Expediting Finite Element Analyses for Subject-Specific Studies of Knee Osteoarthritis: A Literature Review

Round 1

Reviewer 1 Report

This manuscript entitled “Expediting Finite Element Analyses for Subject-specific Studies of Knee Osteoarthritis: A Literature Review” primarily aimed to advised nowadays trends appear analytic methods for subject-specific knee OA studies utilizing FEA. The results of this study may provide guidance for public health and biomedical engineering. While it is a very interesting, there are several questions should be properly addressed, which are listed below.

 

Specific comments

1. In the abstract part, in the opinion of reviewer, the author provided too much descriptions of background, which may be too long-winded. I suggest that the authors provide more descriptions of aim, method and conclusion of this study in the abstract part.
2. What is the aim of this study? Please provide relevant description about it.
3. Please provide the main methodology for this literature review.
4. In the introduction part. “All knee joint tissues work in harmony to maintain the health of the joint, however, when functionality in any of the knee components is disturbed, for instance, due to overweight or trauma, the joint is exposed to the development of osteoarthritis (OA).” Please add some references to support this sentence.
5. “Furthermore, over 600,000 TKR surgeries take place in the US annually [8], exposing the necessity of preventative alternatives to surgery.” The reviewer suggested that the authors provide worldwide survey data rather than a single country.
6. “In addition to MRI-based solutions, ultrasound techniques can also estimate tissue characteristics in vivo, such as thickness and stiffness…” While the Adam 1998 reference is seminal, there are more recent publications that discussed the ultrasound techniques. Please provide the latest references in this sentence.
7. “These papers were sourced from ScienceDirect, Pub-Med, and SpringerLink databases.” The reviewer suggested that the author present the retrieval process in the form of a flow chart.
8. In Knee FEA workflow part.” The linear tetrahedral is the simplest volumetric element and the preferred for automated meshing methods” Please add a reference to supper this sentence.
9. “high-or-der elements (e.g., Figure 3, tet10, tet15, hex20) are recommended to better track deformations and stresses in soft tissues such as cartilage, muscle, or ligament.” please provide more description about why are authors to recommend the high-or-der elements.
10. In the discussion part.” In addition to surgical interventions, conservative options, such as gait retraining and weight loss, could also be aided and encouraged by computational models to prevent dis-ease progression.” Please use more than one references to prove this statement.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

This is a great review on the development and use of finite element analysis for the assessment of knee osteoarthritis. Authors have successfully summarized the available evidence elegantly describing all the main aspects of such a promising technology. The article is very well written and will surely enrich the scientific audience of the journal.

A few minor comments:

• Line 90: It is not needed to reintroduce the full form of "FEA" here.
• Figures 2 and 3: All the abbreviations in the picture should be explained in the Figure caption.

Author Response

Please also find the attachment.

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MANUSCRIPT ID: applsci-1440518

 

MANUSCRIPT TYPE: Review

 

Title: Expediting Finite Element Analyses for Subject-specific Studies of Knee Osteoarthritis: A Literature Review

 

AUTHOR(S): Alexander Paz, Gustavo A. Orozco, Rami K. Korhonen, José J. García, and Mika E. Mononen

 

 

REVIEWER #2

General Comments to the author:

This is a great review on the development and use of finite element analysis for the assessment of knee osteoarthritis. Authors have successfully summarized the available evidence elegantly describing all the main aspects of such a promising technology. The article is very well written and will surely enrich the scientific audience of the journal.

 

Author answer:

We thank the Reviewer for the considerable time and effort taken in the review of our manuscript. We appreciate your comments and recommendations for the improvement of the manuscript. We have now addressed all comments given by the Reviewers and believe that our manuscript has improved significantly. When addressing the Reviewers' comments, the parts that we have changed based on those comments are marked with the red font using the “Track Changes” in the revised manuscript.

Specific comments

Comment 1:

Line 90: It is not needed to reintroduce the full form of "FEA" here.

 

Author answer:

We agree on the FEA abbreviation was used in the immediate previous paragraphs and reintroducing the FEA term in extending it is not necessary.

 

Author action:

We removed the reintroduction of the FEA abbreviation.

 

Comment 2:

Figures 2 and 3: All the abbreviations in the picture should be explained in the Figure caption.

 

Author answer:

We agree some of the abbreviations may not be familiar to the public in general. For more clarity, we included the definition of all the abbreviations used in the figures.

 

Author action:

Updated figure legends:

 

Figure 2. Finite element analysis workflow. Pre-processing integrates preparatory information to define the model. Processing solves the governing equations behind the physical interactions aided by computational tools. Post-processing evaluates the simulation outputs by using qualitative and quantitative methods. Verification and validation feedback the modeling process to ensure logical results that represent the realistic behavior of the problem in question and draw conclusions about the problem simulated. MRI – Magnetic resonance imaging , CT – computed tomography, SSM – statistical shape modeling, CAD – computer aided design, PG – proteoglycan, IMU – inertial measurement unit, EMG – electromyography, AI – artificial intelligence, PDE – partial differential equation, ACL – anterior cruciate ligament, KL – Kellgren-Lawrence score, MOAKS – MRI osteoarthritis knee score, WORMS – whole-organ magnetic resonance imaging score.

 

Figure 3. Some types of solid elements used for FEA. From left to right, tetrahedral of four nodes (tet4), tetrahedral of ten nodes (tet10), tetrahedral of fifteen nodes (tet15), hexahedral of eight nodes (hex8), hexahedral of twenty nodes (hex20). (FEBio User Manual 2.9-3.8.2.1 https://help.febio.org/FEBio/FEBio_um_2_9/index.html).

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Authors should be commended for the substantial revisions made to improve the quality and clarity of this manuscript. Congratulations for this nice study.