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

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.

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.

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).

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.