The upper third of the subscapularis tendon - as described in the original technical paper (Maiotti & Massoni, 2013) - is usually fixed at 3 (R) or 9 (L) o’ clock positions on the glenoid neck. In this technique, the tenodesis bone holes are placed on the anterior glenoid edge in an upper position (at 10 o’clock in the left shoulders and 2 o’clock in the right shoulders) (Fig. 6) in all cases to avoid possible interference with the upper glenoid tunnel used for the fixation of the graft. A second reason is that by elevating the subscapularis, it is possible to shift the inferior capsulolabral complex up to get a better covering of the graft. The middle upper third of the subscapularis tendon was penetrated approximately 5 mm from its superior border with a suture passing device loaded with tape (Ultra Tape; Smith & Nephew) just over the graft (Fig. 7). Then, one of the free end is passed out through the upper cannula with a suture retriever and then passed again into the lower cannula (Fig. 8a-b). A punch device proved extremely useful to assess the direction and depth of the anchor bone hole. At this point, a loop was created, and both free ends of the tape were passed through the anchor’s eyelet (2.9 mm Bioraptor, Smith & Nephew); then, the anchor was pushed along the tape toward the bone hole (Fig. 8c). While the anchor was inserted into the bone, the tape sutures were kept in traction in a parallel position, and care was taken to keep the specimen’s arm in neutral rotation to avoid excessive tension on the tissue repair. It was important to control the insertion of the anchor’s eyelet and tape, thereby maintaining the correct direction before impacting. Advancement of the subscapularis tendon over the graft, effective closure of the anterior pouch and a posterior shifting of the humeral head in a correct position centered on the glenoid socket could be clearly visible and assessed by arthroscopic examination from the posterior and antero-superior portals (Fig. 9). For a good covering of the graft, capsular residue and ligaments should be able to make it almost extracapsular. After ASA procedure, graft and tenodesis stability were tested using a probe and humeral head stability and position were evaluated.Fig. 6Left shoulder, anterior on the top and posterior on the bottom, scope from posterior portal, drill from antero-superior portal. Drill hole at 10 o’clock position for the anchor (BG: bone graft, GL: glenoid)Fig. 7Left shoulder, anterior on the right and posterior on the left, scope from posterior portal, suture passing device from antero-inferior portal. The upper third of the subscapularis tendon is penetrated with a tape (HH: humeral head, SST: subscapularis tendon)Fig. 8The tape is carried out through the upper cannula with a suture retriever (a) and then passed again in the lower cannula (b). A loop was created, and both free ends of the tape were passed through the anchor’s eyelet and the anchor was pushed along the tape toward the bone hole (c)Fig. 9Left shoulder. Final view from the antero-superior portal showing the closure of the anterior pounce on the bone graft and subscapularis tenodesis (HH: humeral head, GL: glenoid, BG: bone graft, SST: subscapularis tendon)