Zip-tie Multidirectional Instability: A Technique for Progressive Tightening of Knotless Anchors in Multidirectional Instability

Multidirectional instability of the shoulder presents a surgical challenge due to capsular laxity and the need for precise, progressive tightening. Traditional arthroscopic techniques risk premature capsular tensioning, complicating anchor placement and potentially compromising outcomes. The zip-tie technique presents an arthroscopic knotless repair method using retensionable sutures designed to optimize surgical efficiency and improve capsular control. This technique allows for percutaneous placement of knotless anchors without early tightening, preserving intra-articular maneuverability. Final tensioning is performed after all anchors are placed, enabling fine-tuned capsular volume reduction and minimizing cartilage trauma. By eliminating stacked knots and allowing for sequential, controlled tensioning, this technique may reduce complications and enhance long-term stability. Our technique description details the surgical steps, rationale, and advantages of this novel method in treating multidirectional instability, proposing a reliable and efficient alternative to traditional capsular shift procedures.