Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic bankart repair

Abstract

Purpose The purpose of this study was to evaluate the prevalence and morphologic characteristics of normal variations in the glenohumeral ligament complex (GHLC). Type of study Anatomic study in cadavers. Methods We investigated 84 cadaver shoulders and recorded visualization of the superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), and anterior band of the inferior glenohumeral ligament (AIGHL). In cases with an AIGHL, we noted the location of its origin with respect to the anterior glenoid in terms of a clock face as in a right shoulder. If an MGHL was present, the site of its glenoid attachment was recorded. The presence of a cord-like MGHL, the Buford complex, and a sublabral foramen was also investigated. Results Of these, 79 (94.1%) manifested an SGHL, 53 (63.1%) an MGHL, and 76 (90.5%) an AIGHL. The AIGHL originated in an area located between the 2- and 5-o’clock position; in 11 (14.5%), the origin was at the 2-o’clock position; in 49 (64.5%) at the 3-o’clock position; in 11 (14.5%), the 4-o’clock position; and in 5 (6.5%) at the 5-o’clock position. Two common variations in the attachment of the MGHL were seen; 30 of 53 MGHL (56.6%) originated from the labrum separate from the origin of the SGHL, and 23 (43.4%) from the labrum at the origin of the SGHL. Of the 84 specimens, 15 (17.9%) manifested a cord-like MGHL, and one (1.2%) the Buford complex. None of the specimens had a sublabral foramen, a finding that requires further investigation. Conclusions Our results suggest that the Buford complex is a rare variant of the GHLC, and the cord-like MGHL appears to be a relatively common normal variant. Clinical relevance The present study provides useful information concerning normal variations of the GHLC to arthroscopists considering Bankart repair.