The Buford Complex Redefined: A Pathologic Morphology in Sheep's Clothing

Area of Science:

• Orthopedics
• Pediatric Imaging
• Anatomy

Background:

• The Buford complex is an anterosuperior labral variant.
• It has been considered a normal anatomic variant.
• Its prevalence and characteristics in children remain unstudied.

Purpose of the Study:

• To investigate the presence and prevalence of the Buford complex in children.
• To compare the incidence of Buford complexes and sublabral foramens in children to adult populations.
• To determine if these variants are congenital or developmental.

Main Methods:

• A cross-sectional study analyzed MRI scans of 122 children (aged ≤11 years) over 13 years.
• Interrater reliability was assessed for identifying anterosuperior labral variants.
• The observed rates of Buford complexes and sublabral foramens were compared to published adult rates using a binomial probability test.

Main Results:

• Interrater reliability for identifying anterosuperior labral variants was high (0.846).
• Only 1 sublabral foramen was identified in children, significantly lower than the expected 23 (P < .001).
• No Buford complexes were identified in the pediatric cohort, significantly lower than the expected 8 (P < .001).

Conclusions:

• The absence of Buford complexes and reduced sublabral foramens in children suggests they are developmental, not congenital.
• These findings challenge the classification of Buford complexes and sublabral foramens as normal variants.
• The presence of a Buford complex may indicate potential long-term shoulder instability requiring further evaluation.