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Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model

Year 2026, Volume: 28 Issue: 1 , 52 - 56 , 25.04.2026
https://doi.org/10.18678/dtfd.1809727
https://izlik.org/JA49SC63UM

Abstract

Aim: Tendon injuries remain challenging to treat, and successful outcomes depend on surgical precision and experience. Simulation-based models are widely used to develop these skills. This study aimed to evaluate the effect of surgical experience on tendon repair quality using an in vitro chicken tendon model, focusing on tensile strength and repair time. Material and Methods: The third deep flexors of 60 adult chicken feet were used in this study. Residents were divided into three groups by experience level as novice (Group A), intermediate (Group B), and experienced (Group C), with two residents per group. Each repaired approximately 10 chicken deep flexor tendons using a standardized technique. Repairs exceeding a 5-mm suture boundary or showing excessive bulk were excluded and repeated. Repair duration and ultimate tensile force (N) were recorded. Groups were compared to evaluate the effect of residents’ experience on operative time and tendon repair strength. Results: Experienced residents achieved significantly higher tensile strength (34.55±6.51 N) compared to intermediate (24.65±6.53 N) and novice (14.91±4.50 N) groups (p<0.001). Pairwise comparisons revealed significant differences for all groups. Repair time showed a non-significant trend toward shorter duration with 324.75±80.42 s in the experienced group compared to the 385.50±108.41 s in Group A, 370.75±69.38 s in Group B (p=0.082) Conclusion: Surgical experience was associated with significantly higher tendon repair strength, and repair time also showed a trend favoring experienced residents. The chicken tendon model provides a low-cost, accessible tool for objective training and assessment.

References

  • Western LF, Roberts PG, Rees J, Howgate D. Construct validation of a novel synthetic tendon model used for assessing surgeon performance in a simulated core suture tendon repair technique. J Plast Reconstr Aesthet Surg. 2024;92:111-7. doi:10.1016/j.bjps.2024.02.057.
  • Vinnicombe Z, Asher CM, Super J, Bystrzonowski N, Katsarma E. A qualitative study of seven simulation models for tendon repairs. J Hand Surg Eur Vol. 2021;46(8):847-51. doi:10.1177/1753193421994470.
  • Kuronen JAE, Riski B, Leppänen OV, Karjalainen T, Linnanmäki L. The learning curves of adelaide- and gan-modified lim-tsai flexor tendon repair techniques. J Hand Surg Am. 2025;50(1):34-42. doi:10.1016/j.jhsa.2024.09.004.
  • Western L, Roberts PG, Rees J, Howgate D. Validation of a novel simulated tendon model for core suture tendon repair. Ann R Coll Surg Engl. 2025;107(5):364-368. doi:10.1308/rcsann.2024.0064.
  • Ingraham JM, Weber RA 3rd, Weber RA. Utilizing a simulated tendon to teach tendon repair technique. Hand (N Y). 2009;4(2):150-5. doi:10.1007/s11552-009-9184-9.
  • Lin GT, An KN, Amadio PC, Cooney WP 3rd. Biomechanical studies of running suture for flexor tendon repair in dogs. J Hand Surg Am. 1988;13(4):553-8. doi:10.1016/s0363-5023(88)80094-7.
  • Taras JS, Raphael JS, Marczyk SC, Bauerle WB. Evaluation of suture caliber in flexor tendon repair. J Hand Surg Am. 2001;26(6):1100-4. doi:10.1053/jhsu.2001.28946.
  • Çolak Ö, Kankaya Y, Sungur N, Özer K, Gürsoy K, Şerbetçi K, et al. Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: an ex vivo biomechanical analysis. Arch Plast Surg. 2019;46(3):228-34. doi:10.5999/aps.2018.00962.
  • Maddox GE, Ludwig J, Craig ER, Woods D, Joiner A, Chaudhari N, et al. Flexor tendon repair with a knotless, bidirectional barbed suture: an in vivo biomechanical analysis. J Hand Surg Am. 2015;40(5):963-8. doi:10.1016/j.jhsa.2015.01.013.
  • Lawrence TM, Davis TR. A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair. J Hand Surg Am. 2005;30(4):836-41. doi:10.1016/j.jhsa.2005.03.011.
  • Saarensilta A, Juthberg R, Edman G, Ackermann PW. Effect of surgeon experience on long-term patient outcomes in surgical repair of acute Achilles tendon rupture. Orthop J Sports Med. 2022;10(2):23259671221077679. doi:10.1177/23259671221077679.
  • Strickland JW. Flexor tendon injuries: I. foundations of treatment. J Am Acad Orthop Surg. 1995;3(1):44-54. doi:10.5435/00124635-199501000-00006.

Year 2026, Volume: 28 Issue: 1 , 52 - 56 , 25.04.2026
https://doi.org/10.18678/dtfd.1809727
https://izlik.org/JA49SC63UM

Abstract

References

  • Western LF, Roberts PG, Rees J, Howgate D. Construct validation of a novel synthetic tendon model used for assessing surgeon performance in a simulated core suture tendon repair technique. J Plast Reconstr Aesthet Surg. 2024;92:111-7. doi:10.1016/j.bjps.2024.02.057.
  • Vinnicombe Z, Asher CM, Super J, Bystrzonowski N, Katsarma E. A qualitative study of seven simulation models for tendon repairs. J Hand Surg Eur Vol. 2021;46(8):847-51. doi:10.1177/1753193421994470.
  • Kuronen JAE, Riski B, Leppänen OV, Karjalainen T, Linnanmäki L. The learning curves of adelaide- and gan-modified lim-tsai flexor tendon repair techniques. J Hand Surg Am. 2025;50(1):34-42. doi:10.1016/j.jhsa.2024.09.004.
  • Western L, Roberts PG, Rees J, Howgate D. Validation of a novel simulated tendon model for core suture tendon repair. Ann R Coll Surg Engl. 2025;107(5):364-368. doi:10.1308/rcsann.2024.0064.
  • Ingraham JM, Weber RA 3rd, Weber RA. Utilizing a simulated tendon to teach tendon repair technique. Hand (N Y). 2009;4(2):150-5. doi:10.1007/s11552-009-9184-9.
  • Lin GT, An KN, Amadio PC, Cooney WP 3rd. Biomechanical studies of running suture for flexor tendon repair in dogs. J Hand Surg Am. 1988;13(4):553-8. doi:10.1016/s0363-5023(88)80094-7.
  • Taras JS, Raphael JS, Marczyk SC, Bauerle WB. Evaluation of suture caliber in flexor tendon repair. J Hand Surg Am. 2001;26(6):1100-4. doi:10.1053/jhsu.2001.28946.
  • Çolak Ö, Kankaya Y, Sungur N, Özer K, Gürsoy K, Şerbetçi K, et al. Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: an ex vivo biomechanical analysis. Arch Plast Surg. 2019;46(3):228-34. doi:10.5999/aps.2018.00962.
  • Maddox GE, Ludwig J, Craig ER, Woods D, Joiner A, Chaudhari N, et al. Flexor tendon repair with a knotless, bidirectional barbed suture: an in vivo biomechanical analysis. J Hand Surg Am. 2015;40(5):963-8. doi:10.1016/j.jhsa.2015.01.013.
  • Lawrence TM, Davis TR. A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair. J Hand Surg Am. 2005;30(4):836-41. doi:10.1016/j.jhsa.2005.03.011.
  • Saarensilta A, Juthberg R, Edman G, Ackermann PW. Effect of surgeon experience on long-term patient outcomes in surgical repair of acute Achilles tendon rupture. Orthop J Sports Med. 2022;10(2):23259671221077679. doi:10.1177/23259671221077679.
  • Strickland JW. Flexor tendon injuries: I. foundations of treatment. J Am Acad Orthop Surg. 1995;3(1):44-54. doi:10.5435/00124635-199501000-00006.
There are 12 citations in total.

Details

Primary Language English
Subjects Hand Surgery, Plastic Reconstructive and Aesthetic Surgery
Journal Section Research Article
Authors

Ertuğrul Karanfil 0000-0003-1705-9781

Ümit Ozan Özlen 0009-0007-1158-0193

Berkalp Berker 0009-0003-9161-324X

Süleyman Mert Kılıç 0009-0006-7206-7441

Edanur Gezer Özçelik 0009-0008-3984-7117

Mehmet Furkan Tuncer 0000-0002-3592-6802

Yasin Burak Bozdemir 0009-0008-6808-5457

Ömer Yiğitalp 0009-0001-2467-7302

Eylem Suveren 0000-0003-1730-6463

Metin Görgü 0000-0001-9077-2976

Submission Date October 23, 2025
Acceptance Date March 28, 2026
Publication Date April 25, 2026
DOI https://doi.org/10.18678/dtfd.1809727
IZ https://izlik.org/JA49SC63UM
Published in Issue Year 2026 Volume: 28 Issue: 1

Cite

APA Karanfil, E., Özlen, Ü. O., Berker, B., Kılıç, S. M., Gezer Özçelik, E., Tuncer, M. F., Bozdemir, Y. B., Yiğitalp, Ö., Suveren, E., & Görgü, M. (2026). Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model. Duzce Medical Journal, 28(1), 52-56. https://doi.org/10.18678/dtfd.1809727
AMA 1.Karanfil E, Özlen ÜO, Berker B, et al. Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model. Duzce Med J. 2026;28(1):52-56. doi:10.18678/dtfd.1809727
Chicago Karanfil, Ertuğrul, Ümit Ozan Özlen, Berkalp Berker, et al. 2026. “Measuring Resident Experience Level in an In-Vitro Organic Tendon Repair Model”. Duzce Medical Journal 28 (1): 52-56. https://doi.org/10.18678/dtfd.1809727.
EndNote Karanfil E, Özlen ÜO, Berker B, Kılıç SM, Gezer Özçelik E, Tuncer MF, Bozdemir YB, Yiğitalp Ö, Suveren E, Görgü M (April 1, 2026) Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model. Duzce Medical Journal 28 1 52–56.
IEEE [1]E. Karanfil et al., “Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model”, Duzce Med J, vol. 28, no. 1, pp. 52–56, Apr. 2026, doi: 10.18678/dtfd.1809727.
ISNAD Karanfil, Ertuğrul - Özlen, Ümit Ozan - Berker, Berkalp - Kılıç, Süleyman Mert - Gezer Özçelik, Edanur - Tuncer, Mehmet Furkan - Bozdemir, Yasin Burak - Yiğitalp, Ömer - Suveren, Eylem - Görgü, Metin. “Measuring Resident Experience Level in an In-Vitro Organic Tendon Repair Model”. Duzce Medical Journal 28/1 (April 1, 2026): 52-56. https://doi.org/10.18678/dtfd.1809727.
JAMA 1.Karanfil E, Özlen ÜO, Berker B, Kılıç SM, Gezer Özçelik E, Tuncer MF, Bozdemir YB, Yiğitalp Ö, Suveren E, Görgü M. Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model. Duzce Med J. 2026;28:52–56.
MLA Karanfil, Ertuğrul, et al. “Measuring Resident Experience Level in an In-Vitro Organic Tendon Repair Model”. Duzce Medical Journal, vol. 28, no. 1, Apr. 2026, pp. 52-56, doi:10.18678/dtfd.1809727.
Vancouver 1.Ertuğrul Karanfil, Ümit Ozan Özlen, Berkalp Berker, Süleyman Mert Kılıç, Edanur Gezer Özçelik, Mehmet Furkan Tuncer, Yasin Burak Bozdemir, Ömer Yiğitalp, Eylem Suveren, Metin Görgü. Measuring Resident Experience Level in an in-vitro Organic Tendon Repair Model. Duzce Med J. 2026 Apr. 1;28(1):52-6. doi:10.18678/dtfd.1809727