Paediatric tibial tubercle fractures – a retrospective case series

PLOS One

Dear Dr. Mosch,

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.

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Please see reviewers' comments and suggestions.

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PLOS One

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Additional Editor Comments:

Please see reviewers' comments

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Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #1: Partly

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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: No

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: No

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Reviewer #1: This manuscript presents a retrospective single-centre case series describing patient characteristics, treatment strategies, outcomes, and complications of paediatric tibial tubercle fractures. Given the rarity of this injury, the study addresses a clinically relevant topic and contributes additional observational data to the existing literature. The cohort size is reasonable for such an uncommon condition, and the manuscript is generally well structured and clearly written.

The study design is appropriate for the stated descriptive aim. Patient selection criteria are clearly defined, fracture classification was performed by multiple investigators, and outcomes are reported transparently using descriptive statistics. The authors appropriately acknowledge the limitations inherent to the retrospective design, including the lack of standardised treatment protocols and variable follow-up duration, and they avoid strong causal claims.

The statistical analysis is suitable for a descriptive case series, with appropriate use of summary statistics and assessment of data distribution. However, the absence of comparative or inferential analyses limits the strength of certain interpretative statements, particularly when discussing differences between surgical and non-surgical treatment outcomes. These observations should be interpreted cautiously and framed strictly as descriptive associations.

A relevant methodological concern is the assumption that unrecorded variables were considered absent, which may introduce information bias and should be discussed more explicitly as a limitation. In addition, while the Data Availability Statement indicates that data are included within the manuscript and supporting files, individual-level or de-identified raw data underlying the reported summary statistics are not fully accessible in a public repository. This does not fully comply with the PLOS Data Policy and should be clarified or addressed.

The manuscript is written in clear and intelligible scientific English. Minor grammatical issues and stylistic inconsistencies are present but do not impede understanding and can be addressed during revision.

Overall, this study provides a useful descriptive overview of paediatric tibial tubercle fractures and their management. With clarification regarding data availability and minor methodological and interpretative refinements, the manuscript would be suitable for publication.

Reviewer #2: Full review added as attachment.

Overall, paper has an interesting premise and the potential to provide useful clinical summary on a relatively obscure injury. However, significant revisions need to be made before publication.

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what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Paediatric tibial tubercle fractures - Review.pdf

Paediatric tibial tubercle fractures – a retrospective case series

PONE-D-25-56381R1

Dear Dr. Mosch,

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,

Paolo Boffano

Academic Editor

PLOS One

Additional Editor Comments (optional):

In agreement with the reviewer, I think that the Authors appropriately performed the suggested changes.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

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

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

**********

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

Reviewer #1: Yes

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Reviewer #1: The authors have addressed the major methodological and reporting concerns raised in the previous review. The revised manuscript is substantially improved, particularly regarding fracture classification methodology, handling of missing data, definition of return-to-sport outcomes, statistical analysis, and clarification of study limitations.

The remaining issues are limited to minor language and stylistic inconsistencies that can be addressed during editorial processing. Overall, the manuscript is now suitable for publication.

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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 #1: No

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