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Scapholunate Ligament Injury

SL interosseous ligament injury: instability spectrum to SLAC, scaphoid-shift and imaging, arthroscopic grading, and repair/capsulodesis/tenodesis by chronicity.

28 citationsUpdated Aug 2026

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

Overview

Scapholunate instability is a complex condition where the pathophysiology is identified through history, physical examination, and imaging [2]. Scientific and clinical evidence is applied to a treatment paradigm for scapholunate injury, which is modified based on emerging evidence [1]. The ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications [3]. Strong evidence (level 1 or 2) for management of scapholunate instability in the absence of arthritis is lacking, and published recommendations are largely experience-based [6].

Treatment options for scapholunate instability range from nonoperative management to surgical techniques including ligament repair, reconstruction, and arthrodesis [2]. Acute intervention (within 6 wk) is preferable to chronic intervention for scapholunate interosseous ligament injuries [4]. Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced acceptable functional mid-term results [5]. Primary scapholunate ligament repairs using double-loaded suture anchors demonstrated significantly higher strength compared with single-loaded anchors and transosseous repairs [33]. Patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results at a minimum of two years of follow-up [8].

For advanced disease, proximal row carpectomy (PRC) is not recommended for the management of scapholunate dissociation in the absence of degenerative changes due to disappointing results compared to other treatments [11]. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis, and the expected benefit of preserving the midcarpal joint was not observed in scapholunate advanced collapse II arthritis [23]. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or distal resection of the scaphoid, allow for less invasive but equally effective procedures in the management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion [32]. The lack of long-term outcome measurements for bone–tissue–bone (BTB) surgeries makes it difficult to determine the appropriate use of these treatment modalities, although early reports indicate that the BTB graft will be an important part of scapholunate dissociation treatment [9].

Anatomy & Pathophysiology

Ligamentous

The scapholunate ligament complex includes critical ligament stabilizers that inform treatment of scapholunate dissociation [7]. Intervention for scapholunate instability aims to arrest the degenerative process by restoring ligament continuity and normalizing carpal kinematics [12]. Bilateral scapholunate widening may have a nontraumatic aetiology [10]. Bilateral scapholunate widening may progress to carpal instability and osteoarthritis with advancing age [10]. There is no absolute evidence to confirm that bilateral wide gaps inexorably progress to carpal instability and osteoarthritis [10].

Kinematics

Four-dimensional computed tomography (4DCT) is a non-invasive and affordable method to assess and quantify wrist kinematics [13]. 4DCT extends conventional CT by incorporating the temporal dimension [13]. Hysteresis is greater in wrists with scapholunate ligament injury than in healthy wrists [20]. Hysteresis can be quantified using 4DCT wrist kinematics [20].

Sectioning multiple ligaments in normal wrists to create scapholunate instability causes average motion comparable to that seen in Geissler IV (G4) wrists [14]. Combined palmar and dorsal scapholunate ligament reconstruction seems to restore wrist kinematics [25]. Combined palmar and dorsal scapholunate ligament reconstruction does not restore the neutral position of the scaphoid and lunate to normal [25]. Each of three repair techniques for scapholunate dissociation with dorsal intercalated segment instability has different effects on carpal posture and alignment [27].

The scaphoid consistently rotated into flexion and supination when the flexor carpi radialis (FCR) was loaded [29]. The triquetrum rotated in flexion and pronation when the FCR was loaded [29].

Classification

Clinical Diagnosis: Scapholunate instability is identified through history, physical examination, and imaging [2]. Dorsal scaphoid subluxation on sagittal magnetic resonance imaging serves as a marker for scapholunate ligament tear [19]. Axial proton-density-weighted fat-suppressed MR images show the dorsal and volar bands of the scapholunate interosseous ligament (SLIL) [21]. Coronal proton-density-weighted fat-suppressed MR images show the triangular interosseous band of the SLIL [21].

Arthroscopic Classification: Wrist arthroscopy is the gold standard for diagnosing carpal ligament injuries [21]. The 3-4, 6R, and midcarpal portals are typically used for wrist arthroscopy [21]. The radiocarpal joint is insufflated with saline through the 3-4 interval during arthroscopy [21]. Interosseous ligament injuries can reveal palpable distension of the midcarpal joint during injection [21]. The SLIL is best viewed through the 3-4 portal [21]. The SLIL should appear concave as viewed from the radiocarpal space [21]. Arthroscopy can demonstrate instability of the scapholunate interval with step off in the radiocarpal and midcarpal joints [21]. Geissler grades III and IV are used to classify scapholunate instability observed during arthroscopy [21].

Other Considerations: Bilateral wide gaps may progress to carpal instability and osteoarthritis with advancing age [10]. Sectioning multiple ligaments in normal wrists to create scapholunate instability causes average motion comparable to that seen in Geissler Grade 4 wrists [14]. Treatment considerations are stratified by the stage of injury, degree and nature of ligament damage, and presence of arthritic changes [16]. A novel ligament-based treatment algorithm is proposed based on injury stage and arthritic changes [7]. Strong evidence (level 1 or 2) for management of scapholunate instability in the absence of arthritis is lacking [6]. Published recommendations for scapholunate instability management are largely experience-based [6].

Clinical Presentation

Diagnosis: Wrist arthroscopy remains the gold standard for diagnosing carpal ligament injuries [21]. It directly visualizes instability of the scapholunate interval, demonstrating step-offs in the radiocarpal and midcarpal joints consistent with Geissler III and IV classifications [21]. Radiographic stress views further support this diagnosis by demonstrating widening of the scapholunate interval [21]. For kinematic assessment, four-dimensional computed tomography (4DCT) offers a promising, non-invasive, and affordable method to quantify wrist kinematics [13].

Arthritic Patterns: While scapholunate dissociation is classically associated with scapholunate advanced collapse (SLAC), the prevailing view that the radiolunate articulation is spared is not universally true [18]. Radiolunate arthritis can occur in association with scapholunate dissociation [18].

Investigations

CT: Dynamic wrist kinematics can be quantified using 4DCT to assess hysteresis [20]. In normal wrists, sectioning multiple ligaments to create scapholunate instability produces average motion comparable to that seen in Geissler grade 4 (G4) wrists [14].

Other Considerations: The traditional view that the radiolunate articulation is spared in scapholunate advanced collapse is not universally true [18].

Treatment

Non-Operative

The provided evidence does not support specific non-operative interventions such as physical therapy, NSAIDs, or injections for scapholunate dissociation.

Operative

Indications: A novel ligament-based treatment algorithm for scapholunate dissociation is proposed, with surgical indications determined by injury stage and the presence of arthritic changes [7].

Surgical Approach / Technique: The Reduction and Association of the Scaphoid and Lunate (RASL) procedure is a safe and effective technique for the treatment of chronic scapholunate dissociation [17]. Additionally, bone–tissue–bone (BTB) grafts are emerging as an important component of scapholunate dissociation treatment, although early reports highlight that the lack of long-term outcome measurements makes it difficult to determine their appropriate use [9].

Complications

Ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications [3].

Instability: Radiolunate arthritis can occur in association with scapholunate dissociation, contradicting the view that the radiolunate articulation is spared in scapholunate advanced collapse [18].

Recovery

Rehabilitation for scapholunate injury involves applying scientific and clinical evidence to a treatment paradigm, which is modified based on emerging evidence [1]. Strong evidence (level 1 or 2) for the management of scapholunate instability in the absence of arthritis is lacking, and published recommendations are largely experience-based [6]. A ligament-based treatment algorithm for scapholunate dissociation is proposed based on injury stage and arthritic changes [7], or based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes to enable comparison of treatment and outcomes stratified by the stage of injury [16].

Light activity (weeks): Acute intervention (within 6 weeks) is preferable to chronic intervention for scapholunate interosseous ligament injuries [4]. At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results [8].

Full activity (months): Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and produces acceptable functional mid-term results [5]. At a median follow-up of 5.5 and 6.1 years, no statistically significant or clinically relevant differences were found when comparing radiographic findings, patient-rated outcomes, and wrist motion following acute and subacute scapholunate ligament (SLL) repair [15].

Complete recovery / outcome plateau (months): The lack of long-term outcome measurements for bone-tissue-bone (BTB) surgeries makes it difficult to determine the appropriate use of these treatment modalities, though early reports indicate BTB grafts will be an important part of scapholunate dissociation treatment [9]. Bone-retinaculum-bone (BRB) autograft reconstruction has the potential to be a viable long-term treatment option for dynamic scapholunate instability, though results may deteriorate over time [34].

Rehabilitation protocol: Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension [13].

Key Evidence

  • [L5] The article demonstrates how scientific and clinical evidence is applied to a treatment paradigm for scapholunate injury and modified based on emerging evidence. [1] (10.1016/j.jht.2016.03.010)
  • [Paper] This article reviews the pathophysiology of scapholunate instability, its identification through history, physical examination, and imaging, and the spectrum of treatment options ranging from nonoperative management to various surgical techniques including ligament repair, reconstruction, and arthrodesis. [2] (10.1016/j.hcl.2009.08.006)
  • [L5] Despite the evolution of diagnostic and treatment options, the ideal treatment for scapholunate instability remains an unresolved problem with inconsistent results and ongoing concerns regarding complications. [3] (10.1177/17531934221148009)
  • [L3] Acute intervention (within 6 wk) was preferable to chronic intervention for scapholunate interosseous ligament injuries. [4] (10.1016/j.jhsa.2014.06.139)
  • [L4] Direct bony fixation of the ruptured scapholunate ligament using a suture anchor is generally successful in restoring scapholunate stability and has produced acceptable functional mid-term results for this difficult-to-treat injury. [5] (10.1054/jhsb.1999.0340)
  • [L5] Strong evidence (level 1 or 2) for management of scapholunate instability in the absence of arthritis is lacking and published recommendations are largely experience-based. [6] (10.1177/1753193412473861)
  • [L5] This review provides an update on the anatomy of the scapholunate ligament complex, the importance of critical ligament stabilizers, and pathoanatomy to inform treatment of scapholunate dissociation, proposing a novel ligament-based treatment algorithm based on injury stage and arthritic changes. [7] (10.1016/j.jhsa.2023.05.013)
  • [L4] At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. [8] (10.1186/s13018-023-04148-y)
  • [L4] The lack of long-term outcome measurements for these BTB surgeries makes it difficult for the hand surgeon to determine the appropriate use of these treatment modalities, but early reports have indicated that the BTB graft will be an important part of scapholunate dissociation treatment. [9] (10.1016/j.jhsa.2006.11.011)
  • [L4] While bilateral SLAC wrists were not exceptional and patients without carpal instability or osteoarthritis were younger, there is no absolute evidence to confirm that bilateral wide gaps inexorably progress to carpal instability and osteoarthritis. [10] (10.1177/1753193418819653)
  • [L4] The authors do not recommend PRC for the management of scapholunate dissociation in the absence of degenerative changes due to disappointing results compared to other treatments. [11] (10.1177/1753193410382719)
  • [L5] Intervention for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalizing carpal kinematics. [12] (10.1016/j.jhsa.2008.04.027)
  • [L5] Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension. [13] (10.1177/17531934251326028)
  • [L5] These findings support the hypothesis that sectioning multiple ligaments in normal wrists to create scapholunate instability causes average motion comparable to that seen in G4 wrists. [14] (10.1016/j.jhsa.2020.12.015)
  • [L3] At a median follow-up of 5.5 and 6.1 years, no statistically significant or clinically relevant differences were found when comparing radiographic findings, patient rated outcomes and wrist motion following acute and subacute SLL repair. [15] (10.1016/j.jhsa.2015.06.055)
  • [L5] The authors propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes to enable comparison of treatment and outcomes stratified by the stage of injury. [16] (10.1016/j.jhsa.2023.06.016)
  • [L4] The RASL procedure is a safe and effective procedure for the treatment of chronic scapholunate dissociation. [17] (10.1016/s0363-5023(10)60091-3)
  • [L4] Radiolunate arthritis can occur in association with scapholunate dissociation, and the generally held view that the radiolunate articulation is spared in scapholunate advanced collapse is not universally true. [18] (10.1016/j.jhsa.2010.04.008)
  • [L2] [19] (10.1016/j.jhsa.2017.06.015)
  • [L3] This study demonstrated that hysteresis can be quantified using 4DCT wrist kinematics and is greater in wrists with scapholunate ligament injury than in healthy wrists. [20] (10.1177/17531934261468199)
  • [L5] [21] (10.1016/j.jhsg.2024.01.015)
  • [L1] A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis, and the expected benefit of preserving the midcarpal joint was not observed. [23] (10.1177/1753193418778471)
  • [L4] Combined palmar and dorsal SL ligament reconstruction seems to restore wrist kinematics, although the neutral position of the scaphoid and lunate are not restored to normal. [25] (10.1016/j.jhsa.2024.11.014)
  • [L5] In this cadaveric model of scapholunate dissociation with dorsal intercalated segment instability and DST, each of the 3 repairs had different effects on carpal posture and alignment. [27] (10.1016/j.jhsa.2021.05.030)
  • [L5] The scaphoid consistently rotated into flexion and supination when the FCR was loaded, while the triquetrum rotated in flexion and pronation. [29] (10.1016/j.jhsa.2010.09.023)
  • [L4] New individualized options, like osteochondral grafting in combination with proximal row carpectomy or distal resection of the scaphoid, allow for less invasive but equally effective procedures. [32] (10.1177/1753193420973322)
  • [L5] Primary scapholunate ligament repairs using double-loaded suture anchors demonstrated significantly higher strength compared with single-loaded anchors and transosseous repairs. [33] (10.1016/j.jhsa.2015.03.031)
  • [L4] BRB autograft reconstruction has the potential to be a viable long-term treatment option for dynamic scapholunate instability, though results may deteriorate over time. [34] (10.1016/s0363-5023(09)60082-4)

See Also

References

[1] Rehabilitation for scapholunate injury: Application of scientific and clinical evidence to practice. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2016.03.010

[2] The Diagnosis and Treatment of Scapholunate Instability. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2009.08.006

[3] Scapholunate instability: why are the surgical outcomes still so far from ideal?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221148009

[4] Scapholunate Interosseous Ligament Injuries: A Retrospective Review of Treatment and Outcomes in 82 Wrists. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.139

[5] Scapholunate Ligament Repair Using the Mitek™ Bone Anchor. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0340

[6] Assessment of scapholunate instability and review of evidence for management in the absence of arthritis. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412473861

[7] Scapholunate Instability: Diagnosis and Management – Anatomy, Kinematics, and Clinical Assessment – Part I. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.05.013

[8] Arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor in acute and subacute scapholunate dissociation. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04148-y

[9] Bone–Tissue–Bone Repairs for Scapholunate Dissociation. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2006.11.011

[10] Bilateral scapholunate widening may have a nontraumatic aetiology and progress to carpal instability and osteoarthritis with advancing age. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418819653

[11] Proximal row carpectomy for scapholunate dissociation. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410382719

[12] Scapholunate Instability: Current Concepts in Diagnosis and Management. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.04.027

[13] Dynamic wrist imaging: How it works and how to assess kinematic changes in wrists with scapholunate instability. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251326028

[14] Carpal Motion in Chronic Geissler IV Scapholunate Interosseous Ligament Wrists. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.12.015

[15] Outcomes of Acute versus Subacute Scapholunate Ligament Repair. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.055

[16] Scapholunate Instability: Diagnosis and Management – Classification and Treatment Considerations – Part 2. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.06.016

[17] Reduction and Association of the Scaphoid and Lunate (RASL): Long-term Follow-up of a Reconstruction Technique for Chronic Scapholunate Dissociation. The Journal of Hand Surgery. 2010. DOI: 10.1016/s0363-5023(10)60091-3

[18] Scapholunate Dissociation With Radiolunate Arthritis Without Radioscaphoid Arthritis. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.04.008

[19] Dorsal Scaphoid Subluxation on Sagittal Magnetic Resonance Imaging as a Marker for Scapholunate Ligament Tear. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.015

[20] Hysteresis in dynamic wrist kinematics: a 4DCT comparison between healthy and scapholunate ligament-injured wrists. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261468199

[21] Scapholunate Ligament Injuries. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.015

[23] A blinded, randomized trial comparing bicolumnar arthrodesis to radioscapholunate arthrodesis in scapholunate advanced collapse II arthritis: a pilot study. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418778471

[25] Scapholunate Kinematics After Combined Palmar and Dorsal Ligament Reconstruction: A Quantitative Evaluation Using Four-Dimensional Computed Tomography. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.11.014

[27] Comparative Analysis of 3 Techniques of Scapholunate Reconstruction for Dorsal Intercalated Segment Instability. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.05.030

[29] The Role of the Flexor Carpi Radialis Muscle in Scapholunate Instability. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.09.023

[32] Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420973322

[33] Biomechanical Analysis of Scapholunate Ligament Repair Techniques. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.031

[34] Long-Term Outcomes of Scapholunate Ligament Reconstruction with Bone-Retinaculum-Bone Autograft. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60082-4

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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.

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