This chapter delves into the intricate aspects of bone graft fixation systems with a focus on screw, button, and tape fixation techniques as it pertains to anterior shoulder instability bone block procedures. It discusses historical perspectives and contemporary advancements, highlighting the emergence of screw, suture button, and tape-based fixation methods. The traditional approach of screw fixation is evaluated to address design elements, biomechanical properties, and associated complications. The advent of cannulated screws as a viable alternative, especially in complex cases, is presented. Attention is also dedicated to screw insertion angles and the debate surrounding one- versus two-screw constructs. In contrast, suture button fixation, introduced as a novel alternative, has gained traction due to its utility in arthroscopic application and reduced risk of hardware-related complications. Biomechanical studies and clinical outcomes are discussed to highlight its promising efficacy, albeit with some debate regarding modes of failure and recurrence rates. Lastly, all-suture fixation constructs are explored, showcasing their potential to mitigate iatrogenic risks associated with metallic implants. Clinical techniques and outcomes are examined to shed light on their feasibility and advantages. Ultimately, this section emphasizes the nuanced decision-making process surrounding graft fixation, acknowledging the multifaceted considerations of biomechanics, surgical subtleties, and patient-specific factors, and underscores the pursuit of the optimal fixation method in the continuously evolving surgical landscapes.