This 1994 retrospective study reviewed 200 consecutive shoulder arthroscopy videotapes to define the incidence of anterosuperior capsulolabral variants. It formally named and characterized the Buford complex as a distinct normal anatomic variant — not a tear or pathologic lesion.
Seeing a bare anterosuperior glenoid with a thick cord running from the biceps anchor to the humerus is not a tear — it is the Buford complex, present in 1.5% of shoulders. When you encounter this pattern arthroscopically, stop and confirm the three elements before touching it. The cord IS the anterosuperior labrum equivalent; there is no missing tissue to repair.
Fixing it to the glenoid is the error this paper documents. The cord gets tethered, and the patient wakes up unable to externally rotate or elevate. Releasing it requires a second surgery. The practical rule: if a sublabral foramen is present, expect a cord-like middle glenohumeral ligament 75% of the time. Recognize the variant, document it, and move on.
This 1994 retrospective study reviewed 200 consecutive shoulder arthroscopy videotapes to define the incidence of anterosuperior capsulolabral variants. It formally named and characterized the Buford complex as a distinct normal anatomic variant — not a tear or pathologic lesion.
Seeing a bare anterosuperior glenoid with a thick cord running from the biceps anchor to the humerus is not a tear — it is the Buford complex, present in 1.5% of shoulders. When you encounter this pattern arthroscopically, stop and confirm the three elements before touching it. The cord IS the anterosuperior labrum equivalent; there is no missing tissue to repair.
Fixing it to the glenoid is the error this paper documents. The cord gets tethered, and the patient wakes up unable to externally rotate or elevate. Releasing it requires a second surgery. The practical rule: if a sublabral foramen is present, expect a cord-like middle glenohumeral ligament 75% of the time. Recognize the variant, document it, and move on.