Utilizing a simulated tendon to teach tendon repair technique

To evaluate the effectiveness of teaching core tendon repairs using a simulation model, ten surgical residents with no prior experience repairing flexor tendons were taught a four-strand cruciate repair. The residents then performed ten repairs each on a simulated tendon (a round synthetic bait worm 10 mm in diameter) while being timed and graded by a hand surgeon using a global rating scale (1 to 5). Six residents also performed a zone IV flexor tendon repair on a fresh frozen cadaver--three residents who had practiced and three other residents who had no practice on the simulated tendon. The mean initial quality score was 2.4/5.0 which improved to 4.8/5.0 by the tenth trial. There was a significant incremental improvement in mean performance from trial 1 to 10 (p < 0.0001). The mean times to complete the first and last repairs were 5.4 and 3.0 min, respectively. In the cadaver trial, there was statistically significant evidence (p = 0.05, one-sided Wilcoxon exact test) that the three residents previously trained with the simulated tendon had a higher median performance (4.4, min = 4.3, max = 4.8) than the three who had not been trained (1.8, min = 1.7, max = 2.1). The mean times to complete the repairs were 4.0 and 5.8 min, respectively. In conclusion, this inexpensive model mimics an in vivo tendon repair experience with sufficient fidelity to justify its use in training residents to perform a tendon repair.