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 retrospectively reviewed, paying specific attention to the anatomy of the anterosuperior glenoid quadrant and especially the labroligamentous complex. Normal glenohumeral anatomy and all variations were carefully evaluated and recorded. Twenty-four (12%) patients had a sublabral foramen below the anterosuperior labrum; a "cord-like" middle glenohumeral ligament 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 glenohumeral ligament that originated directly from the superior labrum at the base of the biceps tendon and crossed the subscapularis tendon to insert on the humerus. There was no anterior-superior labral tissue present between this attachment and the midglenoid notch. This unusual-appearing anatomical variation may lead the surgeon to confuse this complex with a sublabral hole or a pathologic labral detachment. The labral tissue of the remaining three glenoid quadrants was normal. If the Buford complex is mistakenly reattached to the neck of the glenoid, as illustrated in our case example, severe painful restriction of rotation and elevation will occur.