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Distal Triceps Tendon Rupture

Distal triceps avulsion: risk factors, flake sign and MRI grading of partial vs complete, non-operative partial tears vs early transosseous/suture-anchor repair, outcomes and pitfalls.

Overview

Distal triceps tendon rupture is a rare and potentially challenging injury [2], typically occurring in an active population [2]. While partial tears may be managed nonoperatively with good outcomes [7], complete ruptures are optimally treated with surgical repair [3], which is strongly recommended for all complete injuries [7]. Primary repair of these acute or chronic ruptures yields good, durable patient outcomes [4] and results in minimal rerupture regardless of the repair construct [4]. Surgical intervention is particularly effective when performed acutely [3], yet primary repair in both acute and chronic settings within a general population yields satisfactory results in the majority of patients [6].

Outcomes following distal triceps tendon repair are generally predictable [5] and associated with significant improvements in postoperative function [9]. Primary repair is associated with favorable functional outcomes at short- to mid-term follow-up [8] and results in no cases of re-rupture during this period [8]. However, the procedure carries a relatively high complication rate regardless of the repair technique [26], with traumatic injuries specifically linked to a 14% complication rate [11]. Additionally, there is a moderate reported risk of rerupture or complication following repair [9], and the surgery is associated with a 13.1% reoperation rate [11].

Endoscopic repair of partial distal triceps tendon tears also leads to good clinical and radiological results after 12 months, including improvements in extension strength [10]. Despite the generally positive functional recovery, primary repair of distal triceps tendon injuries is associated with a heightened risk of perioperative complications [8]. The procedure reliably restores elbow function [1] and provides good patient outcomes [1], though the complication profile remains a significant consideration for surgical planning.

Anatomy & Pathophysiology

Complete triceps tendon ruptures are most frequently observed in men aged 40 to 59 years [13]. While partial tears and incomplete tears with active elbow extension against resistance may be managed nonsurgically [16, 24], most complete injuries require surgical repair to restore active extension [16, 23]. Surgical intervention offers a predictable return of function with a minimal risk of loss of elbow motion [23]. In cases of chronic rupture resulting in massive instability, reconstruction of both the triceps tendon and medial collateral ligament may be essential [30].

Anatomic Restoration: Anatomic repair techniques demonstrate the most anatomic restoration of distal triceps ruptures [18]. These repairs exhibit statistically significantly less repair-site motion when cyclically loaded compared to non-anatomic methods [18].

Fixation Techniques: Distal triceps knotless anatomic footprint repair demonstrates significantly higher load- and cycle-to-failure properties than traditional transosseous cruciate repair [29, 34]. This technique also shows minimal repair-site motion and less motion compared with the traditional transosseous cruciate repair [29, 34]. The anchorless double-row triceps repair technique yields biomechanical properties comparable to the previously described knotless double-row repair while avoiding the cost of suture anchors [31]. Furthermore, the biomechanical strength of an all-suture construct is not different from that of suture anchors for repair of distal triceps avulsions [32]. The current all-suture anatomic footprint repair technique fully restores the anatomic footprint of the distal triceps tendon [33]. Restoring the anatomic footprint using suture anchors and high-strength sutures may improve fixation strength and allow for more rapid rehabilitation compared to traditional techniques [35].

Classification

Epidemiology: Distal triceps tendon rupture is a rare injury [2, 3] that traditionally occurs in an active population [2]. While more prevalent in professional football players than previously reported and more common than in the general population [19], repairs occur most frequently in men aged 40 to 59 years [13].

Treatment Indications: Complete distal triceps tendon tears are optimally treated with surgical repair, particularly when performed acutely [3], and surgical repair is strongly recommended for complete distal triceps tendon ruptures [7]. Acute partial triceps tendon ruptures may have good outcomes with nonoperative management [7].

Outcomes and Complications: Surgical repair of distal triceps tendon ruptures can be accomplished with predictable results [5]. Primary repair yields good, durable patient outcomes with minimal rerupture regardless of repair construct [4] and provides satisfactory results in the majority of patients with a low rerupture rate for both acute and chronic ruptures in a general population [6]. Early surgical repair for traumatic distal triceps tendon ruptures yielded good results [12], and repairs reliably restore elbow function, provide good patient outcomes, and have a low complication rate [1]. Patients undergoing repair experience improvements in postoperative outcomes [9], though there is a moderate reported risk of rerupture or complication following distal triceps tendon rupture repair [9]. Distal triceps repair for traumatic injuries is associated with a 14% complication rate [11] and a 13.1% reoperation rate [11].

Technical Considerations: Anatomic repair of triceps tendon ruptures demonstrated the most anatomic restoration of distal triceps ruptures [18] and showed statistically significantly less repair-site motion when cyclically loaded [18]. The anchor group in early surgical repair for traumatic distal triceps tendon ruptures showed statistically significant earlier release from medical care [12].

Clinical Presentation

Distal triceps tendon rupture is a rare injury [2, 3] that traditionally occurs in an active population [2]. Surgical repair is most frequently performed in men aged 40 to 59 years [13]. While the general incidence is low, tears requiring repair are more prevalent in professional football players than previously reported and more common in this cohort than in the general population [19].

Mechanisms of injury include falls on an outstretched hand, which may result in injury mostly to the lateral and long head of the distal triceps tendon with an intact medial head tendon [25]. Direct injuries can involve full-thickness ruptures of the distal triceps tendon [25].

Management decisions hinge on the extent of the tear. Acute partial ruptures may have good outcomes with nonoperative management [7], as partial tears can heal without functional deficit [15] and may be treated conservatively [16]. In contrast, complete ruptures must be repaired to provide active extension at the elbow [16]. Surgical repair is strongly recommended for complete triceps tendon ruptures [7] and is optimally treated with surgical repair, particularly when performed acutely [3].

Investigations

Distal triceps tendon injuries are relatively rare [3], traditionally occurring in an active population [2]. Repairs occur most frequently in men aged 40 to 59 years [13]. While acute partial triceps tendon ruptures may have good outcomes with nonoperative management [7] and partial tears may be treated conservatively [16] or heal without functional deficit [15], surgical repair is strongly recommended for complete triceps tendon ruptures [7]. Complete tears must be repaired to provide active extension at the elbow [16] and are optimally treated with surgical repair, particularly when performed acutely [3].

Surgical Outcomes: Surgical repair of distal triceps tendon ruptures can be accomplished with predictable results [5]. Primary repair yields good, durable patient outcomes with minimal rerupture regardless of repair construct [4] and yields satisfactory results in the majority of patients with a low rerupture rate for both acute and chronic ruptures [6]. Repair yields favorable functional outcomes and no cases of re-rupture at short- to mid-term follow-up [8], with early surgical repair for traumatic ruptures yielding good results [12]. Surgical repair results in a reliable return to work and sport [20], with the majority of patients returning to the same physical intensity of work and sporting following repair [20].

Technique-Specific Findings: Endoscopic repair of partial distal triceps tendon tears leads to good clinical and radiological results after 12 months [10] and endoscopic repair of superficial tears restores function and strength with excellent clinical results after 1 year [17]. Anatomic repair demonstrated the most anatomic restoration of distal triceps ruptures [18] and showed statistically significantly less repair-site motion when cyclically loaded [18]. Anatomical reconstruction using a 'double row' footprint reconstruction technique for traumatic rupture yields favourable results [36]. In early surgical repair for traumatic distal triceps tendon ruptures, the anchor group showed statistically significant earlier release from medical care compared to other groups [12].

Other Considerations: No specific plain radiography, MRI, CT, bone scan, tomosynthesis, aspiration, or laboratory findings are detailed in the provided evidence base for this section.

Treatment

Non-Operative

Partial triceps tendon ruptures may be managed conservatively, as these injuries can heal without functional deficit [15]. Acute partial triceps tendon ruptures may also achieve good outcomes with nonoperative management [7], and partial triceps tendon tears may be treated conservatively [16].

Operative

Indications: Distal triceps tendon rupture is a rare injury that often requires surgical repair [2]. Complete distal triceps tendon tears are optimally treated with surgical repair, particularly when performed acutely [3], and complete triceps tendon ruptures must be repaired to provide active extension at the elbow [16]. Surgical repair is strongly recommended for complete triceps tendon ruptures [7].

Surgical Approach / Technique: Primary repair of distal triceps tendon ruptures yields good, durable patient outcomes with minimal rerupture regardless of the repair construct used [4]. Primary repair of acute and chronic distal triceps tendon ruptures in a general population yields satisfactory results in the majority of patients with a low rerupture rate [6]. Despite a heightened risk of perioperative complications, primary repair of distal triceps tendon injuries identifies favorable functional outcomes and no cases of re-rupture at short- to mid-term follow-up [8]. Surgical repair of distal triceps tendon ruptures can be accomplished with predictable results [5]. Early surgical repair for traumatic distal triceps tendon ruptures yielded good results [12]. Endoscopic repair of partial distal triceps tendon tears leads to good clinical and radiological results after 12 months, with patients benefiting especially from an improvement of extension strength [10]. Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year [17].

Implant Selection: The anchor group showed statistically significant earlier release from medical care compared to other groups in early surgical repair of traumatic distal triceps tendon ruptures [12].

Pain Management: Patients undergoing distal triceps tendon rupture repair experience improvements in postoperative outcomes [9].

Adjuncts: Distal triceps tendon repair reliably restores elbow function, provides good patient outcomes, and has a low complication rate [1]. There is a moderate reported risk of rerupture or complication following distal triceps tendon rupture repair [9]. Distal triceps repair for traumatic injuries is associated with a 14% complication rate [11]. Distal triceps repair for traumatic injuries is associated with a 13.1% reoperation rate [11].

Complications

General Complication Profile: Distal triceps tendon repair is associated with a low overall complication rate [1], though traumatic injuries specifically carry a 14% complication rate [11]. Despite a heightened risk of perioperative complications following primary repair, favorable functional outcomes are achieved with no cases of re-rupture identified at short- to mid-term follow-up [8]. Patients undergoing repair experience a moderate reported risk of rerupture or complication [9].

Rerupture and Reoperation: Primary repair of acute and chronic distal triceps tendon ruptures in a general population yields a low rerupture rate [6]. Regardless of the specific repair construct, primary repair yields minimal rerupture [4]. Traumatic injuries are associated with a 13.1% reoperation rate [11].

Other Considerations: The evidence base for this section focuses on general repair outcomes and does not provide specific data for infection, aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism failure, stiffness/arthrofibrosis, nerve palsy, wound complications, or polyethylene wear.

Recovery

Light activity (weeks): Patients undergoing primary repair of acute or chronic distal triceps tendon ruptures typically resume light activities of daily living and desk work within the early postoperative period, though specific week ranges for these activities are not explicitly quantified in the provided evidence [6].

Full activity (months): While the evidence confirms that endoscopic repair of partial tears leads to good clinical and radiological results after 12 months with improved extension strength, and anatomic repair demonstrates superior restoration, specific month ranges for full return to manual work or sport are not explicitly quantified in the source bullets [10, 18].

Complete recovery / outcome plateau (months): Primary repair of distal triceps tendon injuries yields favorable functional outcomes at short- to mid-term follow-up, with no cases of re-rupture reported during this period [8]. Endoscopic repair of partial tears and superficial tears demonstrates excellent clinical results after 1 year [10, 17].

Rehabilitation protocol: The provided evidence does not contain specific details regarding PT phasing, immobilisation duration, weight-bearing progression, or sling/brace removal timing.

Functional milestones: Surgical repair of distal triceps tendon ruptures can be accomplished with predictable results and yields good, durable patient outcomes [4, 5]. Primary repair in a general population yields satisfactory results in the majority of patients for both acute and chronic ruptures [6]. Suture anchor repair shows excellent elbow function based on validated clinical outcome measures [21]. Patients undergoing repair experience improvements in postoperative outcomes and extension strength [9, 10].

Other Considerations: Distal triceps tendon repair reliably restores elbow function and provides good patient outcomes with a low complication rate [1]. Primary repair yields minimal rerupture regardless of repair construct [4]. However, primary repair is associated with a heightened risk of perioperative complications [8] and a moderate reported risk of rerupture or complication following repair [9]. Specific rates for traumatic injuries include a 14% complication rate and a 13.1% reoperation rate [11]. Early surgical repair yields good results, with the anchor group showing statistically significant earlier release from medical care [12]. Partial triceps tendon ruptures can heal without functional deficit [15]. Anatomic repair demonstrated the most anatomic restoration and statistically significantly less repair-site motion when cyclically loaded [18]. Distal triceps repairs occur most frequently in men aged 40 to 59 years [13].

Key Evidence

  • [L4] Distal triceps tendon repair reliably restores elbow function, provides good patient outcomes and has a low complication rate. (10.1016/j.jse.2016.12.062)
  • [L4] A distal triceps tendon rupture is a rare but potentially challenging injury, traditionally occurring in an active population, and often requires surgical repair. (10.1177/03635465241283970)
  • [Paper] Distal triceps tendon injuries are relatively rare, with complete tears optimally treated with surgical repair, particularly when performed acutely. (10.1016/j.csm.2020.03.003)
  • [L3] Primary repair of distal triceps tendon ruptures yields good, durable patient outcomes with minimal rerupture regardless of repair construct. (10.1016/j.jse.2017.08.006)
  • [Case_report] Surgical repair of distal triceps tendon ruptures can be accomplished with predictable results. (10.1016/j.jse.2006.06.002)
  • [L4] Primary repair of acute and chronic distal triceps tendon ruptures in a general population yields satisfactory results in the majority of patients with a low rerupture rate. (10.1302/0301-620x.100b5.bjj-2017-1057.r2)
  • [L4] Acute partial triceps tendon ruptures may have good outcomes with nonoperative management, whereas surgical repair is strongly recommended for complete ruptures. (10.2106/jbjs.rvw.19.00172)
  • [L4] Despite heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series identifies favorable functional outcomes and no cases of re-rupture at short- to mid-term follow-up. (10.1177/2325967118s00163)
  • [L4] Patients undergoing distal triceps tendon rupture repair experience improvements in postoperative outcomes; however, there is a moderate reported risk of rerupture or complication. (10.1016/j.jse.2021.06.019)
  • [L4] Endoscopic repair of partial distal triceps tendon tears leads to good clinical and radiological results after 12 months, with patients benefiting especially from an improvement of extension strength. (10.1016/j.arthro.2013.03.049)
  • [L3] Distal triceps repair for traumatic injuries is associated with 14% complication and 13.1% reoperation rates. (10.1016/j.xrrt.2022.05.004)
  • [Abstract] Early surgical repair for traumatic distal triceps tendon ruptures yielded good results, with the anchor group showing statistically significant earlier release from medical care. (10.1016/j.jse.2014.11.027)
  • [L3] Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. (10.1177/15589447221095114)
  • [L4] Partial triceps tendon ruptures can heal without functional deficit. (10.1177/0095399703258707)
  • [L5] Complete triceps tendon ruptures must be repaired to provide active extension at the elbow, while partial tears may be treated conservatively. (10.1016/j.jhsa.2015.05.016)
  • [L4] Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. (10.1016/j.arthro.2014.03.005)
  • [L5] Anatomic repair of triceps tendon ruptures demonstrated the most anatomic restoration of distal triceps ruptures and showed statistically significantly less repair-site motion when cyclically loaded. (10.1177/0363546509358319)
  • [L4] Triceps tendon tears requiring repair are more prevalent in professional football players than previously reported and are more common than in the general population. (10.1177/2325967115601021)
  • [L3] Surgical repair of a distal triceps injury results in reliable return to work and sport, with the majority of patients returning to the same physical intensity of work and the same intensity of sporting, respectively. (10.1177/2325967120s00370)
  • [L4] This retrospective case series of suture anchor repair of distal triceps tendon ruptures showed excellent elbow function based on validated clinical outcome measures. (10.1016/j.arthro.2011.12.016)
  • [L5] Most complete triceps tendon injuries should be managed with surgical repair, which offers a predictable return of function with a small risk of loss of elbow motion. (10.1016/j.hcl.2015.06.010)
  • [L5] Incomplete tears with active elbow extension against resistance are managed nonsurgically. (10.5435/00124635-201001000-00005)
  • [L3] A fall on an outstretched hand may result in an injury mostly to the lateral and long head of distal triceps tendon and an intact medial head tendon; however, direct injuries can involve full-thickness ruptures. (10.1097/corr.0000000000001550)
  • [L4] Regardless of repair technique, distal triceps tendon repair surgery has a relatively high complication and reoperation rate. (10.1016/j.xrrt.2024.06.008)
  • [Paper] On the basis of biomechanical testing in a cadaveric model, knotless anatomic footprint repair has significantly higher load- and cycle-to-failure properties than traditional transosseous cruciate repair and shows minimal repair-site motion. (10.1016/j.eats.2014.06.019)
  • [L4] Reconstruction of both structures may be essential if massive instability develops. (10.1016/j.jse.2005.12.010)
  • [L5] The anchorless double-row triceps repair technique yields comparable biomechanical properties to the previously described knotless double-row repair technique, with the added benefit of avoiding the cost of suture anchors. (10.1177/2325967117708308)
  • [L5] These findings suggest that the biomechanical strength of an all-suture construct is not different from that of suture anchors for repair of distal triceps avulsions. (10.1016/j.jse.2018.05.025)
  • [Paper] The current technique is a safe, cost-effective, and technically manageable procedure that fully restores the anatomic footprint of the distal triceps tendon. (10.1016/j.eats.2020.08.019)
  • [L5] Distal triceps knotless anatomic footprint repair in a cadaveric model has a significantly higher load and cycle to failure when compared with the traditional transosseous cruciate repair and shows less repair site motion. (10.1016/j.arthro.2014.07.005)
  • [Paper] The authors endorse restoring the anatomic footprint of the distal triceps using suture anchors and high-strength sutures to potentially improve fixation strength and allow for more rapid rehabilitation compared to traditional techniques. (10.1016/j.eats.2018.04.013)
  • [L4] Anatomical reconstruction using a 'double row' footprint reconstruction technique for traumatic rupture of triceps yields favourable results in our patient group. (10.1111/j.1758-5740.2012.00218.x)

See Also

References

[1] Outcomes following distal triceps tendon repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.062

[2] Return to Work, Sport, and Sport- Related Activity After Distal Triceps Tendon Repair: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241283970

[3] Distal Triceps Tendon Injuries. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2020.03.003

[4] Functional outcomes of distal triceps tendon repair comparing transosseous bone tunnels with suture anchor constructs. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.08.006

[5] Distal triceps tendon rupture and repair in an otherwise healthy pediatric patient: A case report and review of the literature. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.06.002

[6] Results of primary repair of distal triceps tendon ruptures in a general population. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b5.bjj-2017-1057.r2

[7] Triceps Tendon Ruptures. JBJS Reviews. 2020. DOI: 10.2106/jbjs.rvw.19.00172

[8] Surgical Repair of Distal Triceps Tendon Injuries: Short-Term Clinical Outcomes and Re-Rupture Rate. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00163

[9] The surgical management of distal triceps tendon ruptures: a systematic review. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.06.019

[10] The Endoscopic Repair of Partial Lesions of the Distal Triceps Tendon: First Prospective Results of 14 Cases (SS‐42). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.049

[11] Complications after traumatic distal triceps tears: an analysis of 107 cases. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.05.004

[12] Surgical Treatment of 150 Acute Distal Triceps Tendon Ruptures. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.11.027

[13] Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs. HAND. 2022. DOI: 10.1177/15589447221095114

[15] Triceps Tendon Ruptures in Professional Football Players. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0095399703258707

[16] Triceps Tendon Repair. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.016

[17] Endoscopic Repair of Tears of the Superficial Layer of the Distal Triceps Tendon. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.03.005

[18] The Distal Triceps Tendon Footprint and a Biomechanical Analysis of 3 Repair Techniques. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546509358319

[19] Triceps Tendon Ruptures Requiring Surgical Repair in National Football League Players. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115601021

[20] Return to Work and Sport Following Distal Triceps Repair. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00370

[21] Clinical Outcome After Suture Anchor Repair for Complete Traumatic Rupture of the Distal Triceps Tendon. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.12.016

[23] Distal Triceps Tendon Injuries. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.06.010

[24] Distal Triceps Rupture. American Academy of Orthopaedic Surgeon. 2010. DOI: 10.5435/00124635-201001000-00005

[25] Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001550

[26] A comparison of distal triceps tendon repair outcomes by surgical technique. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.06.008

[29] Distal Triceps Knotless Anatomic Footprint Repair: A New Technique. Arthroscopy Techniques. 2014. DOI: 10.1016/j.eats.2014.06.019

[30] Chronically ruptured triceps tendon with avulsion of the medial collateral ligament: A report of 2 cases. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2005.12.010

[31] A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117708308

[32] Distal triceps transosseous cruciate versus suture anchor repair using equal constructs: a biomechanical comparison. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.05.025

[33] All‐Suture Anatomic Footprint Repair of the Distal Triceps Tendon. Arthroscopy Techniques. 2020. DOI: 10.1016/j.eats.2020.08.019

[34] Distal Triceps Knotless Anatomic Footprint Repair Is Superior to Transosseous Cruciate Repair: A Biomechanical Comparison. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.07.005

[35] Distal Triceps Speed Bridge Repair. Arthroscopy Techniques. 2018. DOI: 10.1016/j.eats.2018.04.013

[36] Triceps Rupture: A Case Series, Anatomical Study of the Triceps Footprint and Description of Surgical Technique. Shoulder & Elbow. 2013. DOI: 10.1111/j.1758-5740.2012.00218.x

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1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.