Middle Glenohumeral Ligament Research Articles

中関節上腕靭帯断裂により関節内のインピンジメント症状を呈した 2 例

中関節上腕靭帯断裂により関節内のインピンジメント症状を呈した 2 例

Anatomical variations of the anterosuperior labrum: Prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions

Anterosuperior labrum variations have been generally described as innocent anatomical variations without clinical significance. This study was intended to determine their prevalence and reveal their possible relationship with type II SLAP lesions. A total of 713 consecutive shoulder arthroscopies were evaluated retrospectively for anterosuperior labrum variations and co-existing labral pathologies. Twenty two of these were excluded from the study due to the interobserver variability in the categorization process. The relationship of both these anatomic variants and shoulders with a normal appearing anterosuperior labrum to intra-articular pathology was analyzed statistically and compared with each other. Found in 98 patients (14.18%), the anatomic variations in the anterosuperior labrum were classified into 3 groups as the sublabral recess (2.46%), the sublabral foramen (7.67%), and absent anterosuperior labrum with a cord-like middle glenohumeral ligament (4.05%). The latter 2 of these groups displayed a statistically significant relationship with type II SLAP lesions (21 of 53 and 23 of 28 patients; P = .0028 and P < .0001, respectively). Although mostly considered as simple morphological variations, the anatomic variants of the anterosuperior labrum may predispose the shoulder to labrum pathologies by altering the intra-articular biomechanics. As previously suggested in the literature, certain anatomic variants of the anterosuperior labrum are associated with the development of SLAP lesions.

In vivo three-dimensional evaluation of the functional length of glenohumeral ligaments

Background Glenohumeral ligaments play an important role in stabilizing the shoulder. However, it is impossible to know how they function in vivo during shoulder motion. To help elucidate this stabilizing role, we studied the in vivo three-dimensional kinematics of the normal shoulder joint using a markerless bone-registration technique. Methods Our technique utilized image registration to determine corresponding relations between several image volumes represented at different coordinates. Magnetic resonance images of 14 shoulder joints of seven healthy volunteers were acquired for seven isometric abduction orientations between 0° and 180°. We then calculated three-dimensional shortest path between the origin and insertion of each ligament based on anatomical study in each abduction orientation. Findings At 0° of abduction, the posterior band of the coracohumeral ligament displayed the maximum length. At 30° of abduction, the superior glenohumeral ligament displayed the maximum length. At 60° of abduction, the anterior band of the coracohumeral ligament and the middle glenohumeral ligament displayed the maximum length. At 120° of abduction, the anterior band of the inferior glenohumeral ligament displayed the maximum length. Interpretation Based on progressive abduction of the arm, each ligament had different pattern in change of length. At different arm orientation of abduction, each ligament displayed the maximum length. We think that each ligament might play an important role in stabilizing the shoulder at different arm orientation.

Glenohumeral instability associated with Buford complex

Buford complex is described as a normal anatomical variant of the anterosuperior part of the glenoid consisting of the absence of the anterosuperior labrum with the presence of a cord-like middle glenohumeral ligament. Traditionally, reattachment to the glenoid has been discouraged. We present a case of a Buford complex associated with glenohumeral instability. The patient was operated for recurrent instability without a preoperative diagnosis of Buford complex. The diagnosis was made during shoulder arthroscopy and reattachment to the glenoid was performed with a satisfactory outcome. Here, we discuss the relationship of the Buford complex with intraarticular pathology and the surgical treatment in cases when this variant is associated with instability.

「画像診断の進歩」空気造影３ＤＣＴの肩関節前方不安定症に関する有用性について

The authors have demonstrated three-dimensional computed tomography imaging of soft tissues, such as the labrum and the anterior inferior glenohumeral ligament (AIGHL). We have called this imaging method 3DCT shoulder virtual arthroscopy (3DCTSVA). The aim of this study was to investigate whether 3DCTSVA can be used to visualize the internal architecture of anterior shoulder instability in comparison to surgical arthroscopy. This study involved twentytwo patients. There were 17 males and 5 females, with a mean age of 23.8 years. All patients had suspected anterior shoulder instability, as determined by patient history and physical examination, and underwent 3DCTSVA before arthroscopy. Each of the joints was injected with 20 cc air, and was then scanned immediately with a helical CT (Toshiba helical CT Aquilion slice thickness: 1 mm, slice pitch: 0.5 mm, WL: 40, WW: 250). The data obtained was entered into a workstation, and commercially available software was used to create a three-dimensional simulation of a lesion in the shoulder. Reconstruction images were then obtained. The findings of 3DCTSVA were compared with arthroscopy findings. In all 22 cases, Bankart lesion was correctly identified on 3DCTSVA. In 20 of 22 cases, AIGHL was correctly identified. In 20 of 22 cases, middle glenohumeral ligament (MGHL) was correctly identified. The sensitivity, specificity and accuracy predictive values for Bankart lesion were 100%, 100% and 100%, respectively. The sensitivity, specificity and accuracy for AIGHL were 100%, 77% and 90%. The sensitivity, specificity and accuracy for MGHL were 100%, 84% and 90%, respectively. 3DCTSVA offers fine images of the anterior labrum capsule complex of the shoulder with Bankart lesion, AIGHL and MGHL. The use of 3DCTSVA will enable us to determine the state of an anterior lesion of the shoulder before actually performing arthroscopy. 3DCTSVA is a promising method for detecting the sources of derangement of the shoulder.

The treatment of inferior shoulder instability caused by middle glenohumeral ligament dysfunction

The treatment of inferior shoulder instability caused by middle glenohumeral ligament dysfunction

Normal variants of the middle glenohumeral ligament in MR imaging of the shoulder

The middle glenohumeral ligament [MGHL] demonstrates the greatest variation in size and thickness, of all the three glenohumeral ligaments seen on MR imaging of the shoulder. We report a series of patients who underwent routine MR imaging of the shoulder for unrelated pathologies in whom a significant number of MGHL variants were identified. The importance of recognizing this lies in avoiding overdiagnosing or mistaking these for labral or ligamentous pathology. We conclude with a brief review of the importance and functions of the MGHL.

Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability Using a Tibialis Anterior Allograft

Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. To address the problem, a precise analysis of the etiology of instability is necessary. Soft tissue insufficiency, osseous deficiency, and a combination of both have to be considered as etiologic factors. This article focuses on the treatment of recurrent anterior glenohumeral instability secondary to soft tissue insufficiency-especially in patients who have undergone multiple ineffective surgeries before and have soft tissue disorders. Therefore, we present a technique for anterior capsulolabral reconstruction with a tibialis anterior tendon allograft. The main structures that are reconstructed by the allograft are the anterior labrum, the middle glenohumeral ligament, and the anterior band of the inferior glenohumeral ligament. Because of the complexity of the reconstruction, the technique is performed as open surgery, which allows precise placement and tensioning of the allograft tendon. The postoperative protocol requires placing the arm in a sling for 6 weeks and cautious physiotherapy. The results of this salvage procedure are highly satisfactory.

Arthroscopic Management of Posterior Instability: Evolution of Technique and Results

The purpose of this study was to evaluate the effectiveness of arthroscopic posterior shoulder reconstruction. We treated 136 shoulders in 131 patients with a diagnosis of primary posterior instability who failed 6 months of vigorous rehabilitation by operative stabilization between 1989 and 2001. Inclusion criterion was primary posterior instability that failed an extensive rehabilitative program with functional impairment and pain. Exclusion criterion was less than 12 months of follow-up and Suretac (Smith & Nephew, Andover, MA) or laser stabilization, leaving 92 shoulders in 90 patients available for the study (69 male, 21 female). Follow-up ranged from 12 to 132 months (average, 28 months). Each patient underwent diagnostic arthroscopy and surgical repair at the same time using one of several primary procedures. The procedure used was based on the pathologic entity noted at the time of surgery. At an average follow-up of 28 months, 97% of the shoulders were stable and considered a success based on the Neer-Foster rating scale. Posterior pathology varied, and a reverse Bankart lesion alone was found 51% of the time, a stretched posterior capsule 67% of the time, and a combination of a reverse Bankart lesion and capsular stretching 16% of the time. The rotator interval was obviously damaged in 61% of cases. Multiple accompanying lesions were found, including anterior-superior labral tears and SLAP tears (20%), superior glenohumeral ligament injury (7%), middle glenohumeral ligament injury (38%), anteroinferior glenohumaral ligament injury (37%), and an enlarged axillary pouch (20%). No essential lesion is present for posterior instability. Multiple varied pathologies will be present in a shoulder presenting with posterior instability. Arthroscopic surgery allows inspection of the joint and anatomic-specific repairs based on pathology. Careful attention to all the supporting structures of the shoulder, including the rotator interval, the anterior-superior labrum, and its attached superior glenohumeral ligament, the coracohumeral ligament, the inferior glenohumeral ligament complex, and the infraspinatus, in addition to the posterior labrum and capsule, allows excellent outcomes to be achieved with arthroscopic posterior reconstruction techniques. Level IV, therapeutic case series.

Classification of Anterosuperior Glenoid Labrum Variants and Their Association With Shoulder Pathology

This prospective study of 367 consecutive shoulder arthroscopies assessed variants of the anterosuperior glenoid labrum and associated shoulder pathology. Thirty-three shoulders were excluded because of prior surgery, septic arthritis, or adhesive capsulitis. Anterosuperior glenoid variants were classified as: type I, cordlike middle glenohumeral ligament without sublabral foramen; type II, sublabral foramen without a cordlike middle glenohumeral ligament; type III, sublabral foramen with a cordlike middle glenohumeral ligament; and type IV, absent anterosuperior labrum with the anterior aspect of the superior labrum continuous with a cordlike middle glenohumeral ligament. The presence of these variants was correlated with the incidence of shoulder pathology found on arthroscopic inspection. Of 334 shoulders, 118 (35.3%) had variants of the anterosuperior glenoid labrum. Of these, 32 (27.1%) were type I, 27 (22.9%) were type II, 34 (28.8%) were type III, and 25 (21.2%) were type IV. The incidence of advanced superior labrum anterior-posterior lesions in the 86 shoulders displaying a type II, III, or IV variant was significantly higher than in shoulders with no anterosuperior variant (48.8% versus 23.6%, P<.001). Other pathologic findings were not significantly increased in shoulders with variants compared to those without. Level 1.

The Spiral Glenohumeral Ligament: An Open and Arthroscopic Anatomy Study

The purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL). Twenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated. The spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus. Our results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified. Advanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

Simulated Type II Superior Labral Anterior Posterior Lesions Do Not Alter the Path of Glenohumeral Articulation

Background Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. Purpose To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. Study Design Controlled laboratory study. Methods Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30°, 60°, 90°, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. Results A subtle but significant increase in external rotation (2.7°) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. Conclusion The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. Clinical Relevance Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair.

Management of the subscapularis contracture during shoulder arthroplasty for primary glenohumeral arthritis

To evaluate the safety and effectiveness of a particular subscapularis release in shoulder arthroplasty for primary glenohumeral arthritis. Twenty-eight patients (19F, 9M) underwent shoulder arthroplasty for primary glenohumeral arthritis. Preoperative average Constant Score (CS) was 31.2 points (range 14-52), active anterior elevation (AAE) 92 degrees (30-100 degrees ) and active external rotation (AER) 11 degrees (-40 to 20 degrees ). During arthroplasty for subscapularis contracture, patients underwent subscapularis release freeing the superior tubular tendon (STT) with a section of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL) and a deep release consisting of a section of the middle glenohumeral ligament (MGHL), very close to the glenoid labrum, and the inferior glenohumeral ligament (IGHL). An anatomic study was performed on 13 cadavers, verifying the structure of subscapularis tendon and its relationship with the capsule, the surrounding ligaments and the axillary nerve. Moreover, after having placed traction sutures on the subscapularis tendon, its lengthening was measured after STT release alone and after STT and deep release. The complete absence of neurological and vascular lesions was also verified. Average follow-up: 2.9 years. Postoperative mean CS was 70.5 (p[Symbol: see text]0.005), with an absolute gain of 39.1. AAE increased from 92 degrees to 142 degrees (p=0.001) while AER increased from 8 degrees to 48 degrees (p=0.002). At the last follow-up, 19 patients (67.8%) were very satisfied, 5 patients (17.8%) were satisfied, 3 patients (10.7%) partially satisfied and 1 patient (3.5%) unsatisfied. In the anatomic control, the average lengthening of subscapularis tendon was 0.9 cm after STT release alone and 2.5 cm after STT and deep release. No vascular and neurological lesions were observed. The subscapularis release during shoulder arthroplasty is extremely important to obtain the proper balance between anterior and posterior soft tissues and to achieve an optimal range of motion and joint stability. An adequate anatomical dissection could give good tendon mobilisation and lengthening, necessary for a good repair, and lead to a recovery of the range of motion, particularly for external rotation.

The Rotator Interval of the Shoulder: Anatomy, Biomechanics, and Repair Techniques

The role of the rotator interval (RI) in maintaining stability of the shoulder joint remains controversial. Defined as the triangular-shaped space between the supraspinatus and subscapularis tendons, the RI is an area of complex anatomy that contains the superior and middle glenohumeral ligaments, the coracohumeral ligament, the long head of the biceps, and a thin layer of capsule. The RI has frequently been touted as an area that is important in preserving stability of the shoulder because an incompetent RI has been implicated in various conditions of shoulder instability. Biomechanical research suggests that surgical repair of the RI improves the overall stability of the shoulder joint predominantly in the anterior and potentially inferior directions. With the advent of arthroscopic techniques for the treatment of shoulder instability, the differences between an arthroscopic and open RI closure have been delineated. The purposes of this review were to investigate the anatomy and biomechanical function of the RI in shoulder instability, to review the techniques of surgical repair, and to describe the effect of RI closure on glenohumeral kinematics. Additionally, some of the controversies regarding the indications for RI closure will be discussed.

A Biomechanical Comparison of Two Suture Anchor Configurations for the Repair of Type II SLAP Lesions Subjected to a Peel-Back Mechanism of Failure

The purpose of this study was to biomechanically compare 2 different suture anchor configurations in the repair of type II SLAP lesions. Standardized type II SLAP lesions were created in 8 matched pairs of cadaveric shoulders. Two different suture anchor configurations were used to repair the type II SLAP lesions. Group 1 SLAP lesions were repaired with 1 suture anchor placed at the anterior border and a second suture anchor placed at the posterior border of the biceps tendon. Group 2 SLAP lesions were repaired with 2 suture anchors placed posterior to the biceps tendon. Biomechanical testing was conducted in 1 direction. A posterior-directed force, in the plane of the glenoid, simulated the peel-back mechanism that occurs during the late cocking phase of throwing. Biceps-labral complex displacement from the glenoid was measured with 2 miniature displacement transducers. Repair failure (2 mm of posterior labral displacement), ultimate failure, and construct stiffness were measured for each specimen. The mean load to repair failure was 43.66 N in group 1 and 40.70 N in group 2. The mean load to ultimate failure was 156.28 N in group 1 and 162.06 N in group 2. The mean construct stiffness was 25.91 N/mm in group 1 and 30.28 N/mm in group 2. The differences between the 2 groups were not statistically significant in terms of repair failure, ultimate failure, and construct stiffness. When repaired type II SLAP lesions were subjected to a posterior vector load to simulate the peel-back mechanism, the 2 suture anchor configurations were biomechanically equivalent. Placement of an anterior suture anchor could, theoretically, tension the anterior capsulolabral structures via the superior and middle glenohumeral ligaments to the superior labrum. The results of this study suggest that there is no biomechanical advantage to placing an anterior suture anchor and so the use of 2 posterior suture anchors may be preferable in the repair of type II SLAP lesions.

The Inter-rater Reliability of Shoulder Arthroscopy

The purpose of this study was to determine the inter-rater reliability of orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in real-time diagnostic shoulder arthroscopy by use of a videotape model. Twenty patients (nineteen male patients and one female patient) diagnosed with recurrent anterior shoulder instability with a mean age of 27.9 years (range, 15 to 44 years) consented to participate in the study. Standardized diagnostic shoulder arthroscopies (modified Snyder protocol) were done by a single experienced surgeon, and the procedures were videotaped. The patients' clinical information, radiographs, and videotape of the arthroscopy were sent to 6 experienced shoulder surgeons. The surgeons reviewed the clinical information, assessed the intra-articular structures shown on the videotape, and recorded their diagnoses on a standardized data collection form. The primary outcome was the median overall percent agreement for the video review surgeons by structure evaluated. The median values for overall agreement for the video review surgeons were as follows: anterior labrum, 90%; inferior labrum, 75%; superior labrum, 60%; posterior labrum, 65%; superior glenohumeral ligament, 50%; middle glenohumeral ligament, 50%; anterior inferior glenohumeral ligament, 25%; glenoid surface, 35%; detection of Hill-Sachs lesion, 85%; biceps tendon, 70%; supraspinatus tendon, 85%; infraspinatus tendon, 70%; and subscapularis tendon, 80%. The inter-rater reliability for orthopaedic shoulder surgeons' arthroscopic assessment of intra-articular anatomy in patients with anterior shoulder instability varied by structure examined. It was very good (>80%) for the anterior labrum and supraspinatus tendon and in detecting a Hill-Sachs lesion, poor (<40%) for the glenoid and anterior inferior glenohumeral ligament, and intermediate for all other structures examined. Level V, diagnostic study, expert opinion.

Glenoid Exposure During Shoulder Replacement

Glenoid exposure for total shoulder replacement can be challenging and represents the most difficult part of the procedure. Exposure requires both humeral and glenoid-based releases. We prefer a lesser tuberosity osteotomy instead of a subscapularis takedown. The osteotomy offers significant advantages for glenoid visualization by decreasing the encroachment of anterior humeral bone. Specific glenoid-based releases are then performed in this sequential fashion: 1) the rotator interval including the coracohumeral and superior glenohumeral ligament is released, 2) the middle glenohumeral ligament is divided in an inferior direction, 3) the inferior glenohumeral ligament is then divided as the inferior extension of the above dissection, and 4) posterior glenoid retractors are placed and the axillary nerve is directly visualized. An inferior capsular release then is performed dependent on the necessity of further exposure.

Minor Shoulder Instability

The wide spectrum of shoulder instability is difficult to include in 1 classification. The distinction between traumatic, unidirectional, and atraumatic multidirectional instability is still widely used, even though this classification is not sufficiently precise to include all the different pathological findings of shoulder instability. We present “minor instability,” which is a pathological condition causing a dysfunction of the glenohumeral articulation, especially in combination with microtrauma, repetitive or not, or after a period of immobilization or inactivity. When “minor shoulder instability” is suspected, the patient’s history and detailed clinical examination represent the most important factors when establishing the diagnosis. In particular, the apprehension test stressing the middle glenohumeral ligament (MGHL)/labral complex in the position of midabduction and external rotation may be painful and may even reveal anterior instability or subluxation. Conventional radiographs are negative in most cases, as is magnetic resonance imaging arthrography. It is only after an accurate arthroscopic assessment that the pathological lesion can be found. The major pathological process can be identified at the level of the anterior superior labrum, in particular the MGHL complex, and appears as hyperemia, fraying, stretching, loosening, thinning, hypoplasia, or even absence. It may, however, be difficult to distinguish between a normal variant and a pathological lesion. Clinical symptoms and examination should always be correlated with arthroscopic findings. Recommended treatment is to restore shoulder stability and thereby prevent shoulder pain secondary to the increase in laxity. A reduction in range of motion should be expected during the postoperative phase, at least up to six to nine months. External rotation is usually permanently reduced by a few degrees.

Effect of rotator interval closure on glenohumeral stability and motion: A cadaveric study

The effect of rotator interval closure, which is performed as an adjunct to arthroscopic stabilization of the shoulder, has not been clarified. Fourteen fresh-frozen cadaveric shoulders were used. The position of the humeral head was measured using an electromagnetic tracking device with the capsule intact, sectioned, and imbricated between the superior glenohumeral ligament and the subscapularis tendon (SGHL/SSC closure) or between the superior and middle glenohumeral ligaments (SGHL/MGHL closure). The direction of translational loads (10, 20, and 30 N) and arm positions were (1) anterior, posterior, and inferior loads in adduction; (2) anterior load in abduction/external rotation in the scapular plane; and (3) anterior load in abduction/external rotation in the coronal plane. The range of motion was measured using a goniometer under a constant force. Both methods reduced anterior translation in adduction. Only SGHL/MGHL closure reduced anterior translation in abduction/external rotation in the scapular plane and posterior translation in adduction. Both methods reduced the range of external rotation and horizontal abduction. Rotator interval closure is expected to reduce remnant anterior/posterior instability and thereby improve the clinical outcomes of arthroscopic stabilization procedures.

The correlation of the Buford complex and SLAP lesions

The Buford complex has previously been thought to be a normal anatomic variant with minimal clinical significance. The purpose of this study was to determine a potential correlation of an arthroscopic finding of a Buford complex and superior labrum anterior-posterior (SLAP) lesions in patients. Two hundred fifty consecutive shoulder arthroscopies performed at one institution were reviewed retrospectively. Operative reports and arthroscopic pictures were carefully inspected, with particular attention paid to descriptions of labral variations and pathology. Two hundred thirty-five reports met criteria for study inclusion. Of the 235 cases, 6 had a Buford complex (2.5%), displaying a cordlike middle glenohumeral ligament and absent anterior-superior labral tissue. Of these 6 patients, 5 had a corresponding SLAP lesion (83.3%). Of the remaining 229 patients 40 had SLAP lesions (17.5%). The significant difference between these groups (P < .003) indicates that there is a correlation of patients with Buford complexes and SLAP lesions.