Reply to Sun et al.: Methodological clarifications regarding “Ultratape and sutures combination versus conventional sutures in arthroscopic rotator cuff repair: a 6-month retrospective matched cohort study”

Abstract

We thank Sun et al. for their interest in our article, “UltraTape and Sutures Combination Versus Conventional Sutures in Arthroscopic Rotator Cuff Repair: A 6-Month Retrospective Matched Cohort Study”, and for their constructive comments. Their concerns regarding temporal bias and methodology merit clarification. Here, we detail our study design and efforts to minimize bias, and discuss the interpretation and clinical value of real-world, retrospective cohort data in the context of new surgical technologies.

We thank Sun et al. [1] for their interest in our article, “UltraTape and Sutures Combination Versus Conventional Sutures in Arthroscopic Rotator Cuff Repair: A 6-Month Retrospective Matched Cohort Study” [2], and for their constructive comments.

The comparison of two consecutive time periods was a deliberate design choice reflecting the real-world introduction of UltraTape into our practice. This approach is commonly used when evaluating new surgical materials and allowed us to assess clinical impact under otherwise unchanged perioperative conditions. During both study periods, all procedures were performed by a single senior surgeon using the same single-row configuration, with identical anchor types (apart from UltraTape), no biologic augmentation, and an unchanged rehabilitation protocol. Patient selection criteria were stable across both cohorts.

To further minimize confounding, the groups were strictly matched for age, tear size, and preoperative shoulder stiffness—three of the strongest predictors of retear risk. Outcome assessment included ultrasound-confirmed tendon integrity and functional measures, ensuring objective and reliable evaluation. The longer operative time in the UltraTape group primarily reflected the additional handling required for tape constructs rather than a change in surgical efficiency or evolving technique. Similarly, the combination of improved lift-off strength and slightly lower patient satisfaction is more likely related to the biomechanical characteristics of tape constructs than to temporal effects, consistent with published biomechanical data [3].

We acknowledge that temporal bias is an inherent limitation of retrospective studies [4]. However, the single-surgeon design, stable rehabilitation pathway, and strict matching reduce this risk significantly, aligning with best practices for observational surgical research [5]. While we agree that future prospective randomized studies remain the gold standard, real-world retrospective comparisons such as ours are an important early step when new surgical materials are introduced.

Our findings—no reduction in retear rates despite biomechanical advantages, with mixed functional results—provide practical early evidence to guide clinical decision-making. We thank Sun et al. for engaging with our work and hope this dialogue encourages further investigation into suture-tape technology.

Author contributions

All authors contributed to the writing and approval of this reply.

Funding

No funding was received for this work.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.