Evaluation of Flexor Tendon Repair Training in Orthopedic Residents Using a Simulated Model

Abstract

Background:

Flexor tendon repair is a technically demanding surgical procedure that requires precise execution to minimize functional complications. Although simulation-based training can enhance surgical learning, accessible and reproducible biologic models that allow objective technical assessment remain limited. This study evaluated a porcine tendon–based simulated model for training orthopedic residents in flexor tendon repair.

Methods:

A quasi-experimental longitudinal study was conducted over 5 training sessions within 1 month. Nine orthopedic residents performed standardized flexor tendon repairs using a 4-strand modified Kessler technique reinforced with a continuous epitendinous suture. Outcomes included execution time, gap formation, tensile resistance under progressive loads (2.5-50 N), and technical performance assessed using structured evaluation rubrics. Data were analyzed using nonparametric methods.

Results:

Progressive improvement was observed across sessions. Epitendinous suture time decreased significantly. Gap formation diminished progressively and was absent from the third session onward, with significant differences in the global assessment and under 30 N and 50 N tensile loads. Tendon handling and overall performance scores improved significantly. Resistance at 50 N and total execution time showed favorable trends without statistical significance. All participants rated the model as useful for training.

Conclusion:

The porcine tendon–based simulated model is an effective, accessible, and reproducible tool for flexor tendon repair training, supporting its integration in orthopedic residency programs.