PURPOSE: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.

Clinic of Trauma Surgery Masaryk Hospital Usti nad Labem Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

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Bachler J, Bergman S, Lancigu R, Ropars M, Rony L. Arthroscopic anatomy of the middle glenohumeral ligament. A series of 300 cases. Morphologie. 2020;104:187–195. doi: 10.1016/j.morpho.2020.03.002. PubMed DOI

Bain GI, Galley IJ, Singh C, Carter C, Eng K. Anatomic study of the superior glenoid labrum. Clin Anat. 2012;26:367–376. doi: 10.1002/ca.22145. PubMed DOI

Bents RT, Skeete KD. The correlation of the Buford complex and SLAP lesions. J Shoulder Elbow Surg. 2005;14:565–569. doi: 10.1016/j.jse.2005.01.002. PubMed DOI

Connell DA, Potter HG, Wickiewicz TL, Altchek DW, Warren RF. Noncontrast magnetic resonance imaging of superior labral lesions: 102 cases confirmed at arthroscopic surgery. Am J Sports Med. 1999;27:208–213. doi: 10.1177/03635465990270021601. PubMed DOI

Crockett HC, Wingert NC, Wright JM, Bonner KF. Repair of SLAP lesions associated with a Buford complex: a novel surgical technique. Arthrosc. 2011;27:314–321. doi: 10.1016/j.arthro.2010.09.005. PubMed DOI

Handelberg F, Willems S, Shahabpour M, Huskin JP, Kuta J. SLAP lesions: a retrospective multicenter study. Arthrosc. 1998;14:856–862. doi: 10.1016/S0749-8063(98)70028-3. PubMed DOI

Harzmann HC, Burkart A, Wotler K, Vaitl T, Imhoff AB. Anatomische Normvarianten des superioren Labrum-Bizepssehnenanker-Komplexes: anatomische und kernspintomographische Befunde. Orthopade. 2003;32:586–594. doi: 10.1007/s00132-003-0488-0. PubMed DOI

Henry BM, Tomaszewski KA, Ramakrishan PK, Roy J, Vikse J, Loukas M, et al. Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat. 2017;3:6–13. doi: 10.1002/ca.22799. PubMed DOI

Henry BM, Tomaszewski KA, Walocha JA. Methods of evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat. 2016;205:16–21. doi: 10.1016/j.aanat.2015.12.002. PubMed DOI

Ide J, Maeda S, Takagi K. Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic Bankart repair. Arthroscopy. 2004;20:164–168. doi: 10.1016/j.arthro.2003.11.005. PubMed DOI

Ilahi OA, Cosculluela P, Ho D. Classification of anterosuperior glenoid labrum variants and their association with shoulder pathology. Orthopedics. 2008;31:1–4. doi: 10.3928/01477447-20080301-18. PubMed DOI

Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior labrum and associated pathology. Arthroscopy. 2002;18:882–886. doi: 10.1053/jars.2002.36119. PubMed DOI

Kanatli U, Ozturk BY, Bolukbasi S. Anatomical variations of the anterosuperior labrum: prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. J Shoulder Elbow Surg. 2010;19:1199–1203. doi: 10.1016/j.jse.2010.07.016. PubMed DOI

Kaptan AY, Ozer M, Alim E, Percin A, Ayanoglu T, Ozturk BY, Kanatli U. The middle glenohumeral ligament: a classification based on arthroscopic evaluation. J Shoulder Elbow Surg. 2022;31:e85–e91. doi: 10.1016/j.jse.2021.07.026. PubMed DOI

Mohana-Borges AVR, Chung CB, Resnick D. Superior labral anterosuperior tear: classification and diagnosis on MRI and MR arthrography. Am J Roent. 2013;181:1449–1462. doi: 10.2214/ajr.181.6.1811449. PubMed DOI

Ozer M, Kaptan AY, Ataoglu MB, Cetinkaya M, Ayanoglu T, Ince B, Kanatli U. The Buford complex: prevalence and relationship with labral pathologies. J Shoulder Elbow Surg. 2021;30:1356–1361. doi: 10.1016/j.jse.2020.08.037. PubMed DOI

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLOS Med. 2021;18:e1003583. doi: 10.1186/s13643-021-01626-4. PubMed DOI PMC

Pappas ND, Hall DC, Lee DH. Prevalence of labral tears in the elderly. J Shoulder Elbow Surg. 2013;22:e11–e15. doi: 10.1016/j.jse.2012.08.023. PubMed DOI

Park YH, Lee JY, Moon SH, Mo JH, Yang BK, Hahn SH, Resnick D. MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. Am J Roent. 2000;175:667–672. doi: 10.2214/ajr.175.3.1750667. PubMed DOI

Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Jt Surg. 2003;85A:653–659. doi: 10.2106/00004623-200304000-00011. PubMed DOI

Shortt CP, Morrison WB, Shah SH, Zoga AC, Carrino JA. Association of glenoid morphology and anterosuperior labral variation. J Comput Assist Tomogr. 2009;33:584–586. doi: 10.1097/RCT.0b013e31818da69d. PubMed DOI

Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–279. doi: 10.1016/0749-8063(90)90056-J. PubMed DOI

Thompson JM, Carrino JA, Skolasky RL, Chhabra A, Fayad LM, Machado A, II, Soldatos T, Morrison WB, McFarland EG. Glenoid notch MRI findings do not predict normal variants of the anterior and superior labrum. Clin Radiol. 2015;70:e90–e96. doi: 10.1016/j.crad.2015.04.016. PubMed DOI

Waldt S, Metz S, Burkart A, Mueller D, Bruegel M, Rummeny EJ, Woertler K. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol. 2006;16:451–458. doi: 10.1007/s00330-005-2864-0. PubMed DOI

Williams MM, Snyder SJ, Buford D., Jr The Buford complex - the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy. 1994;10:241–247. doi: 10.1016/S0749-8063(05)80105-7. PubMed DOI

Wilson WR, Magnussen RA, Irribarra LA, Taylor DC. Variability of the capsular anatomy in the rotator interval region of the shoulder. J Shoulder Elbow Surg. 2013;22:856–861. doi: 10.1016/j.jse.2012.08.024. PubMed DOI

Yeh LR, Kwak S, Kim YS, Pedowitz R, Trudell D, Muhle C, Resnick D. Anterior labroligamentous structures of the glenohumeral joint: correlation of MR arthrography and anatomic dissection in cadavers. Am J Roent. 1998;171:1229–1236. doi: 10.2214/ajr.171.5.9798852. PubMed DOI