Unlocking the Secrets of Post-Surgical Flexion: The Vital Role of Rehabilitation in Total Knee Arthroplasty Recovery
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe manuscript, “Unlocking the Secrets of Post-Surgical Flexion: The Vital Role 2 of Rehabilitation in TKA Recovery”, is devoted to the post-surgical flexion, desired range, surgical factors influencing it, and the critical role of rehabilitation in helping patients achieve functional flexion after TKA surgery. A review of the contribution of rehabilitation in assisting patients regains functional flexion after surgery is also announced.
Because of the manuscript analysis, the following wishes and comments arise.
1. There is no clearly defined purpose and novelty of the research.
2. The title of the manuscript announces the rehabilitation of patients, which arouses a certain interest in reading the article and its possible further citation, since currently the topic of rehabilitation is relevant in the medical community due to the search for new effective types and techniques for its implementation. But in the manuscript only one sentence is devoted to this with a simple listing of known types of rehabilitation, which thereby reduces the scientific interest in this article and in order to raise it, the coverage of this topic should be expanded.
3. The References section contains a list of 38 refs, 12 of which are from the last 5 years, which is approximately 32%. It is desirable that this indicator be higher since, as a rule, almost everything that has been previously researched has already been analyzed in articles for the specified period. In addition, if the author offers something new in the field of rehabilitation after TKA, then links to the existing state of the art should be provided.
4. The Conclusion section should indicate the limitations of the study.
5. There are also technical notes:
- In lines 84, 87, 93, 100 italics is used, therefore italics should be done by analogy in line 109;
- In Figure 4, the same scale should be indicated for cases A and B in order to more clearly represent their difference;
- What does the abbreviation UKA mean in lines 193, 194, 204?
- What does the abbreviation ATG mean in lines 206, 208?
- What do the Q-angles in line 219 mean?
6. In the References section, the DOI is not indicated everywhere, although it is present in the cited articles.
In my opinion, based on the above, the manuscript requires major revision.
Author Response
Reviewer 1
Firstly, we, the authors of the present manuscript wish to thank you for thoughtful commentary you have provided to improve the quality of the paper. We are very grateful for the time and effort you have devoted to this task. We have extensively revised my manuscript according to the recommendations. All changes in the text and the new figures that we have redesigned are highlighted. Please, see the point-by-point answers to your comments below. All correction was highlighted in the manuscript.
The manuscript, “Unlocking the Secrets of Post-Surgical Flexion: The Vital Role 2 of Rehabilitation in TKA Recovery”, is devoted to the post-surgical flexion, desired range, surgical factors influencing it, and the critical role of rehabilitation in helping patients achieve functional flexion after TKA surgery. A review of the contribution of rehabilitation in assisting patients regains functional flexion after surgery is also announced.
Because of the manuscript analysis, the following wishes and comments arise.
- There is no clearly defined purpose and novelty of the research.
Response: Thank you for observation. I completed with a defined purpose and objective. (lines 86-96)
- The title of the manuscript announces the rehabilitation of patients, which arouses a certain interest in reading the article and its possible further citation, since currently the topic of rehabilitation is relevant in the medical community due to the search for new effective types and techniques for its implementation. But in the manuscript only one sentence is devoted to this with a simple listing of known types of rehabilitation, which thereby reduces the scientific interest in this article and in order to raise it, the coverage of this topic should be expanded.
Response: Thank you very much for the comment. I completed the manuscript. (lines 50-62, 118-131, 261-269)
- The References section contains a list of 38 refs, 12 of which are from the last 5 years, which is approximately 32%. It is desirable that this indicator be higher since, as a rule, almost everything that has been previously researched has already been analyzed in articles for the specified period. In addition, if the author offers something new in the field of rehabilitation after TKA, then links to the existing state of the art should be provided.
Response: Thank you for observation. We reviewed and corrected the references.
4.The Conclusion section should indicate the limitations of the study.
Response: Thank you very much for the comment. I moved the limitations in Conclusion section.
- There are also technical notes:
- In lines 84, 87, 93, 100 italics is used, therefore italics should be done by analogy in line 109;
Response: Thank you for observation. I modified in italic style. (line 148)
- In Figure 4, the same scale should be indicated for cases A and B in order to more clearly represent their difference;
Response: Thank you for observation. I used the same score for both figures (Figure 4A and figure 4B).
- What does the abbreviation UKA mean in lines 193, 194, 204?
Response: Thank you for observation. I complete with explanation of abbreviation. (Lines 249-250)
- What does the abbreviation ATG mean in lines 206, 208?
Response: Thank you for observation. It was a mistake. I corrected them.
- What do the Q-angles in line 219 mean?
Response: Thank you for observation. I corrected it into „quadriceps-angle”. (Line 286)
- In the References section, the DOI is not indicated everywhere, although it is present in the cited articles.
Response: Thank you for observation. I completed them.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsThe present study aims to explore post-surgery flexion, the desired range, the surgical factors that influence it, and the essential role of rehabilitation in assisting patients in achieving functional flexion after total knee arthroplasty.
The results highlighted a significant improvement in the quality of life at 12 months after the surgery compared to preoperative and 6-month assessments, with most patients achieving good or excellent scores.
The manuscript is well structured, with the primary purpose so clear.
However, I have several suggestions.
TITLE:
It is suggested to expand the abbreviation TKA in the title of the presented paper
Introduction:
Line 47: While the surgical procedure is pivotal, the journey towards optimal post-surgical flexion heavily relies on postoperative rehabilitation - Please describe in more detail the rehabilitation models for patients after TKA and the methods of physiotherapy used in patients after TKA. Moreover, it is worth mentioning pre-operative rehabilitation.
Line: 60: The Knee Association Score (KSS) score is a measure utilized to evaluate the function and clinical outcomes of patients who have undergone knee surgery, including procedures like total knee arthroplasty – you have a 2x “score”. Moreover, it would be worth describing other methods of assessing the musculoskeletal system in patients after TKA (e.g., movement analysis, sEMG analysis, etc.).
Material and Methods:
- please provide data regarding rehabilitation and physiotherapy
- Figure 5 is not clear - please make it clearer.
Overall:
Please standardize the language and style in your work (e.g., Parametri, luni etc.)
In general, the work is interesting and can contribute to the literature.
I hope my suggestions will help improve this work.
Comments on the Quality of English LanguagePlease standardize the language and style in your work (e.g., Parametri, luni etc.)
Author Response
Reviewer 2
Firstly, we, the authors of the present manuscript wish to thank you for thoughtful commentary you have provided to improve the quality of the paper. We are very grateful for the time and effort you have devoted to this task. We have extensively revised my manuscript according to the recommendations. All changes in the text and the new figures that we have redesigned are highlighted. Please, see the point-by-point answers to your comments below. All correction was highlighted in the manuscript.
The present study aims to explore post-surgery flexion, the desired range, the surgical factors that influence it, and the essential role of rehabilitation in assisting patients in achieving functional flexion after total knee arthroplasty.
The results highlighted a significant improvement in the quality of life at 12 months after the surgery compared to preoperative and 6-month assessments, with most patients achieving good or excellent scores.
The manuscript is well structured, with the primary purpose so clear.
However, I have several suggestions.
Comment 1. TITLE:
It is suggested to expand the abbreviation TKA in the title of the presented paper
Response: Thank you for suggestion. I corrected the title.
Comment 2. Introduction:
Line 47: While the surgical procedure is pivotal, the journey towards optimal post-surgical flexion heavily relies on postoperative rehabilitation - Please describe in more detail the rehabilitation models for patients after TKA and the methods of physiotherapy used in patients after TKA. Moreover, it is worth mentioning pre-operative rehabilitation.
Response: Thank you very much for the comment. I completed the manuscript. (lines 50-62, 118-131, 261-269)
Comment 3. Line: 60: The Knee Association Score (KSS) score is a measure utilized to evaluate the function and clinical outcomes of patients who have undergone knee surgery, including procedures like total knee arthroplasty – you have a 2x “score”. Moreover, it would be worth describing other methods of assessing the musculoskeletal system in patients after TKA (e.g., movement analysis, sEMG analysis, etc.).
Response: Thank you for amendment! This study is a component of a broader retrospective investigation. While four evaluation methods were employed, the results of those assessments are currently in the process of being published. Instead, the focus here is on the completion of the documentation of the rehabilitation techniques that were utilized.
Comment 4. Material and Methods:
- please provide data regarding rehabilitation and physiotherapy
Response: Thank you very much for observation! I completed the „Material and Methods” section with the required description. (Lines 118-131)
Comment 5.- Figure 5 is not clear - please make it clearer.
Response: Response: Thank you very much for comment! The explanation of the figure 5 was added. (Lines 229-244)
Comment 6. Overall:
Please standardize the language and style in your work (e.g., Parametri, luni etc.)
In general, the work is interesting and can contribute to the literature.
I hope my suggestions will help improve this work.
Response: Thank you for your comments! He was a great help! The English language was checked, and the mistakes were corrected.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsI endorse this manuscript.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
Thank you for considering my comments.
In its current form, the presented paper meets the criteria for publication. Congratulations to the authors.
Comments on the Quality of English LanguageMinor editing of English language required
