Dear Dr. Chang,

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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?

Reviewer #1: Yes

Reviewer #2: No

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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

Reviewer #1: Yes

Reviewer #2: No

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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: I read this manuscript and I enjoyed the concept of the research which focuses on sports injuries and the wellbeing of tendons. There are many points to address before the manuscript is ready for publication.

Explain how the participants were made aware of this study and thus recruited in it.

It is important in a study like this to split volleyball players according to their playing position. A libero does not jump as much as attacking and blocking players, and setters don’t have the same jump and land biomechanics as hitters. Therefore, the authors must correct for playing position: liberos, setters, and attacking players. Also, it would be very interesting to see if the different players would show different patellar anatomies.

Please describe the breakdown between D1 and Olympic players. I noticed that the age range goes up to 34. was that specific athlete still playing professionally at that time, or have they retired and now play recreationally while maintaining the same workout regimen and play time?

It is not clear how many players never had PT, how many have a history but were asymptomatic when participated in the study. This is important to show.

Table1 needs to be split between no history of PT, history of PT but currently asymptomatic, and the currently symptomatic PT group.

Table1 Years of play: the range starts from 0...how is someone with 0 years of experience playing NCAA volleyball. Also, if they have 0 years of experience how are they suitable for inclusion in this study of elite players. Surely there should be a minimum number of years applied as inclusion criterion. How many players have less than 2 years experience?

Also, here it is important to split males from females especially that females in the US start playing volleyball at a younger age than males. Therefore, this will affect the average years of play.

Reviewer #2: The study is of interest and thorough, albeit carried out a long time ago (almost 20 years). Do the authors foresee any changes in the management of tendinopathy over the last 20 years affecting the relevance of the study today?

The authors set out their aim to understand how structural changes from jump-landings relate to anthropometrics and range of motion. Firstly, the authors replicate known results that tendinopathy correlates with increased tendon thickness and decreased PSFR. Because of this, the inclusion of participants both with and without tendinopathies is a clear confounding factor which makes it difficult to decouple whether the correlations observed relate to an individual's tendon morphology or their history of tendinopathy.

Throughout, very weak correlations are oversold based on the statistical significance of these weak correlations. I worry this will mislead readers as to the importance of these correlations. Regardless of correlation strength, publication of the results is certainly of interest to the field, but the weakness of these correlations should be made much clearer to readers throughout.

e.g. "A novel finding of our study is that distal tendon micromorphology, as indexed by the

PSFR, is significantly associated with hip and ankle joint ROM (Fig 3A)" - Figure 3A shows an incredibly low r^2 = 0.0484, and the tone of the text misrepresents this as an important correlation. Another example is in the conclusions: "Athletes with worse distal tendon morphology had reduced hip and ankle ROM, larger body mass, and greater mass concentration around the waist" - anyone can see from Figure 3 that this is hyperbole and does not reflect the reality of the results. Equally, I'm not convinced the title of the manuscript is supported.

A majority of the results are merely stated without graphical representation of the data and, given the above issues, it would be in the reader's interest to have visualisation of all stated results, either in figures in the main article or in supplementary material.

The introduction, methodology, and discussion sections mention a single leg squat test, the results of which don't appear to be included.

The acquired data is worthy of publication, however as the current conclusions are not supported by the data, I cannot recommend publication in its current state.

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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.

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Reviewer #1: No

Reviewer #2: No

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Relationship of patellar tendon micromorphology with body anthropometrics and lower-limb range of motion in volleyball athletes

PONE-D-26-03907R1

Dear Dr. Chang,

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,

Laura-Anne Marie Furlong

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

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5. 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: The authors have addressed all my comments satisfactorily.

I enjoyed reading their work and wish them all the best in future projects.

I would be delighted to review more submissions by this group on this topic.

Reviewer #1.

Reviewer #2: The response of the authors is comprehensive, primarily including a rigorous reanalysis of the data. This has led to a greatly improved manuscript, and I am pleased to see this has also led to new and more in-depth results, discussions, and conclusions. The manuscript is an important reference for the relationships between body anthropometrics/ROMs and PSFR as a readout of collagen fibril organisation.

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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

Reviewer #2: No

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