The Buford Complex: Prevalence and Relationship with Labral Pathologies

J Shoulder Elbow Surg. 2020 Sep 16;S1058-2746(20)30730-8. doi: 10.1016/j.jse.2020.08.037. Online ahead of print.


Purpose: This study aimed to determine the prevalence of the Buford complex and to investigate its associated with labral pathologies [superior labrum anterior posterior (SLAP) lesion and anterior/posterior/multidirectional instabilities] using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined.

Methods: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of Buford complex and co-existing labral pathologies. The relationshipsbetween Buford complex, SLAP lesions, andinstability were evaluated statistically.

Results: The Buford complex was observed in 83 shoulders (2.65%). The SLAP lesion was significantly more frequent in patients with Buford complex than those without (81.9% v 33.1%, P< .001) Shoulders with a Buford complex presented a lower frequency for anterior instability (10.8% v 19.3%, P = .052) and a higher frequency for posterior instability (1.2% v 0.9%, P = .789). The prevalence of Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001).results CONCLUSIONS: This study, to our knowledge, has the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tear or multidirectional instability, the prevalace of a Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than thatof reported previously. In addition to these aforementioned conclusions, the identification of a buford complex should prompt through evaluation for a concomitant SLAP lesion.conclusion LEVEL OF EVIDENCE: Level III; Cross-Sectional Design; Epidemiology Study.

Keywords: Anterior instability; Buford complex; Labrum; Middle glenohumeral ligament; Posterior instability; SLAP lesions.