THE BUFORD COMPLEX - THE CORD-LIKE MIDDLE GLENOHUMERAL LIGAMENT AND ABSENT ANTEROSUPERIOR LABRUM COMPLEX - A NORMAL ANATOMIC CAPSULOLABRAL VARIANT

Two hundred consecutive shoulder arthroscopy videotapes were retrospec tively reviewed, paying specific attention to the anatomy of the anter osuperior glenoid quadrant and especially the labroligamentous complex . Normal glenohumeral anatomy and all variations were carefully evalua ted and recorded. Twenty-four (12%) patients had a sublabral foramen b elow the anterosuperior labrum; a ''cord-like'' middle glenohumeral li gament was present in 75% (18 of 24) of those cases or 9% of the study population. A smaller group of patients demonstrated a unique variant of normal capsulolabral anatomy that, for convenience, is termed the ''Buford complex.'' This unusual variant was noted in 3 of the 200 (1. 5%) shoulders and was distinguished by a ''cord-like'' middle glenohum eral ligament that originated directly from the superior labrum at the base of the biceps tendon and crossed the subscapularis tendon to ins ert on the humerus. There was no anterior-superior labral tissue prese nt between this attachment and the midglenoid notch. This unusual-appe aring anatomical variation may lead the surgeon to confuse this comple x with a sublabral hole or a pathologic labral detachment. The labral tissue of the remaining three glenoid quadrants was normal. If the Buf ord complex is mistakenly reattached to the neck of the glenoid, as il lustrated in our case example, severe painful restriction of rotation and elevation will occur.