Hamstring vs. All-Soft-Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Early Follow-Up Results of a Prospective Study
Round 1
Reviewer 1 Report
Dear authors, I thank you for the effort and effort you put forth in your research. Your research is important in terms of subject and scope. As you said, your research on ACL injuries, which are rare in pediatric groups, will make significant contributions to the literature.
-Your research, in general, clearly reveals almost all the requirements of an article format in the scientific flow.
Introduction
-In this section, you gave information about ACL injuries only in pediatric groups. I would like you to add a short paragraph or sentence that mentions the incidence of ACL and different grafting methods in adult groups. This will highlight the difference between adult and pediatric groups and highlight the importance of your research. I suggest you refer to this situation using the references I will give below.
1-) Güzel, N., Genç, A. S., Yılmaz, A. K., & Kehribar, L. (2023). The Relationship between Lower Extremity Functional Performance and Balance after Anterior Cruciate Ligament Reconstruction: Results of Patients Treated with the Modified All-Inside Technique. Journal of Personalized Medicine, 13(3), 466.
2-)Güzel, N., Yılmaz, A. K., Genç, A. S., Karaduman, E., & Kehribar, L. (2023). Pre-and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes. Journal of Clinical Medicine, 12(1), 63.
Also, please highlight your main hypothesis from your purpose statement at the end of this section.
Method
In this section, I request you to support with photographs if possible by creating separate titles for both HT and QT in the surgical technical section. If there is no photo, please write under separate headings.
I think there is no need for any revision in other sections. After all these corrections, I think the research should be accepted.
Yours sincerely
Author Response
Please see the attachment
Author Response File: 
Author Response.docx
Reviewer 2 Report
This RCT assesses the effects of spinal mobilization on disk height, facet joint distance, and VAS in patients with LDH.
Title:
" 68 patients younger than 18 years of age were randomly assigned to HT (38 patients) or QT (30 patients) ACLR groups."
Based on the method, this study is an RCT, and it should be mentioned in the title.
Introduction:
"randomized perspective study" What is this type of study? If the authors compare the effects of interventions on randomized groups, this type of study will be an RCT.
Method:
What is the RCT registration number?
How did the authors perform randomization?
Did the participants receive any rehabilitation before surgery?
How did the authors calculate the sample size?
"quantitative data in two independent samples were compared by using non-parametric Mann-Whitney test." Did the author adjust the analysis based on the age and sex (confounders) of participants?
Results:
Where is the study flowchart?
Did the participants report any side effects?
While inclusion criteria were "This randomize perspective study was performed in Lithuanian University of Health Sciences (LUHS) Kaunas Clinics and included a total of 68 (37 male, 31 female) patients from 12 to 17 years old," the results have participants with the age of 18 (Totally 68 (37 male, 31 female) patients from 12 to 18)." Why?
What were the reasons for missing follow-up in 3 and 6-month follow-ups?
Discussion?
What is the generalizability of the results?
Minor editing of English language required.
Author Response
Please see the attachment
Author Response File: Author Response.docx
Reviewer 3 Report
The manuscript titled “HAMSTRING VS ALL-SOFT TISSUE QUADRICEPS TENDON AUTOGRAFT FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ADOLESCENT ATHLETES. EARLY FOLLOW-UP RESULTS OF PROSPECTIVE STUDY”
Introduction is not clear.
The manuscript needs to be improved.
The font size is not correct with the journal template.
The objectives of the study are not clear.
Figure 1 is confusing.
For what reasons do young people tear LCA?
Playing sports or for another reasons?
After 3 months of surgery is there any type of muscle strengthening or physical therapy? Which methods?
The manuscript contains many errors and makes it difficult to understand.
Comments for author File: 
Comments.pdf
Author Response
Please see the attachment
Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
The authors compared the results of two groups, but the distribution of patients in those groups was not randomized. While the distribution is not randomized many other factors could be responsible for the difference in results between the two groups, such as their diet, their genetics, their level of education, and many others. That is why RCT studies are developed. Therefore, the authors cannot compare the results of the two groups and assign them to the treatment.
Minor editing of the English language required.
Author Response
Dear reviewer,
Thank you for comment. You are absolutely right about proper randomization process. And we do understand that RCT studies provide the highest level of evidence. But we have never mentioned either in the title or in the paper itself that our study should be considered RCT. We do analyze differences in the parameters of homogenous samples. As we have shown in sample calculations, our sample size was adequate and appropriate statistical methods were used. In our case due to limited resources it was not possible to randomize the groups because as you mentioned we cannot guarantee the same recovery and return to sport protocol. The aim of the study was to follow up the recovery of the patients according to the graft type and measure the difference between the groups at certain time of the recovery. We are grateful for your remarks as we will definitely benefit from information you have provided in our future research.
Kind regards,
Ritauras Rakauskas
Reviewer 3 Report
I suggest acceptance of the manuscript!
Author Response
Thank you for your insights!
