported speeds in the literature for assessing H/Q ratios, including systematic reviews and meta-analyses in combat sports (Rašković, S., et al. 2023). The information was added to text. “These angular velocities were selected because they are widely used in the literature to assess H/Q strength balance at low and moderate movement speeds [29].” Q10. You can use the following reference: Esmaeili, H. and Sharifi, A., 2022. Bilateral asymmetry of hamstring to quadriceps isokinetic torque ratio in different angular velocities in professional basketball players. The Knee, 37, pp.3-9. A10. It was added. Q11. As like as other references A11. It was fixed. Q12. Holm-Bonferroni ??????? A12. As this criticism was also made by the previous referee, it was added to the text and highlighted in yellow. “We additionally tested simple main effects (Holm-adjusted) of Velocity within each level of Time and of Time within each Velocity. For QCON, the within-speed time contrasts reproduced the same direction but did not reach significance at either speed (60°/s: Rest−Post = +9.62 Nm, 95% CI [−2.79, 22.00], p = .119; 180°/s: +3.00 Nm, [−4.95, 11.00], p = .434). For HCON, Velocity was significantly higher at 60°/s than 180°/s both at rest and post-fatigue (Rest: +17.1 Nm, [+10.8, +23.3], p < .001; Post: +19.1 Nm, [+10.4, +27.8], p < .001), whereas the Time simple effects were not significant within either speed (60°/s: Rest−Post = −4.25 Nm, [−12.3, 3.84], p = .281; 180°/s: −2.19 Nm, [−10.5, 6.10], p= .582). For HECC, the Velocity simple effect was significant only post-fatigue (Post: +7.5 Nm, [+1.81, +13.19], p = .013), with no significant time contrasts within speeds. For H:QConv, the Time simple effect was significant at 60°/s(Rest−Post = −0.104, [−0.174, −0.034], p = .006), but not at 180°/s (−0.042, [−0.109, 0.025], p = .201); the Velocity simple effect was significant at rest (−0.132, [−0.185, −0.078], p < .001). For H:QFunc, the Time×Velocity interaction was clarified by a significant time contrast at 60°/s (Rest−Post = −0.131, [−0.217, −0.044], p = .006) but not at 180°/s(−0.035, [−0.114, 0.043], p = .356), while the Velocity simple effects were significant at both time levels (Rest: −0.329, [−0.430, −0.228], p < .001; Post: −0.233, [−0.312, −0.154], p < .001). These simple-effects results make explicit how velocity behaves within rest and post-fatigue and confirm the omnibus ANOVA conclusions.” Q13. Δlog(HKON) A13. It was fixed. 4. RESULTS Q14. Present as normalized to Body mass to make comparison with other studies????????? A14. Dear Reviewer, we thank you for your suggestion regarding comparability based on body mass. While maintaining the main analysis plan, we additionally (i) analysed torques in Nm·kg⁻¹ and allometric (T/mass^b, where the coefficient b was estimated using log–log regression in the sample) form; (ii) constructed repeated measures ANCOVA models including weight as a covariate and reported simple effects adjusted for weight using emmeans. These sensitivity analyses showed that the direction and magnitude of the main findings did not change. Therefore, we added the corresponding method to the statistical analysis section. “For sensitivity purposes, torques were additionally normalised according to body mass (Nm·kg⁻¹) and analysed allometrically as T/mass^b (b estimated via log–log regression in the sample); repeated measures ANCOVA (simple effects adjusted for mass using emmeans) were also conducted, including mass as a covariate.” 5. DISCUSSION Q15. Kraemer et al is correct. Please note that you have only considered youth Greco-Roman wrestlers. You must take into account through the discussion. A15. “In this study, conducted in youth Greco-Roman wrestlers, a similar phenomenon seems to explain the increase in the H:QConv and H:QFunc ratios after fatigue events”. “After fatigue, both the H:QConv and H:QFunc ratios increased in youth Greco-Roman wrestlers, mainly due to a significant decrease in quadriceps strength, while the hamstrings remained relatively unchanged”. “In contrast to the findings observed in youth Greco-Roman wrestlers in the present study, fatigue has been reported to affect the hamstrings more severely in sports such as soccer, futsal, basketball, and handball, thereby decreasing the H:Q ratio”. “This study examined the effects of a fatigue-inducing protocol on the muscle strength profiles of youth Greco-Roman wrestlers.” Were added to discussion. Q16. This is on the soccer players. Please use it correctly. A16. The sentence correctly rewritten again in form of your suggestion. “Fatigue has been associated with impaired muscle function and an increased risk of hamstring strain, particularly in soccer players [35], as well as anterior cruciate ligament injuries [36]”. Q17. Use correct style for refering. Look jPONE guidelines A17. Thank you for the comment. The manuscript has been revised, and all citations have been carefully checked and adjusted in accordance with the journal’s citation guidelines. In particular, references referring to studies conducted in other sports have been clarified and used in their appropriate context. Q18. Discuss about effect sizes. A18. This paragraph was rewritten in accordance of your suggestion. “In this study, both the H:QConv and H:QFunc ratios increased after fatigue. However, only the functional ratio showed a significant time×velocity interaction, indicating greater sensitivity to changes in both fatigue and contraction angular velocity. The effect size analysis revealed a large effect of fatigue on the H:QFunc ratio, whereas the effects observed for the H:QConv ratio were comparatively smaller and less sensitive to velocity-related changes. This is consistent with previous studies that identified the H:QFunc ratio as a more robust indicator of neuromuscular balance and injury risk [4]. Croisier et al reported that reduced H:QFunc ratios represent one of the most common neuromuscular imbalances in athletes and are better predictors of injury risk than reduced H:QConv ratios [10]. Baroni et al. also emphasized that the H:QFunc ratio more accurately reflects sport-specific muscle coordination demands, particularly at higher angular velocities [42]. Overall, the presence of larger and velocity-dependent effects for the H:QFunc ratio supports its greater practical relevance compared with the conventional ratio. These results highlight the importance of assessing the H:QFunc ratio, especially under conditions of fatigue and varying angular velocities, as a more informative and practical approach for monitoring muscular balance and injury susceptibility in athletes.” 6. CONCLUSION Q19. You can only generalize your results for young Greco-Roman wrestlers. Please acknowledge it. A19. Thank you for this comment. We have revised the Conclusions section to explicitly acknowledge that the findings of the present study are specific to youth Greco-Roman wrestlers and should not be generalized to adult or elite wrestling populations. “However, these findings should be interpreted with caution, as they are specific to youth Greco-Roman wrestlers and may not be directly generalizable to adult or elite wrestling populations”. Reviewer 2 Minor comments 1. ABSTRACT Q1. - When using abbreviations, please first provide the full term followed by the abbreviation in parentheses (e.g., functional hamstring-to-quadriceps ratio (H:QFunc) or conventional hamstring-to-quadriceps ratio (H:QConv) and then use the abbreviation throughout the manuscript. This will improve clarity and readability for all readers. A1. Thank you for your valuable comment. The manuscript has been carefully revised, and all abbreviations used in the text are now written in their full form at Attachments Attachment Submitted filename: R1. Respose to Reviewer 2 - Kopya.docx https://doi.org/10.1371/journal.pone.0342975.r002
2 Feb 2026 Decision Letter - Esedullah Akaras, Editor <p>Comparative Analysis of Isokinetic Ratios Between Hamstrings and Quadriceps in Wrestlers: Resting State Versus Post-Fatigue Evaluation PONE-D-25-60422R1 Dear Dr. Kurtoğlu, 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. 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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 ****** -->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: Dear Authors, All of my comments are addressed accordingly, The manuscript has been improved. Congratulations to your study Reviewer #2: The authors have addressed all comments well. In my opinion, the article is suitable for publication in this journal. ****** -->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: Yes: Hamed Esmaeili Reviewer #2: Yes: Mohamadreza Hatefi ******** https://doi.org/10.1371/journal.pone.0342975.r003
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