Shoulder Center
The Buford Complex
The Buford Complex is an anatomical variant of the glenoid labrum and the middle glenohumeral ligament. Inexperienced radiologists or even inexperienced surgeons can be misled by this normal variation. On MRI images, this finding very closely resembles a tear of the glenoid labrum from the glenoid, the so-called Bankart lesion.
In fact, however, it is by no means the result of an accident or a traumatic tear of the labrum. In Buford Complex, the anterior superior labrum is almost undeveloped as a result of a congenital anomaly. Instead, there is a significantly thickened middle glenohumeral ligament. In English, it is also referred to as a "cord-like" lesion. This ligament originates at the superior glenoid, from the superior labrum, at the base of the long biceps tendon, and extends in front of the subscapularis tendon to the humerus. The frequency of this congenital anomaly is reported in the literature to be between 2 and 6 percent.
As an experienced shoulder surgeon, one frequently encounters these or other congenital anomalies due to the large number of surgeries performed. How to classify these changes is not a problem for the experienced surgeon.
It can end badly if an inexperienced surgeon is misled by a Buford complex. Attempting to reattach the supposedly torn glenoid labrum results in significant functional impairment of the shoulder and usually also pain for the patient.
This video beautifully demonstrates a Buford complex in a shoulder.