Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex

Round 1

Reviewer 1 Report

very interesting

Author Response

Thank you for the positive response. The manuscript has been further improved to meet a number of suggestions and recommendations from the other reviewers. Regards

Reviewer 2 Report

the work does not add a significant thing to the field and suffers from critical limitations in the methods applied and describing them. Also, the discussion and conclusion are poorly written.

Author Response

Thank you for reviewing our manuscript. This has been improved considerably, particularly the sections here recommended, also to meet a number of relevant suggestions from the other reviewers. Regards

Reviewer 3 Report

Thank you for the opportunity to review this well-written manuscript.

In the abstract section, please re-write the conclusion part, by answering the study objective, which method is better and its practical application.

Similarly, please edit the conclusion at the end of the manuscript. Provide conclusion based on the results, and relate it to study objectives.

Author Response

Thank you for the positive response and encouraging review. The manuscript has been further improved according to these suggestions, also to meet a number of recommendations from the other reviewers.

In particular, in the Abstract section the conclusion part has been re-written, by answering more clearly the original study objective; we also suggest here, as recommended, which scheme is better, of course for our present application.

Also the conclusion at the end of the manuscript has been adjusted, possibly to be  even more consistent with the results reported and the study objectives.

Regards

Reviewer 4 Report

Title is too general. There is no clear indication for the reader about the purpose of this paper. I recommend replacing “medical imaging” with MRI, maybe something like: …different magnetic resonance images quality on the stability of a dynamic model of …

Abstract well structured

Please define abbreviations at the first mention of the term - see row 14 and 15

Introduction

Row 31 - ankle sprain does not usually lead to irreversible ligament tears. Only severe sprains can lead to complete ligaments tears, and however, some of these tears will heal with proper treatment. The outcome is even better for partial tears. “Ligament stretch” is not a proper medical term, sprain occurs only when the elastic elongation of the ligament is overfulfilled and then a plastic deformation (rupture) occurs. Please rephrase this statement.

Review of literature is then presented, w ch lead to the hypothesis in row 75

Row 54 - there are only 3 bones involving in ankle joint. Calcaneus is not participating in this joint. Subtalar joint is not ankle. There are ligaments from tibia and peroneus to the calcaneus, but these complex structures are involved in stabilizing 2 different joints. Please rephrase this statement.

Row 88 - again, hindfoot is not equal ankle bones.

Row 97 - please explain this statement:” The contact between the bones was based on the properties of articular cartilage.”

The computational model creation is presented, and ligaments to be analyzed are defined. Acquisition methods with 1.5 T and 3 T MRI are also presented. Definition of insertion points is presented, with limitations due to image quality.

Dissection - row 127: there are no data regarding what type of specimen is used: fresh frozen, acquiring method, etc,

Row 109, 124 and 132 - acquisition data lead to modification of insertion sites of the computational model, resulting three different models to compare. “large differences” is not a proper value, rather a subjective impression

Row 139 - one cannot send the reader to another study for understanding the mechanical model, and the loading axes. The way the model was loaded should be at least briefly described here: force direction, rotation, fixed point.

Results section starts with main finding of this study, which should be in first paragraph of discussion section.

Discussion section starts with a section that repeat introduction. I recommend deleting this and replace with the most important finding of this study. There is almost no discussion regarding other similar studies published.

I agree with the authors regarding the limitations of this study. The limitations of this study are significant: First, this is an observational study on one specimen, there is no significance in data resulting from this analysis. I do not agree with authors regarding the statement in row 216. There is also no mentioning about the author/s who made the interpretation and discretization of the MRI images and their qualification. Multiple readers, even experienced ones, might have improved the accuracy of the data acquired and reduces subjectivity. This issue is quite easy to improve since the authors have all the images. Number and qualification of persons who acquired MRI images should be mentioned in material and methods section.

Conclusions should be a different section, not within discussions. The paragraph starting in row 218 might be a proper conclusion.

Author Response

Please see the attachment. Because of the list of relevant recommendations, the reply point-to-point is enclosed in the Word file here attached. Regards

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The quality of work is now increased. 

Reviewer 4 Report

Dear Authors, 

I consider that your manuscript is much improved from the previous one. I appreciate your understanding that my comments are aimed to help that your work will be better communicate.