Validation of a novel simulated tendon model for core suture tendon repair

Abstract

Introduction: Simulation training can develop surgical procedural skills in a safe environment. Able to offer high-intensity exposure, simulation is increasingly important as working time for surgeons becomes more protected. Materials used in simulated tendon repair play a critical role in the fidelity and face validity of the model. Although organic materials like porcine tendon are commonly used, non-organic materials offer advantages such as accessibility, reproducibility, cost-effectiveness and ease of use without the need for special licences or facilities. This study aims to establish the face, content and concurrent validity of using a novel silicone material in a simulated tendon repair model.

Methods: Three tendon models, bathroom silicone sealant, DragonSkin^® silicone and organic porcine tendons, were evaluated for concurrent validity through mechanical load to failure testing. Face and content validity were assessed, following participant repair of a DragonSkin^® tendon, using a 5-point Likert scale for five clinically relevant parameters.

Results: Significant differences in load to failure were observed among bathroom sealant, DragonSkin^® and porcine tendon (11.1N, 31.7N and 56.2N; p < 0.001). Participant feedback on the DragonSkin^® tendon indicated that it was suitably representative, easy to use and useful for training (agreement rates 58%, 75% and 83%, respectively). However, participants noted that the model did not handle or glide like human tendon (both 8% agreement).

Conclusion: DragonSkin^® silicone is an adaptable and valid material for simulated tendon repair models. It is low cost, widely available and shows promise as a training tool. Future research will focus on exploring its effectiveness in training settings.

Keywords: Education Q000193; Silicones D012828; Simulation Training D000066908; Tendon D013710.

Figure 1

A model Achilles tendon was cast in a custom mould. The simulation rig was created with wood, foam and plastic. Clips mounted to the rig hold the tendon in place during the simulation exercise.

Figure 2

Load testing of the organic and non-organic materials: (a) demonstrates sealant silicone at preload 0.5N; (b) demonstrates DragonSkin^® silicone at failure via tendon rupture; and (c) demonstrates porcine tendon at failure via suture rupture.

Figure 3

A box and whisker plot with interquartile range illustrating the load to failure in newtons (N) for each material. Black dots represent individual data points.