Dear Dr. Chiaramonte,

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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?

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: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Dear Author,

You can find my comments below,

Best regards

Title

• Consider simplifying wording for clarity:

“Comparison of Infection Rates for Needle Arthroscopy in Operating Room vs. Outpatient Sedated Settings in Dogs”

• Avoid overly long phrasing; keep terminology consistent throughout the manuscript.

Abstract

• State follow-up duration more explicitly (mean ± range).

• Add a sentence clarifying no inferential statistics were performed due to zero infection event rate.

• Mention the study design as retrospective in the first or second sentence.

Introduction

• Clarify why infection rates may theoretically differ between OR and outpatient sedated settings (e.g., environmental sterility differences).

• Strengthen motivation: emphasize the clinical relevance of avoiding general anesthesia and using minimally invasive diagnostic options.

Methods

1. Infection definition must be clearly stated.

Define what constitutes septic arthritis (e.g., clinical signs, cytology, culture positivity, response to treatment).

2. Outpatient procedural environment should be described more thoroughly:

• Room type

• Draping and barrier techniques

• Number of personnel

• Air handling/ventilation, if relevant

3. Follow-up description is insufficient:

• Specify how follow-up was conducted (in-person exam vs. phone follow-up vs. primary veterinarian exam).

• Indicate how many cases were lost to follow-up and how these were handled analytically.

4. Antibiotic protocol rationale should be briefly justified (why no prophylaxis in NOR).

Results

• Present follow-up duration for each group clearly and consistently.

• Specify how many cases had repeat arthroscopy and whether this was related to unresolved pathology vs. potential infection concerns.

• If possible, include a small table summarizing follow-up type (clinic vs. referring vet vs. phone).

Discussion

• Expand on the clinical implications of being able to safely perform NA outside the OR (cost, anesthesia avoidance, accessibility).

• Limitations should be more prominently discussed:

• Retrospective design

• Small sample size

• Zero-event data preventing statistical comparison

• Variable and sometimes short follow-up

• Lack of routine post-procedure cultures

• Consider rephrasing the conclusion to avoid overgeneralization:

The data suggest that needle arthroscopy performed under outpatient sedation did not demonstrate increased infection risk in this cohort when appropriate aseptic technique was used.

Conclusion

• Avoid implying equivalence without statistical testing.

• Use cautious phrasing: “no observed difference” rather than “no difference.”

Reviewer #2: The authors can be commended for bringing this information forward to share. That said I have concerns with the thrust of the paper being a determination of an infection rate without any infections and a too small of a population to be confident that the lack of infections isn't a type 2 error. Their cited sources regarding infections rates for arthroscopy all point to needing a larger population that that presented - unless you combine both groups which would not be recommended as they have significantly different antisepsis protocols which could also effect infection rate. I have attached more in-depth comments in a PDF of their manuscript.

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Reviewer #1: Yes: Mustafa Akkaya

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-25-49231 Needlescope review.pdf

Observed Joint Infection Incidence Following Needle Arthroscopy Performed in Operating and Nonoperating Room Environments in Client-Owned Dogs: A Retrospective Cohort Study.

PONE-D-25-49231R1

Dear Dr. Chiaramonte,

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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Kind regards,

Xiaoen Wei

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #2: N/A

Reviewer #3: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #2: The authors have addressed my concerns to the best of their ability and as the data and study allows. I have no further suggestions or recommendations. Thank you for giving me the option to review the manuscript revision.

Reviewer #3: This retrospective study by Chiaramonte et al. reports that needle arthroscopy procedures performed in non-operating room environments do not have a higher incidence of post-operative infections when compared to those performed in operating rooms in the population cohort studied. In the first round of review, the reviewers raised concerns regarding the low sample number and requested clarifications regarding some of the methodology and results reported.

In response, the authors have thoroughly revised the manuscript, added a detailed discussion on the limitations of the small cohort size and provided clarifications about the methods and results wherever requested. The manuscript in its current form is acceptable.

I have a few minor suggestions that the authors may add for better readability and interpretability of the manuscript:

1.For summary of cases, the authors may consider combining the two tables and adding separate columns for OR and NOR, for easier comparison between the cases across the groups.

2.The authors mention that repeat culture was performed only for one case and note as a limitation that cultures were not performed for all cases. The authors could clarify in how many cases culture was performed overall and provide the data regarding the same. They could also provide the data regarding the percentage of neutrophil population wherever available.

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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: No

Reviewer #3: Yes: Reema Banarjee

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