ISOCAN method and device for arthroscopic suture management

ISOCAN refers to a method and device that functionally isolates sutures within the working cannula during arthroscopic rotator cuff repair, allowing passage of instruments through the same cannula through an instrument-passing quadrant. As sutures are passed, tension and orientation are maintained with each limb by parking each limb into a suture-holding slot. Suture tension prevents loops from forming and functionally isolates each limb. Attention to detail as the sutures are passed, keeping track of the cuff limb and the lateral limb, and parking them in sequence, prevents tangles. The instrument-passing quadrant is kept clear by parking sutures in only 3 of the 4 quadrants around the ISOCAN. Advantages extend beyond suture management and include the ability of an ISOCAN ring to hold reduction tension on the cuff edge, spreading the reduction force over multiple points of fixation, allowing individual suture pairs to be tied down without tension. This enhances knot security and loop security. The technique is especially helpful in arthroscopic rotator cuff repair but can be used wherever arthroscopic suture management is needed, including arthroscopic Bankart repairs and SLAP lesion repairs. A do-it-yourself ISOCAN may be constructed intraoperatively using an 8.25-mm Arthrex clear screw in cannula with a no-spray stopper (Arthrex, Naples, FL). Radial cuts can be made in the no-spray stopper to serve as ISOCAN suture parking slots. A metal ISOCAN ring prototype has been adapted to press-fit over this same cannula and has been used to great advantage in over 100 arthroscopic rotator cuff repairs by the author.