Guided Growth of the Proximal Femur for the Management of the ‘Hip at Risk’ in Children with Cerebral Palsy—A Systematic Review
Round 1
Reviewer 1 Report
I think the main question is to evaluate scientific wait of different papers to determine the efficacy of proximal femoral epiphysiodesis In the management and prevention of hip subluxation in cerebral palsy. The technique originally described by previous work has been pursued in the last 10 years and produced a large number of papers that has been well analyzed in the current paper. This paper represent a comprehensive and extensive Systematic review of all paper written on epiphyseal disease especially on the proximal femur. The text is well written and easy to read and very clear in its discussion where the conclusions are consistent with the purpose of the study. The initial purpose of the study is well reached at the end with the conclusions.
Author Response
Dear sir, madam,
Thank you so much for your time and effort in reviewing this paper. We are very grateful for the feedback of the two reviewers.
As there are no further suggestions and concerns we have not uploaded any additional documents specific to reviewer 1.
We have made small adjustments based on the feedback of reviewer 2 and have submitted the revised manuscript under the "authors reply to the review report (reviewer 2)".
If there are any further questions please let us know,
Kind regards,
Renée van Stralen
Reviewer 2 Report
The present manuscript is a systematic review about the outcomes of a guided growth technique of proximal femur in pediatric patients with CP.
Methods and results are well described.
In the Third section of the introduction, please specify the anatomical consequences of the proximal femur guided growth in order to better clarify the scientific background of this surgical technique.
Author Response
Dear sir, madam,
Thank you so much for your time and effort in reviewing this paper. We are very grateful for the feedback of the two reviewers.
With regard to the comment on the anatomical consequences of the hemi-epipoysiodeses we have added the following sentence to line 59-63:
By placing a screw over the physis on the medial side, the tethering that occurs on the medial side will result in progressive varus of the proximal femur. It is understood that this manipulation of the proximal femoral anatomy can alter the course of secondary acetabular dysplasia [36, 37]. We have made minor adjustments to grammar throughout the text which are highlighted by the "track changes" function.Thank you again for your time and effort,
If there are any further questions please let us know,
Kind regards,
Renée van Stralen
Author Response File: 
Author Response.docx
