The Greek way to Arthroscopic Subscapularis Augmentation (ASA) for augmenting the classic Bankart repair in cases of recurrent anterior shoulder instability: A technical note

DOI: 10.70885/hmsj.2026.07.002

Abstract

Recurrent anterior shoulder instability with capsulolabral insufficiency and subcritical glenoid bone loss remains challenging. Arthroscopic Bankart repair alone may be inadequate in selected patients, with an unacceptable long-term recurrence rate, whereas bone-block procedures can be unnecessary when glenoid or humeral bone loss is limited. This Technical Note describes a reproducible all-arthroscopic subscapularis augmentation (ASA) technique performed with a soft anchor and using the Nice knot to reinforce the anterior soft-tissue wall. The procedure is mainly used as an augmentation to the classic arthroscopic Bankart repair and, in specific cases, as an augmentation of arthroscopic bone-grafting procedures when the anterior capsulolabral tissue is deficient. The anterior portal is positioned just above the subscapularis; the tendon is penetrated approximately 5 mm below its superior border at the glenoid level, and tenodesis is completed with the arm in 0° abduction and maximal external rotation to prevent overtightening. Key indications, contraindications, technical tips, pitfalls, and postoperative rehabilitation are outlined. ASA offers an easy-to-perform, low-morbidity procedure that improves the recurrence rate of the classic arthroscopic Bankart repair in patients with subcritical glenoid bone loss.Keywords: Recurrent anterior shoulder instability; ASA; subscapularis augmentation; Nice knot; Bankart repair; subcritical glenoid bone loss; tenodesis; augmentation techniquehttps://doi.org/10.70885/hmsj.2026.07.002

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