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Open AccessCase ReportPost Publication Peer ReviewVersion 1, Original

Assessment of Static Steadiness and Dynamic Stability at Various Stages of Healing a Grade 2 Medial Collateral Ligament Tear (Version 1, Original)

School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85281, USA
Authors to whom correspondence should be addressed.
Received: 26 September 2019 / Accepted: 9 October 2019 / Published: 15 October 2019
(This article belongs to the Section Wearable Biomedical Systems)
Peer review status: 1st round review Read review reports

Reviewer 1 Laura Gastaldi Department of Mathematical Sciences, Politecnico di Torino, Torino, Italy Reviewer 2 Luis A. Feigenbaum Department of Physical Therapy Miller School of Medicine University of Miami (FL)
Version 1
Approved with revisions Not approved
Injuries to the ligaments of the knee are extremely common among athletes who participate in high-risk sports, or any sport that requires frequent cutting motions, jumping, or contact. In order to determine the best way to heal these injuries, it is important to understand not just the pathology of the injury, but also the biomechanical factors that are affected, including stability and steadiness. While many studies have been done to examine the stability of healthy knees, there is little to no existing literature on stability of knees afflicted by injury. In order to surpass this obstacle, static steadiness and dynamic stability data was collected using the Lockhart Monitor phone application and Xsens accelerometers, respectively, both before and after completion of a course of physical therapy in a patient with a grade 2 medial collateral ligament (MCL) tear. These results were then used to determine the degree to which the prescribed physical therapy protocol was effective in healing the MCL, which can be useful for tweaking the individual protocol for future conservative treatment and management of the injury. View Full-Text
Keywords: biomechanics; dynamic stability; inertial measurement unit; MCL tear; static stability biomechanics; dynamic stability; inertial measurement unit; MCL tear; static stability
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Glattke, K.; Smith, M.; Tsuchiya, T.; Wells, J.; Lockhart, T. Assessment of Static Steadiness and Dynamic Stability at Various Stages of Healing a Grade 2 Medial Collateral Ligament Tear. Sci 2019, 1, 60.

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Reviewer 1

Sent on 15 Jan 2020 by Laura Gastaldi | Approved with revisions
Department of Mathematical Sciences, Politecnico di Torino, Torino, Italy

The case study reported in the paper focuses on a quantifiable assessment of knee stability.

The manuscript is well written and it flows well. However, I have some concerns about its scientific value, since a lot of details are missing. As it is a good example of class report, but not a scientific paper. For this reason, in my opinion authors should address their attention to some issues.

The main points are:

The aims of the paper are not clearly stated. It is not clear to me if authors want to assess the outcome of the physical therapy or the validity of the protocol to measure static and dynamic stability. In the first case I expect that the proposed measurement set up had already been validated in previous work. The tests protocol should be described in details. This is important both to evaluate the soundness of the test, but also to allow readers to repeat the test. There is a lack of references, both in the introduction and in the discussion section I do not think it is possible to draw any conclusion from a single case, also considering the limited number of test performed. Results are not substantial, but they represent a good example of which measurements can be achieved with the presented methodology. Future research will then be necessary to assess if there are variables that are correlated to an improved knee stability. The discussion section is very short, even considering that it is a case report.

Here after some more detailed comments.

Section 2.2: it is not reported if the injured knee was the left or the right.

Section 2.3: authors state that an iOS app developed by one of the authors had been used. There are no details about this app, its technical characteristics, what is measured (acceleration, velocity, frequency….), how it works, if it had been validated against a gold standard etc. Is there any reference paper that can be cited?

Xsens inertial sensors were used, also in this case it would be relevant to let the reader know where the sensors on the trunk and on the lateral shank were positioned (for example vertebra level and which level of the shank) and which was the acquisition frequency.

2.4 Procedure

Static stability measurements: it is relevant to describe the test. For example, was the subject wearing shoes? which type?  How the subject was standing (feet positioned apart, angle….)? With eyes open was he focusing on a spot? how was the verbal instruction given to the subject, etc. The same for the trails in which the subject was standing only on one leg.  In this case, the time length of the test is not indicated.

About the dynamic stability test, which was the protocol? Was the velocity fixed or was it self-selected? How were the data from the straight line portion isolated? Were they then averaged an in which way?

In this paragraph, also how data were managed should be reported.

3.1.Postural stability

Romberg ratio is a common index used in posturography, which refers to COP position. In this case which data were used to calculate it? Again a reference would be useful is also used, but it is not clear on which data it was applied is calculated, but it is not clear which data were used.

In general, I do not think that is correct to speculate on the obtained results, since only one subject was tested and hence there is no statistical evidence that can support any statement. I would rather base the discussion on the applied methodology.

Table 3: which is the accuracy of the reported results? How was the stride duration evaluated?


I am not native English, but page 2 in the sentence “For four of these trials,

the subject stood on both legs for 60 s with the device at their hip..” I think it should be his and not their.

The same at page 3 in the sentence “as part of their individualized physical” should be his and not their. Please check it through all the document.

Reviewer 2

Sent on 11 Mar 2020 by Luis A. Feigenbaum | Not approved
Department of Physical Therapy Miller School of Medicine University of Miami (FL)

Consistent use of the MCL versus medial collateral ligament once it has been established that MCL is the acronym.

In the "subjects" section, the name of the professor and course are not acceptable for a journal publication. The inclusion criteria could also be better formatted. I did not see any exclusion criteria.

In the "apparatus" section, you would not use the pronoun of "Dr." when citing a source. When introducing a piece of equipment, you must reference the company's information. I would encourage you to look at other published journal articles that have used an Apple device; the same holds true for the Xsens MTw Awinda device.

Procedure section: first sentences need to be re-worded. The treatment portion of the procedures section may be better presented in a table format; also the information on the rehabilitation protocol needs to be more detailed, so that other practitioners who would like to follow this protocol, would be able to replicate it in their own practice.

Results section: I would recommend tables for the results section.

Discussion: The discussion section is too short.

Also the language needs to be more formal throughout the text.

I recommend more than 5 total references.

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