Hamstrings on Morphological Structure Characteristics, Stress Features, and Risk of Injuries: A Narrative Review
Round 1
Reviewer 1 Report
The manuscript reviews the potential biomaterials form hamstring injury. The manuscript presents the characteristics of hamstring injury. However, the vital information on state of the art of biomaterials application on hamstring injuries has not been well reviewed.
Author Response
Dear Reviewer,
First, thank you for your comments on our manuscript. Your affirmation and recognition of this manuscript are very helpful for our work.
About comment ＂The manuscript reviews the potential biomaterials form hamstring injury. The manuscript presents the characteristics of hamstring injury. However, the vital information on state of the art of biomaterials application on hamstring injuries has not been well reviewed.＂
Response: The work of this manuscript mainly reviews the characteristics of hamstring biological autologous material and its possible relationship with injury. Hamstring injury frequently occur in sports, and it mostly occur proximal part to the biceps femoris. Researchers explored the underlying mechanism of hamstring injury through an-atomical, kinematic, and kinetic analyses of sprinting, but the reasons and mechanisms for why hamstring injuries tend to occur proximal remain unclear. This review focused on discussing proximal structural features of the hamstrings to understand the reason that hamstring injuries tend to occur in the proximal area. Some misnomers and unclear statements have been modified to give a more accurate overview on the characteristics of hamstring biological autologous material and its possible relationship to injury. The comment ＂the vital information on state of the art of biomaterials application on hamstring injuries＂is a very good proposal. We might be able to build on it in our future research work. Special thanks to you for your comments.
Once again, thank you very much for your comments and suggestions.
Reviewer 2 Report
Title
Abstract
There should be finale sentence saying "future work in this research should comprise................................."
Literature Search
When you say we found 117 studies, I prefer to locate bar chart of number of studies per year.
Before Conclusion
Insert table containing 5-10 rows, each row is a research article with its methods and findings
Try introducing biomaterials or tissue engineered soln. Refere to these two citations
In Vitro Electrochemical Corrosion Assessment of Magnesium Nanocomposites Reinforced with Samarium (III) Oxide and Silicon Dioxide Nanoparticles
Advances in the Development of Biodegradable Polymeric Materials for Biomedical Applications
Author Response
Dear Reviewer,
First, thank you for your comments on our manuscript. Your comments are very helpful for us to improve our manuscript.
About comment of abstract＂There should be finale sentence saying ＇future work in this research should comprise.................................＇＂
Response: We are very sorry for our negligence of it. In abstract, finale sentence ＂Future work in this research should be aimed at exploring the most effective prevention programs base on the material structure and motor control to enhance the properties of hamstring muscle materials to minimize the risk of injury.＂was added.
About comment of Literature Search and Before Conclusion ＂suggest inserting table and bar chart＂, we deleted the part and adjusted the manuscript based on paradigm of narrative review and comments provided by another reviewer. The details of the revisions to the manuscript were marked up using the “Track Changes” function in the paper.
Special thanks to you for your recommendation two citations.
Thank you again for your comments on the manuscript.
Reviewer 3 Report
Yinbin Shi and co-authors wrote a review called “Hamstrings on Biomaterials Structure Characteristic, Stress Features, and Risk of Injuries; A Narrative Review”. The paper talks about hamstring injuries, the mechanisms that causes the injuries, and some diagnostics to identify the problem.
Overall, the review is interesting, but the title over-sells the idea of biomaterials, whereas the bulk of the paper does not focus on materials properties. Much of the discussion is also hard to follow because of the lack of visuals. The organization of the manuscript is also confusing in some respects. The goal of the manuscript is not clear. For this reasons, I recommend major revisions.
1. Authors say “hamstring biomaterials” but hamstring is heterogeneous. What part of hamstring being discussed is unclear.
2. What “biomaterials characteristics” are reported? Rational for use of this phrase is unclear based on data and discussion provided.
3. Introduction should be replaced by 3. Epidemiology, which provides same information but with more quantification and detail. Authors should add a paragraph that steps through manuscript and provides clear goal. For example, authors say that purpose of paper is to “provide suggestions to prevent hamstrings injury for sports participants”. In this case the authors should use language that a layman can also understand or provide additional descriptions (with images/illustrations).
4. Authors need to add several schematics/visuals:
a. Anatomy of hamstring showing all relevant tissues, bones, parts described in the paper (e.g., first half of page 4)
b. Anatomy of MTJ and tendon (second half of page 4)
c. Stress-strain curve of tendon (normal vs after different types of injury) [last paragraph of page 6]
5. 2. Literature search is a methods section, which should not be a part of the main text or should be summarized. If the authors want to add this methods, more details are needed. How were studies reviewed? Summary of the discussions should be provided as supplementary information along with a table of all papers found and discussed. The Disagreements should be described and analyzed as part of review.
6. Move 4. Different diagnosis before conclusion. Anatomy of injury necessary for reader to know before diagnosis. Also in this section, authors mention many types of injuries but only describe acute in detail. Authors need to elaborate on the other types, especially overuse and give more details on why “Researchers suggested that not all hamstring injuries are the same”.
7. Authors need to define several terms like:
a. Peetrons classification
b. Osseous junction
c. Periosteum
d. Eccentric contraction
8. Authors should add numbers for tensile properties and state what the different Young’s moduli are (in Morphological diversity of the tendons of Hamstrings Complex). Also Shi et al need to tabulate the relevant values presented in Connected pattern diversity of hamstring with other known values of bone/muscle for direct comparison. This way readers can interpret hamstring values with respect to other part of the body.
9. Authors need to clarify second paragraph on page 5. What are the types of insertions and what is their prevalence.
10. Authors say “Stress must be transferred among materials whose stiffness differs by two or more orders of magnitude”. Why? The reason is unclear, and the authors should elaborate. What is advantage of “insertion of the tendon into the bone” over other types of structures?
11. What is the amount of energy that adaptive entheses can absorb? How does it compare to cases without entheses?
12. First two paragraphs of The transfer of force between muscle fibers and tendons should be a separate section on the ECM and its role in energy transfer/stiffness of hamstring. Authors should elaborate on the ECM and its role in injury or healing after injury.
13. Shi et al need to add example on page 6 of when muscle “always contract in the same way when they are working as a unit, more or less independently of the other motor units in the same muscle”
14. Transfer of force between tendons and bone should be moved to after the section on ECM (Comment 12).
15. Beginning of page 7 authors talk about Achilles rupture, the relation to BFLH and hamstring injury is unclear. The authors should connect this part with the rest of the paper more clearly.
16. Move 7. Possible performance of motor control during hamstrings acute strain to immediately after introductions. This section is helpful to visualize the injury and how it can happen. But, last sentence of this section is confusing. Methods to prevent injury or to recover from injury should be a separate section.
17. Authors say “ The intricate connection of gradient compliance between tissue materials with different mechanical properties leads to the susceptibility of materials to detach near the junction sites under sudden stress conditions, which is perhaps the primary reason most damage occurs at these sites.” This is true for all materials after the elastic regime. Why do authors consider this an “opinion” that “needs to be tested experimentally”? Is hamstring materials in elastic zone before injury? Research discussed in the paper suggested hamstring are undergoing plastic deformation from repeated stress, so this first statement is true. Authors need to clarify this point.
18. Conclusion and paper in general is missing discussion about what are the limitations of the studies so far. If hamstring injury is so common, why are there still unanswered questions? What are the technical, methodology, clinical limitations that have prevented full resolution of this medical problem? The authors should add a section on this as part of the conclusion.
Minor comments:
- Some sentences are cut in the middle and continued as two sentences. This is confusing and should be remedied.
- Flow of manuscript is a little hard to follow, strongly encourage rearrangement of sections.
Author Response
Dear Reviewer,
First, thank you for your detailed comments on our manuscript. Your comments are very helpful for us to improve our manuscript.
According to your comments, we have made significant adjustments and revisions to the manuscript, and it looks more standardized. The details of the revisions to the manuscript were marked up using the “Track Changes” function in the paper.
About comment of ＂the organization of the manuscript＂in Point 3,6,12,14,15,16, we have made a major adjustment to the order of the manuscript organization based on your suggestion:
- In background introduction, description of epidemiology was added, which provides more quantification and detail information. (Response to point 3)
- Move ＂The anatomy morphological structure of hamstrings＂right after introduction, ＂Different diagnosis＂ before conclusion, ＂Possible performance of motor control＂before Different diagnosis, Anatomy of injury necessary for reader to know before diagnosis. It is more convenient for readers due to the logical order as follow: First, understand the anatomical morphology and composition characteristics of the hamstring muscle. Then, comprehend the performance of the movement control and the possible injury caused in the process of movement. Finally, know the different diagnosis of the injury. (Response to point 6,15,16)
- About comment of ＂First two paragraphs of the transfer of force between muscle fibers and tendons should be a separate section on the ECM．．．．．．＂, The elaborate on the ECM and its role in injury were added, see three paragraphs later on page 2. (Response to point 12)
- About comment of ＂Transfer of force between tendons and bone should be moved to after the section on ECM (Comment 12).＂, we did it according to the suggestion, see it on page 4. (Response to point 14)
About comment of ＂Authors need to add several schematics/visuals, and Supplementary descriptions＂in Point 4,7,8,9,10,11,13, we have inserted a few illustrations and added descriptions where appropriate, details as follows:
- About comment of ＂Authors need to add several schematics/visuals…＂, we have inserted a few illustrations according to your suggestion, see them on page 3. About comment of＂Stress-strain curve of tendon (normal vs after different types of injury)＂，The suggestion is very interesting; however, we only got some information about before and after exercise intervention from the references, the information about normal vs after different types of injury is not available from the currently references, so we are very sorry for not being able to provide the information. (Response to point 4)
- About comment of ＂Authors need to define several terms……＂, we have added descriptions about ＂Peetrons classification＂and＂Eccentric contraction＂, see it in 4th paragraph on page 6 and last paragraph on page 2, respectively. About＂tendon-osseous junction，periosteum＂, they are anatomical terms for bone, and will not be described in detail. (Response to point 7)
- About comment of ＂Authors…… need to tabulate the relevant values presented……＂, we did the table 1 based on the values presented in reference and added it in our revised manuscript, see it on page 3. (Response to point 8)
- About comment of ＂What are the types of insertions and what is their prevalence.＂, we have added some descriptions, see them in 4th paragraph on page 4(While kinds of insertions exist between tendons and bones, for example……) (Response to point 9)
- About comment of ＂Authors say “Stress must be transferred among materials whose stiffness differs by two or more orders of magnitude”. Why?＂, we added the table 1. As shown in Table 1, the elastic modulus values are vastly different three kinds of different tissue elements among muscles, tendons, and bones, come up to two or more orders of magnitude. See it on page 3 (Efficient interleaved fusion connection of muscle-tendon and tendon-bone are necessary to……). About comment of ＂What is advantage of “insertion of the tendon into the bone” over other types of structures?＂, we described it in 2nd and 3rd on page 6(The attachment of tendons to the skeleton is unique to vertebrates [28]. The be-coming of entheses is essential for musculoskeletal functionality, because they provide flexible, robust, and resilient anchor points for muscles, and transmits force by muscle generated to the skeleton; When the tendon is acted upon by the muscle force, the directionally distributed collagen fiber bundles show force compliance, rapidly following the direction of tension, transferring tension along the extremely tenacious tendon to the entheses) (Response to point 10)
- About comment of ＂What is the amount of energy that adaptive entheses can absorb? How does it compare to cases without entheses?＂, Related experiment exhibited measurable local strains above 7%. The description was added, see it in last paragraph of page 4. (Response to point 11)
- About comment of ＂Authors need to add example on page 6 of when muscle “always contract in the same way when they are working as a unit, more or less independently of the other motor units in the same muscle”＂, we add example at last sentence in 4th paragraph of page 5 according to your advice. (Response to point 13)
About comment of ＂Literature search is a methods section, which should not be a part of the main text＂, we deleted the part and adjusted the manuscript based on paradigm of narrative review and comments provided by another reviewer. The details of the revisions to the manuscript were marked up using the “Track Changes” function in the paper. (Response to point 5)
About comment 1 and 2, we are very sorry for some statements that we made were slightly ambiguous; we have clarified the text. For example, we used ＂Hamstrings on Morphological Structure Characteristics, Stress Features, and Risk of Injuries: A Narrative Review＂replaced ＂Hamstrings on Biomaterials Structure Characteristic, Stress Features, and Risk of Injuries: A Narrative Review＂. We focus on the structure of proximal hamstring and injuries that occurred here, so we have tried our best to make them to clear. The more details of the revisions to the manuscript were marked up using the “Track Changes” function in the paper. (Response to point 1,2)
About comment of ＂Conclusion and paper in general is missing discussion about what are the limitations of the studies so far.＂, we added this part before conclusion, see it on page 9. (Response to point 18)
About comment 17, we clarified this point according to the opinion＂This is true for all materials after the elastic regime＂that provided by reviewer. (Response to point 17)
About minor comment, we have modified it accordingly.
Once again, thank you very much for your comments and suggestions.
Round 2
Reviewer 1 Report
The manuscript discus a well known fact. The question to answer is also unclear.
Author Response
First, thank you once again for your comments on our manuscript.
Natural or synthetic medical biomaterials have been widely used in the prevention and treatment of tendon adhesion after repair and reconstruction of tendon injury. Although the technology of tendon repair and reconstruction is becoming more and more mature, non-biosynthetic materials affect the infiltration of nutrients in the process of tendon healing and increase the rate of tendon necrosis. However, the source of autologous tissue is limited and can cause new donor damage, so the clinical application is obviously limited. Therefore, using natural biomolecular materials (such as amniotic membrane, collagen, chitosan, etc.), materials with specific structure and function can be processed and applied in the prevention and treatment of adhesion after tendon repair and reconstruction, which has a broader development and application prospect.
Because the rupture rarely occurs in hamstrings, it is not discussed in this paper. We will try to clarify this question when we focus on the common proximal injuries to the hamstring.
Reviewer 3 Report
The authors have addressed all of my comments. While the manuscript would benefit from additional English changes, I can recommend the publication of this manuscript. I would suggest however that the authors review the manuscript for scientific errors (minor typographical) prior to publication. For example, the reference to biomaterial should be removed from the abstract.
Author Response
First, thank you once more for your detailed comments and recommend on our manuscript.
According to your comments, we have revised the manuscript:
1). We have deleted the slightly ambiguous ＇biomaterial / biomaterials＇and revised it in the text. These modifications are respectively in the summary and the conclusion. And you can also see them by checking the time marked in the “Track Changes” function.
2). We checked carefully and had revised a few minor typographical errors in our manuscript, for example, some issues of capital and small letter misuse (in 4th paragraph on page 2, in 1st and 2nd paragraph on page 5); Some mistaken vocabularies are revised (in 1st paragraph on page 3, in 4th and 5th paragraph on page 4, 2nd and 6th paragraph on page 5). You can also see them by checking the time marked in the “Track Changes” function.
Thank you and best regards.
