Clinical and Kinematic Outcomes Based on Bone Graft Utilization for Salvage First Metatarsophalangeal Arthrodesis: A Systematic Review

Round 1

Reviewer 1 Report

Dear Authors, 

Thank you for having the opportunity to review this article. 

The article is a systematic review of the outcome of salvage first MP arthrodesis based on the type of bone graft used during the procedure. It is a very interesting and well-documented article. It is well structured. The results are well presented, especially the section related to clinical and radiological outcomes. The discussion section is appropriate, with a remarkable reference to the limitations of the study. The conclusions support the content of the article. There are no English scientific language issues.  

I would only recommend including data related to the AOFAS score in the Abstract section.  

Author Response

Response to Reviewer 1's Comments:

Point 1: I would only recommend including data related to the AOFAS score in the Abstract section.  

Added abstract data to the abstract on page 1, lines 34-36.

 

Thanks for the comment! 

 

Reviewer 2 Report

This is a very interesting piece of work. It is well written and explicit. It is a good review and analysis manuscript.

I think the manuscript can be accepted with only minor revisions.

Point 1 - The manuscript should be revised regarding the way of referencing articles throughout the text. After writing a sentence suggested by a particular author, you should identify the reference, and only then put the full stop. I add an example of how you should write the following sentence (page 2 line 48):

‘The shortening of the first ray not only increases the risks of metatarsalgia, but also 48 has upstream effects by altering hindfoot alignment, [8,9].’

Point 2 - Need revise the legend of all tables; the legend should be placed above the tables and all with the same formatting. The tables should be complete on sheet for better visualization.

Point 3 - page 8, line 173, revise font size.

Point 4 - In conclusion when you say, ‘allograft may hold promise’, The use of allografts being promising is very interesting! a good suggestion would be to optimize the bone bank of each country or maybe worldwide.

I attach some notes on the manuscript.

I suggest essentially that figure 3 be improved, essentially in the text that has added.

Very good work! congratulations

Comments for author File: Comments.pdf

Author Response

Responses to Reviewer 2:

Point 1 - The manuscript should be revised regarding the way of referencing articles throughout the text. After writing a sentence suggested by a particular author, you should identify the reference, and only then put the full stop. I add an example of how you should write the following sentence (page 2 line 48):

Fixed all of these in the manuscript

Point 2 - Need revise the legend of all tables; the legend should be placed above the tables and all with the same formatting. The tables should be complete on sheet for better visualization.

Moved the table legend above the table for each table. Also made them the same format and best visualization as possible.

Point 3 - page 8, line 173, revise font size.

Fixed font size. Now is found on line 180 for reference

Point 4 - In conclusion when you say, ‘allograft may hold promise’, The use of allografts being promising is very interesting! a good suggestion would be to optimize the bone bank of each country or maybe worldwide.

Added this to conclusion - really liked this suggestion!

 

Thanks for the comments!

Reviewer 3 Report

July 22, 2023

Journal: Applied Sciences

Manuscript ID: applsci-2521854

Title: Clinical and Kinematic Outcomes Based on Bone Graft Utilization for Salvage First Metatarsophalangeal Arthrodesis: A Systematic Review

 

The aim of this systematic review is to determine the optimal graft type for metatarsophalangeal salvage arthrodesis in terms of clinical outcomes, kinematic outcomes, and bony integration to improve patient care. This paper is considered a welcome addition to the current literature, which attempts to manage bone graft utilization for salvage first metatarsophalangeal arthrodesis. In my opinion, the idea of this manuscript is good, and the systematic review was technically well performed. However, this paper contains some limitations that are even mentioned.

Hereinafter, some major comments:

1.      The abstract section should be presented as one paragraph. Please avoid introductions, methods, results, and conclusions.

2.      There is no claim about what originality is compared to what has been done by others on the same matter. Are there any previous studies that have done similar work?

3.      Since this study was centered around three different graft groups (foot and ankle autograft, non-foot and ankle autograft, and allograft) qualitatively, this should be highlighted at the end of the introduction section.

4.     The authors should add some examples of commercial products related to MTP arthrodesis, especially for applications in foot and ankle autograft, non-foot and ankle autograft, and allograft.

5.      In this review, tables alone are not satisfying. The manuscript should be highlighted with figures and schemas.

6.     Bibliographic references are not enough for this review. The authors should use more literature on salvage MTP arthrodesis.

7.      The major references are obsolete and should be updated with more recent ones.

8.     A section dedicated to "Future Trends" in this area should be proposed.

9.     Conclusions should be improved, and the authors should highlight the limitations and perspective of the study in the "conclusions" section.

Author Response

1. The abstract section should be presented as one paragraph. Please avoid introductions, methods, results, and conclusions.

Reformatted as requested. I kept the sections clearly separated to allow for clarity, but I removed the section subheadings.

2. There is no claim about what originality is compared to what has been done by others on the same matter. Are there any previous studies that have done similar work?

lines 60-62 on page 2. Highlighted and rewritten for clarity

3. Since this study was centered around three different graft groups (foot and ankle autograft, non-foot and ankle autograft, and allograft) qualitatively, this should be highlighted at the end of the introduction section.

Added this information to the introduction on page 2, lines 62-65.

4. The authors should add some examples of commercial products related to MTP arthrodesis, especially for applications in foot and ankle autograft, non-foot and ankle autograft, and allograft.

Introducing specific products could dilute the analysis as each product has a specific method of fusion - this review was only focused on graft type. As graft type tends to be complete surgeon preference to supplement a certain product, adding in product information would not have much relevance on the topic and may add confounding factors. A separate review analyzing method of arthrodesis on kinematic and clinical outcomes would be better for introducing specific products. Thank you for the comment.

5. In this review, tables alone are not satisfying. The manuscript should be highlighted with figures and schemas.

I reformatted the tables to make them clearer and easier to interpret. While including a figure of graft being inserted into the MTP space may be interesting, the appearance of each graft type is nearly identical. And, as this review includes radiographic measurement quantitative analysis, including radiograph and surgical images does not add to the analysis. Thanks for the comment.

6. Bibliographic references are not enough for this review. The authors should use more literature on salvage MTP arthrodesis.

7. The major references are obsolete and should be updated with more recent ones.

While major references may seem outdated, there are nearly no updates to graft use in MTP arthrodesis in the literature. If there were such articles, they would be included in our review. Nearly all mentions of graft use are composed within the methodology of articles highlighting various methods of arthrodesis. I do agree that more recent updates would improve the information presented, but no such articles exist. Thank you for the comment, and I hope this review leads to additional research into graft type.

8. A section dedicated to "Future Trends" in this area should be proposed.

Great idea! Thank you for the comment. I added this section on page 11, lines 358-365.

9. Conclusions should be improved, and the authors should highlight the limitations and perspective of the study in the "conclusions" section.

moved the limitations and perspective to the conclusion. Additionally, I added to the conclusion and highlighted my change. This was per the comment of another reviewer as well. Thanks for the suggestion.

 

 

Round 2

Reviewer 3 Report

All my comments had been addressed properly.