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Sagittal Band Rupture (Boxer's Knuckle)

Sagittal band injury with extensor subluxation: Rayan-Murray classification, relative-motion splinting vs repair/reconstruction, boxer's knuckle vs spontaneous.

43 citationsUpdated Oct 2026
Illustration: Sagittal Band Rupture (Boxer's Knuckle)

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Boxer's knuckle is defined as a dorsal capsular rupture of the metacarpophalangeal (MCP) joint of a finger resulting from closed direct trauma to the knuckle of the index or long fingers [2]. The consistent characteristic of this injury is rupture of the sagittal band with subluxation or obvious dislocation of the central tendon [5]. Extensor tendon instability following sagittal band disruption is most common in the long finger and least common in the small finger [15]. Even minimal sagittal band damage results in measurable subluxation, but the presence of even 10% intact fibers confers some stability against subluxation [9]. Dislocation may occur when the radial sagittal band is only partially divided, which may explain why conservative treatment of tendon dislocation in the middle and ring fingers is feasible [10].

Acute, closed sagittal band injuries in nonrheumatoid patients can be treated conservatively even when notable subluxation of the extensor tendon is present [7]. MP joint blocking orthosis for sagittal band injury led to mostly satisfactory results, with 71% of patients achieving good to excellent outcomes [19]. Even in patients with chronic sagittal band incompetence, splintage is a reasonable first line of treatment before advising surgical intervention [31]. If surgical management is required, it consists of repair or reconstruction of the radial sagittal band, with numerous adjunctive techniques described to prevent subluxation [14]. The authors recommend centralization of the extensor tendon and sagittal band repair as the treatment of choice for this injury [12].

Extensor tendon and/or sagittal band injury may lead to complications including volar subluxation of the MCP joints, extensor quadriga, swan neck deformity, and subsequent joint contractures [25]. Precisely executed operative treatment of both injuries has resulted in an expectant favorable outcome, as in the vast majority of cases the boxers have experienced relief of pain, restoration of function, and an unrestricted return to competition [1]. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications [8]. This review provides a contemporary perspective on sagittal band injuries and describes a modification to the most prevalent classification system to guide treatment and allow standardization in documenting and describing injuries [4].

Anatomy & Pathophysiology

Extensor Mechanism & Sagittal Bands

The extrinsic extensor tendons are stabilized over the midline of the metacarpophalangeal (MCP) joint by their attachment to sagittal band fibers [36]. These fibers insert onto the volar proximal phalanx and onto the lateral borders of the volar plate [36]. By forming a sling, the sagittal bands allow proximal extrinsic extensor tension to be transmitted to the proximal phalanx, permitting MCP joint extension without a direct tendinous insertion onto the proximal phalanx [36]. This mechanism holds the extrinsic extensor tendon balanced over the prominence of the metacarpal head, keeping it as far as possible from the center of rotation of the MCP joint to maximize mechanical efficiency [36]. Consequently, MCP joint extension relies on extrinsic extensor force transmitted through these sagittal bands [36]. With rupture or attenuation of the sagittal band fibers, the extrinsic extensor tendon can sublux to the ulnar side of the metacarpal head, causing ulnar deviation of the finger [36].

The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the MCP joint [49]. The lateral bands are joined by the lateral slips of the extensor tendon to form the conjoined lateral band [49]. The two conjoined lateral bands for each finger unite at the distal third of the middle phalanx to form the terminal tendon [49].

Joint Anatomy & Stability

The MCP joints serve as the keystones of the longitudinal arches of the hand [52]. Their stability is essential to the support of both the longitudinal arch and the transverse metacarpal arch [52]. The MCP joint is stabilized by the collateral ligaments and by the thick volar articular capsule, known as the volar plate [52]. The sagittal bands of the extensor apparatus insert on this volar plate [52]. The deep transverse intermetacarpal ligament ties together the anterior glenoid ligaments of the MCP articulations, which are the volar plates [52]. Additionally, the deep fibers of the superficial palmar fascia continue dorsally to merge with sagittal interosseous fascia fibers, pierce the transverse deep intermetacarpal ligament, and merge with fibers of the sagittal bands of the extensor mechanism [59].

Pathophysiology & Injury Mechanisms

Boxer's knuckle refers specifically to an injury or tear of the MCP joint capsule [13]. Although often associated with or confused for sagittal band injuries, the term reflects injury specifically to the MCP joint capsule [13]. These injuries are most commonly attritional, resulting from repetitive trauma and progressive capsular attenuation [13]. Forceful hyperflexion of the MCP joint tensions the capsule and extensor hood over the narrow dorsal ridge of the metacarpal head, rendering it vulnerable to injury from a direct blow [13]. Athletes competing in boxing, martial arts, or other combat sports are at particular risk for these injuries [13].

A tear of the dorsal capsule of a finger MCP joint is an uncommon injury that must be differentiated from an injury to the sagittal fibers of the extensor hood [17]. While sagittal fiber injuries can often be treated nonoperatively, dorsal capsular injuries usually require surgery, particularly in athletes who are disabled by the injury [17]. On examination, a subtle but detectable defect in the dorsal joint capsule is often palpable radial, ulnar, or deep to the extensor tendon; this finding is the hallmark of the injury [13]. Chronic injuries may exhibit thickening of the extensor mechanism due to scar tissue formation [13]. In one case of traumatic extensor tendon dislocation in a boxer, the sagittal bands were found to be intact, while the extensor digitorum communis and extensor digiti minimi tendons were separated into two divergent strands [28]. A tear in the capsular tissue on the ulnar side of the tendon, deep to the extensor digiti minimi tendon, was noted, exposing the underlying metacarpal head [28].

Classification

Terminological Distinction: Boxer's knuckle is defined as an injury or tear of the metacarpophalangeal (MCP) joint capsule [13]. This term reflects injury specifically to the MCP joint capsule, which is distinct from sagittal band injuries [13]. Conversely, boxer's knuckle is also defined as an injury of the sagittal band, which normally keeps the extensor digitorum communis (EDC) tendon centralized over the metacarpal head at the level of the MCP joint [21]. The sagittal bands are composed of transverse, sagittal, and oblique fibers [21].

Etiology and Risk Factors: Boxer's knuckle injuries are most commonly attritional due to repetitive trauma and progressive capsular attenuation [13]. Athletes competing in boxing, martial arts, or other combat sports are at particular risk for boxer's knuckle injuries [13]. In a cohort of 172 hand and wrist injuries in elite boxers, finger metacarpophalangeal joint extensor hood and capsule sprain (boxer's knuckle) accounted for 15.8% of injuries [39]. Sagittal band injuries can be caused by blunt trauma over the MCP joint with a clenched fist impact [21]. The central rays are more often affected by sagittal band injuries due to more prominent bony structure, thinner superficial tissue, longer radial fibers, and single extensor tendons [21].

Pathomechanics and Stability: Painful EDC tendon subluxation following sagittal band injury causes an inability to achieve active extension of the finger at the MCP joint, although extension can be maintained [21]. Dislocation may occur when the radial sagittal band is only partially divided [10]. Even minimal sagittal band damage results in measurable subluxation [9]. The presence of even 10% intact fibers confers some stability against subluxation [9].

Other Considerations: A 2022 review describes a modification to the most prevalent classification system for sagittal band injuries to guide treatment and allow standardization in documenting and describing injuries [4]. A 1957 paper presents a classification of injuries to boxers' knuckles based on limited observations, ranging from soft tissue thickening to tears extending into the joint space [23]. Chronic boxer's knuckle injuries may exhibit thickening of the extensor mechanism on examination due to scar tissue formation [13]. A subtle but detectable defect in the dorsal joint capsule is often palpable radial, ulnar, or deep to the extensor tendon and is the hallmark examination finding for boxer's knuckle [13]. Weakness of MCP joint extension in the affected digit is evident on examination for sagittal band injuries [21]. Painful tendon subluxation, usually in an ulnar direction, is evident on examination for sagittal band injuries [21]. Tenderness over the injured sagittal band is evident on examination for sagittal band injuries [21].

Clinical Presentation

Mechanism and Risk Factors

The term "boxer's knuckle" is often associated with or confused for sagittal band injuries, but it specifically reflects injury to the MCP joint capsule [13]. These injuries are most commonly attritional, resulting from repetitive trauma and progressive capsular attenuation [13]. Forceful hyperflexion of the MCP joint, such as a thrown punch, tensions the capsule and extensor hood over the narrow dorsal ridge of the metacarpal head, rendering the structure vulnerable to injury from a direct blow [13]. The sagittal bands consist of transverse, sagittal, and oblique fibers that can be injured by blunt trauma over the MCP joint with a clenched fist impact [21]. In a cohort of 172 hand and wrist injuries in elite boxers, finger metacarpophalangeal joint extensor hood and capsule sprain (boxer's knuckle) accounted for 15.8% of diagnoses [39].

Clinical Findings

Athletes often delay presentation until the injury has begun to affect their performance, such as after recurrent injuries and worsening symptoms [13]. On inspection, weakness of MCP joint extension in the affected digit is evident [21]. Palpation reveals tenderness over the injured sagittal band [21]. A subtle but detectable defect in the dorsal joint capsule is often palpable radial, ulnar, or deep to the extensor tendon and is a hallmark of examination [13].

Range-of-motion testing may demonstrate painful extensor digitorum communis (EDC) tendon subluxation, causing an inability to achieve active extension of the finger at the MCP joint, although extension can be maintained [21]. Painful tendon subluxation usually occurs in an ulnar direction [21]. The central rays are more often affected due to more prominent bony structure, thinner superficial tissue, longer radial fibers, and single extensor tendons [21]. Six cases in the same family suggest a possible familial predisposition to extensor tendon dislocation, potentially due to a genetic weakness in the sagittal bands or common environmental factors, though the condition is not proven to be truly genetic [18].

Investigations

Clinical Examination

A careful physical examination is essential to direct care and determine the need for future testing, as diagnostic imaging can be expensive, time-consuming, and often nonspecific [35]. The hallmark finding for boxer's knuckle injuries is a subtle but detectable defect in the dorsal joint capsule, which is often palpable radial, ulnar, or deep to the extensor tendon [13]. Clinical examination alone is insufficient for diagnosing pulley ruptures; sonography and MRI are required to distinguish between distension and partial, complete, or multiple ruptures [29].

Imaging

Plain radiography: Radiographs may reveal a congruent joint space with no fracture or subluxation in cases of radial collateral ligament avulsion with secondary sagittal band concerns [22]. The presence of a second small bone fragment, known as the 'two fleck sign,' on X-ray may indicate a Stener lesion requiring surgical repair, which can be missed on initial evaluation [41]. Detection of avulsion-fracture at the proximal attachment of the radial collateral ligament is problematic due to the rarity of this injury and the difficulty in interpreting radiographs of the avulsed fragment [109].

MRI: Magnetic resonance imaging (MRI) is used to determine the severity and location of ligament tears and to further define injury to the extensor mechanism [22].

Anatomical and Biomechanical Basis

The sagittal band fibers insert onto the volar proximal phalanx and onto the lateral borders of the volar plate [36].

Treatment

Non-Operative

Nonoperative management yields satisfactory results when initiated within 3 weeks of injury [104]. For sagittal band injuries without subluxation or dislocation, treatment consists of MCPJ extension splinting with the PIP joint free [21]. An MCP extension orthosis has demonstrated mostly satisfactory outcomes, with 71% of patients achieving resolution of symptomatic tendon translocation [34]. Conservative management using a sagittal band bridge is supported for acute closed injuries in non-rheumatoid patients, producing results comparable to surgical reconstruction without associated scar formation [107]. A trial of conservative treatment may be attempted even in the presence of frank EDC subluxation or dislocation, although literature reports mixed results [21]. Factors associated with a higher likelihood of treatment failure in nonsurgically managed cases include manual labor, longer symptom duration, and grade III injury [34]. Early joint motion and extension block splinting have resulted in excellent range of motion in compound dislocations of four metacarpophalangeal joints [16].

Operative

Indications: Centralization of the extensor tendon and sagittal band repair is the treatment of choice for boxer's knuckle in the professional athlete [12]. Surgery is typically recommended for symptomatic capsular tears [13], and dorsal capsular injuries usually require surgical intervention, particularly in athletes disabled by the injury [17]. Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration [106].

Surgical Approach / Technique: The sagittal band is approached through a longitudinal dorsal incision overlying the MP joint, using a spreading technique to preserve veins and nerves [38]. A distally based segment of the extensor digitorum communis tendon, consisting of approximately one quarter to one third of the width of the tendon, is developed on the same side as the tear in the sagittal band [38]. This tendon segment is passed through a small opening created in the remaining extensor tendon at the desired level of the sagittal band to prevent further unraveling and distal migration [38]. The free end of the tendon segment is looped through the deep transverse metacarpal ligament on the side of the tear [38]. Finally, the free end is woven into the long extensor tendon and sutured after tension is adjusted to maintain the extensor tendon in a centralized position [38]. In full MP joint flexion, the center of the band should lie 8–14 mm proximal to the articular surface of the proximal phalanx, depending on hand size [38].

Other Considerations: MCPJ immobilization is required after repair or reconstruction to allow adequate healing, after which aggressive range of motion can be initiated [21]. Athletes should be cautioned about returning to sports too quickly to prevent wound complications and recurrence [21].

Complications

Instability: An extensor tendon and/or sagittal band injury may lead to volar subluxation of the MCP joints [25]. Such injuries may also result in extensor quadriga [25] or swan neck deformity [25].

Stiffness / Arthrofibrosis: An extensor tendon and/or sagittal band injury may lead to subsequent joint contractures [25].

Wound complications: Athletes should be cautioned about returning to sports too quickly to prevent wound complications [21].

Other Considerations: Athletes should be cautioned about returning to sports too quickly to prevent recurrence [21].

Recovery

Operative Outcomes: Precisely executed operative treatment of boxer's knuckle and traumatic carpal boss results in an expectant favorable outcome, with the vast majority of boxers experiencing relief of pain, restoration of function, and an unrestricted return to competition [1]. A reproducible surgical technique for treating extensor hood injuries in elite boxers allows patients to return to boxing with little risk of complications [8]. Reconstructive surgery on the sagittal band with stabilization of the extensor tendon over the metacarpophalangeal joint resolved symptoms in a martial arts athlete [3]. Primary repair of the radial sagittal band led to a good functional outcome in a patient with a traumatic thumb radial sagittal band injury [27]. In reported cases of complex dislocation of the metacarpophalangeal joint of the little finger, the surgical technique resulted in normal function with no pain or instability at follow-up [26]. An anomalous slip of the extensor tendon to the middle finger can be used as a resource for surgical reconstruction that adds stability to primary sagittal band repair [20].

Non-Operative Outcomes: An MP joint blocking orthosis for sagittal band injury led to mostly satisfactory results, with 71% of patients achieving good to excellent outcomes [19].

Rehabilitation Protocol: Postoperative treatment for a boxer with extensor tendon dislocation involved 4 weeks in an ulnar gutter splint followed by 4 weeks in a removable ulnar gutter splint, progressing to active and passive range of motion exercises [28]. Relative motion splinting permitted 98% recovery of flexion and 96% recovery of total active motion compared with the normal uninjured side in a series of 180 patients with lacerated extensor tendons [45]. The use of early joint motion and extension block splinting resulted in an excellent range of motion in cases of compound dislocations of four metacarpophalangeal joints [16].

Functional Milestones: The patient returned to boxing at 4 months postsurgery and successfully defended his third national championship 10 months after surgery [28].

Key Evidence

  • [L4] Precisely executed operative treatment of both injuries has resulted in an expectant favorable outcome, as in the vast majority of cases the boxers have experienced relief of pain, restoration of function, and an unrestricted return to competition. [1] (10.1016/j.csm.2009.06.004)
  • [L4] Eight dorsal capsular ruptures are described in six patients who had closed direct trauma to either the knuckle of their index or long fingers. [2] (10.1016/0363-5023(89)90011-7)
  • [L5] The patient's symptoms resolved after reconstructive surgery on the sagittal band with stabilization of the extensor tendon over the metacarpophalangeal joint. [3] (10.1142/s0218810417720017)
  • [L4] This review provides a contemporary perspective on sagittal band injuries and describes a modification to the most prevalent classification system to guide treatment and allow standardization in documenting and describing injuries. [4] (10.1016/j.jhsa.2021.09.011)
  • [L4] The consistent characteristic was rupture of the sagittal band with subluxation or obvious dislocation of the central tendon. [5] (10.1016/s0894-1130(02)70024-0)
  • [L4] Chronic dislocations should be treated with a primary repair of the defect in the sagittal band. [6] (10.1016/s0363-5023(96)80364-9)
  • [L4] We believe that acute, closed sagittal band injuries in nonrheumatoid patients can be treated conservatively even when notable subluxation of the extensor tendon is present. [7] (10.1016/j.jhsa.2005.10.009)
  • [L4] A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications. [8] (10.1177/17531934221123139)
  • [L5] Even minimal sagittal band damage results in measurable subluxation, but the presence of even 10% intact fibers confers some stability against subluxation. [9] (10.1016/j.jhsa.2025.04.026)
  • [L5] Dislocation may occur when the radial sagittal band is only partially divided, which may explain why conservative treatment of tendon dislocation in the middle and ring fingers is feasible. [10] (10.1177/1753193420963257)
  • [L4] The authors recommend centralization of the extensor tendon and sagittal band repair as the treatment of choice for this injury. [12] (10.1177/03635465000280061701)
  • [L5] [13] (10.5435/jaaos-d-21-01031)
  • [L5] Surgical management consists of repair or reconstruction of the radial sagittal band, with numerous adjunctive techniques described to prevent subluxation. [14] (10.5435/jaaos-d-13-00203)
  • [L5] Extensor tendon instability following sagittal band (SB) disruption is most common in the long finger and least common in the small finger. [15] (10.1053/jhsu.2000.18495)
  • [L5] The use of early joint motion and extension block splinting resulted in an excellent range of motion in this uncommon injury. [16] (10.1016/0266-7681(85)90025-7)
  • [L5] [17] (10.1097/00130911-200212000-00007)
  • [L4] Six cases in the same family suggest a possible familial predisposition to extensor tendon dislocation, potentially due to a genetic weakness in the sagittal bands or common environmental factors, though the condition is not proven to be truly genetic. [18] (10.1177/1753193413489083)
  • [L4] MP joint blocking orthosis for sagittal band injury led to mostly satisfactory results, with 71% of patients achieving good to excellent outcomes. [19] (10.1016/j.jhsa.2018.06.113)
  • [L4] An anomalous slip of the extensor tendon to the middle finger can be a resource for surgical reconstruction that adds stability to primary sagittal band repair. [20] (10.1016/j.jhsa.2012.05.029)
  • [L5] [21] (10.1186/s13018-016-0432-8)
  • [L4] [22] (10.1007/s11552-008-9087-1)
  • [L4] The paper presents a classification of injuries to boxers' knuckles based on limited observations, ranging from soft tissue thickening to tears extending into the joint space. [23] (10.1016/0002-9610(57)90828-0)
  • [Paper] An extensor tendon and/or sagittal band injury may lead to a number of complications including volar subluxation of the MCP joints, extensor quadriga, swan neck deformity, and subsequent joint contractures. [25] (10.1007/s12593-015-0172-8)
  • [L4] In the reported cases, this technique resulted in normal function with no pain or instability at follow-up. [26] (10.1016/0266-7681(87)90029-5)
  • [L5] This injury was treated with primary repair of the RSB and lead to a good functional outcome for the patient. [27] (10.1142/s2424835516720139)
  • [L5] [28] (10.1249/01.mss.0000089340.89660.eb)
  • [L5] Clinical examination alone is insufficient for diagnosing pulley ruptures; sonography and MRI are required to distinguish between distension and partial, complete, or multiple ruptures. [29] (10.1016/j.main.2005.01.011)
  • [L4] Even in patients with chronic sagittal band incompetence, splintage is a reasonable first line of treatment before advising surgical intervention. [31] (10.1177/1753193414530591)
  • [L4] An MCP extension orthosis for sagittal band injury led to mostly satisfactory results with 71% of patients achieving resolution of symptomatic tendon translocation, but manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure. [34] (10.1016/j.jhsa.2018.11.011)
  • [L4] [38] (10.1016/s0363-5023(97)80012-3)
  • [L3] [39] (10.1177/1558944716642756)
  • [L5] The presence of a second small bone fragment ('two fleck sign') on X-ray may indicate a Stener lesion requiring surgical repair, which can be missed on initial evaluation. [41] (10.1177/1753193408087106)
  • [L4] In a series of 180 patients with 1 to 3 lacerated extensor tendons studied over a 10-year interval, relative motion splinting permitted 98% recovery of flexion and 96% recovery of total active motion compared with the normal uninjured side. [45] (10.1053/oa.2000.5972)
  • [L4] Satisfactory results were achieved with nonoperative treatment when it was initiated within 3 weeks of injury. [104] (10.1016/0363-5023(94)90261-5)
  • [L4] Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration. [106] (10.1177/1558944719895622)
  • [L4] The study supported the hypothesis that acute closed sagittal band injuries in non-rheumatoid patients can be successfully treated with conservative management using a sagittal band bridge, producing results comparable to surgical reconstruction without associated scar formation. [107] (10.1197/j.jht.2006.11.007)
  • [L5] The rarity of its occurrence, together with the difficulty in interpretation of radiographs of the avulsed fragment, contributed to the problems in its detection. [109] (10.1016/s0363-5023(82)80055-5)
  • [L4] The developed substitution technique for sagittal band reconstruction allows for a strong and reliable interlace of the graft that does not require postoperative immobilization and allows an unprotected motion protocol. [110] (10.1097/bth.0000000000000208)

See Also

References

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Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

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.

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