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

Jasmine A Scott1, Jerry R Dwek2, Karen Y Cheng3

  • 1Naval Medical Center San Diego, Department of Orthopedic Surgery, San Diego, California, USA.

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|June 4, 2024
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Summary

The Buford complex, previously thought to be a normal variant, was not found in children under 11. This suggests it may be a developmental finding, potentially indicating underlying shoulder instability.

Keywords:
Buford complexchildrengeneralglenoid labrumimagingmagnetic resonancepediatric sports medicineshouldersublabral foramen

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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.