With this new technique, after the stabilization of the anterior glenoid graft, a Bankart repair is mandatory to center the head on the glenoid fossa. In cases of recurrent instability, the percentage of anterior capsule inconsistency can be very high, and this problem can create conditions not conducive to obtaining a good result. In 2013, it was proposed to treat recurrent instability with a moderate bone glenoid defect and capsular deficiency with a Bankart repair associated with an ASA technique (Maiotti & Massoni, 2013). In 2016, the first short term follow up series reported very good clinical results with recurrences of 2.5% without impairment of external rotation (Maiotti et al., 2016). The good biomechanical effect of the upper subscapularis tenodesis (Klungsøyr et al., 2015), as an anterior barrier in recentering the humeral head and a good sliding effect of the tendon with the arm in abduction, was demonstrated in a biomechanical study on specimens (Schröter et al., 2016). In a publication of a multicenter study, the reproducibility of this combination of treatments using the Bankart repair and the ASA technique was confirmed showing good results relative to failures and external rotation (Maiotti et al., 2017). Our aim was to demonstrate that the association of a free bone block using four buttons and the ASA technique to treat complex recurrent instability with glenoid bone loss and capsular insufficiency could be feasible and reproducible. We focused on glenoid defect in order to have less variables, without considering humeral head defects also because it is difficult to verify the position and the shape of the Hill Sachs lesion arthroscopically. We observed arthroscopically at the end of the procedure that the humeral head was recentered, even if an inferior gleno-humeral ligament reconstruction was not done. The association of both procedures can be easily performed after an adequate training by surgeons having a good skills level for arthroscopic shoulder surgery. No anatomical interference was observed between the two tunnels for the bone block stabilization and the subscapularis tenodesis hole anchor. In our opinion, the stabilization of the bone graft with four buttons can certainly be considered an improvement over the use of screws, and the procedure avoids the risk of mechanical contact with the humeral head and a non-orthogonal pressure on the fixation strength of the graft on the glenoid bone defect while in this procedure graft compression is perpendicular and not oblique allowing a better healing. We could verify in all specimens the high stability of the graft on the glenoid without any micro-motion. In all procedures, the partial subscapularis tenodesis allows the recentering of the head, pushing it posteriorly and acting in a way opposite to that of the Remplissage technique, creating a lift up effect on the inferior capsule. The procedure achieved closure of the axillary pouch and increased the contact between the graft, the subscapularis muscle and the residual capsule. We noticed no complications to the main vessels and nerves around the joint anteriorly and posteriorly using the four portals and the dedicated new instrumentation. In particular, the distance between the mid-glenoid portals of the 15 mm cannula can be considered not a risk for axillary nerve injury because it is 40 mm superior to the nerve. On the back side, the superior button for graft stabilization is less than 1 cm from the suprascapular nerve and can thus be used with relative safety, even though it might be at a relative risk. In conclusion, this new proposal of an all arthroscopic bone grafting procedure with concomitant soft tissue reconstruction using the upper part of the subscapularis tendon on specimens showed good stabilization of the shoulder in patients with combined glenoid defect of about 25% and capsular insufficiency. This procedure can be considered safe with respect to the risk of nerve damage, in the same manner as a simple Bankart repair anteriorly and posteriorly. Furthermore, we think that this new technique could be a feasible and reproducible alternative to the arthroscopic or open Latarjet procedures for patients with bone defect associated to capsular insufficiency practicing contact sports. In fact the effect of tenodesis could be comparable to that of the conjoint tendon in Latarjet procedure. Moreover this procedure is a low-risk technique, that can be performed using only three portals and not five as for the arthroscopic Latarjet; graft compression is perpendicular and not oblique allowing a better healing; the present technique is more anatomic, not modifying the coraco-acromial arch. Finally, the use of a preformed graft consistently reduced the surgical time.