Achilles Tendinopathy Pathogenesis and Management: A Narrative Review^†

Round 1

Reviewer 1 Report

The article titled “Achilles Tendinopathy: an overview of the Pathogenesis and Management” aims to give readers a comprehensive knowledge of the pathogenesis and management of Achilles tendinopathy. Although the authors have written an introduction where they introduce the problem and show the possible lack of knowledge on the subject, the review methodology is scarce and lacks information, and the results are presented in a somewhat diffuse way that it would be necessary to order and clarify. Below is a list of suggestions and possible improvements that this reviewer proposes to improve the quality of the article.

 

TITLE:

P1Ln2. Identify in the title that it is a scoping or narrative review.

 

METHODS

P2Ln65. Identify each of the electronic databases consulted, as well as other possible bibliographic sources consulted. Provide the complete search strategy of at least one of them. Was gray bibliography taken into account?

Inform whether a previous registration of the review protocol was carried out.

 

DISCUSSION

P2Ln75. A narrative review on the Achilles tendon should include a section on diagnostic criteria, the most commonly used clinical and diagnostic tests due to their high specificity and sensitivity, as well as their differential diagnoses.

P2Ln80. Could the authors include two microscope images showing the normal and pathological appearance of the tendon?

P3Ln85. This paragraph could be described under the subheading “Risk Factors” for better understanding.

P3Ln88. Briefly list the main differences that characterize each of these phases and relate them to their recovery process.

P3Ln93-106. These lines would be better understood if they were in a single paragraph, which talks about systemic comorbidities.

P3Ln117. These histological changes make more sense if they are written after the clinical symptoms (P2Ln77-84).

P3Ln130. The heading “Conservative treatment” should in turn be divided into subheadings, such as pharmacology, physical therapy, orthotics, or injections, for example, for a better understanding of the reader.

P4Ln136. Conservative treatment techniques could be described with a better criteria based on placing first those considered as first line of treatment (exercise, for example) and that have more scientific evidence, and then those considered as second line of treatment (ESWT, for example). In the same way, it is recommended to cite articles with higher levels of evidence, as meta-analyses whenever possible, instead of RCTs in isolation. Regarding therapeutic exercise, the authors do not cite studies that evaluate the efficacy of the “Heavy slow resistance training” protocol, which has shown positive effects as well as eccentric exercise. Please revise.

P5Ln202. Insert ® if applicable.

P6Ln227. Explain the meaning of PRP in its first appearance.

P7Ln243. Explain the meaning of HVIGI in its first appearance.

P11Ln378. Discuss the limitations of this narrative review process.

 

CONSLUSIONS

P12Ln379. Provide next steps for research.

 

 

Author Response

Thank you for your valuable suggestions. Please find a point-to-point response to your queries in the attached file.

Author Response File: Author Response.pdf

Reviewer 2 Report

In this review, the subsection “Use of Stem cells: where are we?” is novel compared with the other reviews of AT.

 

Methods 

 

The authors ruled out the papers regarding insertional Achilles tendinopathy from this review. This process should be included in method section.

 

Please describe that this paper dealt only with non-insertional AT. 

 

Lines 182-185.  Please revise this sentence so it is easy to understand. 

 

Author Response

Thank you for your valuable suggestions. Please find a point-to-point response to your queries in the attached file.

Author Response File: Author Response.pdf

Reviewer 3 Report

Dear authors,

 

this is an interesting article however the methods need to be improved.

It is important to descrebited with more details the procedures , with exclusion or inclusion criterias.

Tables with main results would be useful.
the limitations need also to be refered.

 

 

 

Author Response

Thank you for your valuable suggestions. Please find a point-to-point response to your queries in the attached file.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

 Suggestions for Authors

The authors have done a proper job of reviewing and improving the article.