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What's New — Shoulder — April 2026

37 new articles published this month.

Themes: Shoulder Instability and Bone Loss · Rotator Cuff Repair and Healing · Reverse and Anatomic Arthroplasty · Proximal Humerus Fractures and Imaging

Digest generated 2026-05-09 04:03:33+00:00.

Highlights

Shoulder Instability and Bone Loss

This theme addresses the management and predictors of recurrence in anterior shoulder instability, particularly focusing on glenoid bone loss and Hill-Sachs lesions. Article [1] establishes a threshold for preoperative instability episodes predicting recurrence after arthroscopic Bankart repair (ABR), while article [37] evaluates long-term outcomes of isolated ABR in patients with on-track Hill-Sachs lesions and less than 20% bone loss. Article [7] compares anatomical differences between posterior and anterior dislocations, noting higher acromion flatness in posterior cases. Additionally, article [16] compares Bristow and Latarjet procedures in rugby players, and article [5] provides a state-of-the-art review on failed instability surgeries. These studies collectively highlight the importance of patient selection, anatomical assessment, and surgical technique in optimizing instability outcomes.

Rotator Cuff Repair and Healing

Articles in this cluster focus on rotator cuff repair techniques, biological augmentation, and associated factors influencing outcomes. Article [4] demonstrates that duloxetine improves early clinical outcomes and reduces psychological distress in patients with anxiety or depression undergoing arthroscopic rotator cuff repair. Article [13] assesses the effect of bioinductive collagen patches in revision surgery for retears. Article [18] investigates the critical nature of graft position in lower trapezius tendon transfers for irreparable tears. Article [22] identifies subcoracoid impingement as a factor exacerbating pain in full-thickness tears. Finally, article [36] links higher preoperative anxiety levels to increased postoperative opioid use, emphasizing the role of psychological factors in recovery. These studies underscore the integration of biological, surgical, and psychological interventions in rotator cuff care.

Reverse and Anatomic Arthroplasty

This theme covers outcomes and complications associated with shoulder arthroplasty, including reverse total shoulder arthroplasty (RTSA) and anatomic total shoulder arthroplasty (ATSA). Article [12] reports on aseptic glenoid baseplate loosening with the Aramis implant. Article [15] compares lateralization and distalization effects on tuberosity healing in RTSA for fractures. Article [23] provides a meta-analysis on RTSA's impact on scapulohumeral rhythm. Article [24] examines the effect of glenoid component retroversion on ATSA outcomes. Article [26] evaluates stem length and cement use in revision RTSA. Article [29] identifies surgical and patient factors associated with baseplate failures. Article [31] analyzes return to sport after arthroplasty. These articles provide critical data on implant selection, surgical technique, and long-term functional outcomes in arthroplasty.

Proximal Humerus Fractures and Imaging

This cluster focuses on the diagnosis, treatment, and imaging of proximal humerus fractures. Article [2] is a cadaveric study investigating how reduced orbital rotation in intraoperative 3D imaging affects screw detection accuracy during plate fixation. Article [14] compares pyrolytic carbon head hemiarthroplasty with cobalt-chromium heads for proximal humerus fractures. Article [30] identifies fracture-dislocation of the proximal humerus as a marker of poor outcomes. These studies address technical challenges in surgical fixation, implant material selection, and prognostic indicators for severe fracture patterns, offering insights into improving surgical precision and patient counseling.

Articles by Theme

Shoulder Instability and Bone Loss (6)

1. Lin RT, Gilbert R, Dadoo S, et al. Preoperative Instability Episodes as a Predictor of Recurrence After Arthroscopic Bankart Repair. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261430925

This retrospective cohort study aimed to establish a specific threshold of preoperative instability episodes that predicts recurrence after arthroscopic Bankart repair. The findings identify a critical number of prior dislocations that significantly increases the risk of recurrent instability, aiding in surgical decision-making. Clinically, this threshold helps surgeons stratify patients and anticipate higher failure rates in those with extensive instability history.

3. Bauer J, Rajan R, Singh R, et al. Restoring Glenoid Concavity: Angled Bone Blocks Provide Biomechanically Superior Function and Restore Glenohumeral Forces Over Flat Constructs in Glenoid Augmentation. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261429466

This biomechanical study compared angled versus flat bone block placements for glenoid augmentation in shoulders with 20% anterior bone loss. Angled bone blocks restored native glenoid concavity and generated superior distraction forces, closely mimicking intact shoulder mechanics compared to flat constructs. Clinically, angled graft positioning may provide better biomechanical stability and reduce the risk of recurrent instability in patients requiring glenoid augmentation.

5. Luengo-Alonso G, Mirzayan R, Oh JH, et al. Failed shoulder instability surgery: State -of-the-art. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101011

This review article provides a state-of-the-art overview of the management and treatment strategies for failed shoulder instability surgeries. It synthesizes current evidence on diagnostic challenges and surgical techniques to address recurrent instability. The article serves as a comprehensive guide for clinicians navigating complex revision scenarios in shoulder instability.

7. Jessen M, Willinger L, Lacheta L, et al. Posterior shoulder dislocation shows a higher, flatter acromion, and increased glenoid retroversion compared with anterior dislocation: A matched computed tomography/magnetic resonance imaging analysis. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101071

This matched imaging analysis compared anatomical features between posterior and anterior shoulder dislocations, finding that posterior dislocations are associated with higher, flatter acromions and increased glenoid retroversion. These distinct morphological differences may contribute to the differing mechanisms and risks of dislocation types. Understanding these anatomical variations aids in diagnosis and surgical planning for posterior instability.

16. Hirose T, Tanaka M, Nakai H, et al. Comparing Bristow and Latarjet procedures for anterior shoulder instability in competitive rugby players: a unique within-subject clinical analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.002

The study compared the Bristow and Latarjet procedures for anterior shoulder instability in competitive rugby players using a within-subject analysis. The Latarjet procedure demonstrated superior stability and return-to-play rates compared to the Bristow procedure. This suggests the Latarjet procedure may be the preferred option for high-demand athletes requiring reliable stability.

37. Dadoo S, Williams TC, Lin RT, et al. Long-Term Outcomes following Instability After Isolated Arthroscopic Bankart Repair for On-Track Hill-Sachs Lesions With <20% Glenoid Bone Loss. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261430742

This study evaluated long-term outcomes for patients with on-track Hill-Sachs lesions and less than 20% glenoid bone loss who underwent isolated arthroscopic Bankart repair. The results indicate that this patient population has favorable long-term stability and patient-reported outcomes, supporting the continued use of isolated Bankart repair for these specific cases.

Rotator Cuff Repair and Healing (5)

4. Han SC, Han J, Min YK, et al. Duloxetine Improves Early Clinical Outcomes Including Range of Motion, Functional Scores, Pain, and Psychological Distress After Arthroscopic Rotator Cuff Repair in Patients With Anxiety or Depression: Prospective Randomized Controlled Trial. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261430918

This randomized controlled trial investigated the impact of preoperative duloxetine administration on clinical outcomes in patients with anxiety or depression undergoing arthroscopic rotator cuff repair. Patients receiving duloxetine showed significantly improved early range of motion, functional scores, pain reduction, and reduced psychological distress compared to untreated controls. These findings support integrating pharmacological management of psychological distress to optimize postoperative recovery in high-risk patients.

13. Delgado C, Rodríguez G, Ortega C, et al. Biological augmentation in revision surgery: effect of a bioinductive collagen patch (REGENETEN) in patients with rotator cuff retear and a previous arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.031

This study examined the effect of using a bioinductive collagen patch (REGENETEN) for biological augmentation in revision rotator cuff surgery. Results demonstrated improved healing rates and clinical outcomes in patients with previous arthroscopic repairs who received the patch. This suggests that biological augmentation may be a valuable adjunct in managing recurrent rotator cuff tears.

18. Baek CH, Elhassan BT, Lim C, et al. Is the graft position critical for functional outcomes following arthroscopy-assisted lower trapezius tendon transfer for posterosuperior irreparable rotator cuff tears? A comparison of anterior vs. posterior position of graft. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.005

This study compares functional outcomes following arthroscopy-assisted lower trapezius tendon transfer for posterosuperior irreparable rotator cuff tears, specifically analyzing whether anterior versus posterior graft positioning influences results. The findings will help surgeons optimize graft placement strategies to maximize functional recovery and patient satisfaction in complex rotator cuff repairs.

22. Weng Y, Chien Y, Wong C, et al. Subcoracoid impingement exacerbates pain and scapular dysfunction in full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.009

This study investigates the relationship between subcoracoid impingement and clinical outcomes in patients with full-thickness rotator cuff tears, focusing on pain levels and scapular dysfunction. The findings highlight the role of subcoracoid impingement in exacerbating symptoms, suggesting that addressing this impingement may improve surgical outcomes and patient recovery.

36. Simpson ER, Smith K, Mathur A, et al. Preoperative Anxiety Levels and Postoperative Opioid Use in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261427788

This prospective cohort study found that higher preoperative anxiety scores were associated with increased postoperative opioid consumption in opioid-naive patients undergoing arthroscopic rotator cuff repair. Clinically, this suggests that screening for and managing preoperative anxiety may help reduce opioid use and support stewardship efforts.

Reverse and Anatomic Arthroplasty (7)

12. Klein A, Nové-Josserand L, Collotte P, et al. Incidence and risk factors for aseptic glenoid baseplate loosening in primary reverse shoulder arthroplasty using the Aramis implant baseplate with a minimum of 2 years follow-up. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.030

The authors assessed the incidence and risk factors for aseptic glenoid baseplate loosening in primary reverse shoulder arthroplasty using the Aramis implant. The study found a notable incidence of loosening associated with specific patient and surgical risk factors. This highlights the need for careful patient selection and monitoring when using this particular baseplate design.

15. Rius X, Gonzalez-Morgado D, Matellanes J, et al. Effect of lateralization and distalization on tuberosity healing and functional outcomes after reverse total shoulder arthroplasty with the Univers Revers Total Shoulder System for proximal humerus fractures: a randomized controlled trial comparing 135° and 155° uncemented stems. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.033

This randomized controlled trial compared lateralization and distalization effects on tuberosity healing and functional outcomes using 135° and 155° uncemented stems in reverse shoulder arthroplasty. The 155° stem group showed superior tuberosity healing and functional scores compared to the 135° stem. Clinically, this supports the use of distalized stems to enhance healing and function in fracture-related reverse shoulder arthroplasty.

23. Johnson MA, Cogsil T, White AE, et al. Impact of reverse total shoulder arthroplasty on scapulohumeral rhythm: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.010

This systematic review and meta-analysis evaluate the impact of reverse total shoulder arthroplasty on scapulohumeral rhythm, synthesizing data from multiple studies. The results provide evidence on how this surgical intervention alters shoulder biomechanics, aiding clinicians in understanding functional changes and setting realistic patient expectations.

24. Checketts JX, Sanchez B, Norris G, et al. Does postoperative glenoid component retroversion following anatomic total shoulder arthroplasty affect clinical outcomes? A systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.011

This systematic review and meta-analysis assess whether postoperative glenoid component retroversion following anatomic total shoulder arthroplasty affects clinical outcomes. The findings help determine the clinical significance of glenoid version changes post-surgery, guiding surgeons in managing component positioning to optimize long-term success.

26. Lee H, King JJ, Wright JO, et al. Impact of cement use and stem length on clinical outcomes in revision reverse shoulder arthroplasty: is a short stem with cementless fixation a viable option?. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.013

This investigation compared clinical outcomes in revision reverse shoulder arthroplasty, specifically analyzing the impact of cement use and stem length to determine if short cementless stems are a viable alternative. The results demonstrate that short cementless stems achieve comparable clinical outcomes to longer or cemented options. This supports the use of short cementless stems as a safe and effective strategy in revision settings, potentially preserving bone stock.

29. Bowler A, Glass EA, Corban J, et al. Surgical and patient factors associated with baseplate failures after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.017

This multicenter study by the ASES Complications of RSA Group identified surgical and patient factors associated with baseplate failures after reverse shoulder arthroplasty. The analysis highlighted specific risk factors, such as certain surgical techniques and patient demographics, that correlate with higher failure rates. Understanding these factors allows surgeons to mitigate risks and improve patient selection and surgical planning to reduce baseplate failure.

31. Corban J, Kirsch JM, Bowler A, et al. Return to Sport After Shoulder Arthroplasty: An ASES Multicenter Analysis of Sport-Specific Predictors of Performance in Reverse Shoulder Arthroplasty and Total Shoulder Arthroplasty. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.03.014

Précis unavailable.

Proximal Humerus Fractures and Imaging (3)

2. Bullert B, Morlock L, Brunken F, et al. Effect of reduced orbital rotation on image quality and intra-articular screw detection in intraoperative 3D imaging of proximal humerus plate fixation: a cadaveric study. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06800-9

This cadaveric study evaluated how reducing orbital rotation during intraoperative 3D imaging affects image quality and the detection of intra-articular screw perforations in proximal humerus fixation. Results demonstrated that reduced rotation angles maintain sufficient image quality for accurate screw detection while minimizing technical constraints. This suggests that modified imaging protocols can enhance safety and efficiency during complex shoulder surgeries.

14. Rotman D, Maman O, Kazum E, et al. Pyrolytic carbon head hemiarthroplasty vs. cobalt-chromium head for proximal humerus fractures: a short-term follow-up study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.032

The study compared short-term outcomes between pyrolytic carbon head hemiarthroplasty and cobalt-chromium heads for proximal humerus fractures. Findings revealed no significant difference in functional outcomes or complication rates between the two implant materials. This indicates that either material can be effectively utilized in hemiarthroplasty for these fractures.

30. Adams JC, Rivero S, Stevens N, et al. Fracture-dislocation of the proximal humerus: a marker of poor outcome. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.020

This study examined the outcomes of patients with proximal humerus fracture-dislocations, identifying this injury pattern as a marker for poor clinical results. The findings indicate that these patients experience significantly worse functional outcomes and higher complication rates compared to other fracture types. Clinically, this underscores the need for aggressive management and realistic counseling regarding prognosis for patients with this specific injury.

6. Buijze GA, Shirinskiy IJ, Commeil P, et al. Posterior sentinel sign of the biceps tendon as an arthroscopic indicator of supraspinatus tears. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101065

This study identifies the posterior sentinel sign of the biceps tendon as a reliable arthroscopic indicator of supraspinatus tears. The presence of this sign allows surgeons to detect hidden rotator cuff pathology during arthroscopy for other indications. Recognizing this sign can prevent missed diagnoses and ensure comprehensive treatment of concomitant shoulder injuries.

8. Sclafani S, Oury J, Schoofs E, et al. Iatrogenic suprascapular neuropathy secondary to drilling for superior labrum anterior-posterior repair: a case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101083

This case report describes iatrogenic suprascapular neuropathy resulting from drilling during superior labrum anterior-posterior (SLAP) repair. The injury highlights the risk of nerve damage when instruments are placed near the suprascapular notch during arthroscopic procedures. Surgeons must exercise caution and awareness of anatomical landmarks to prevent this potentially debilitating complication.

9. Schoon N, Shirinskiy I, Macken AA, et al. Factors influencing surgeons’ decision-making in the treatment of SLAP lesions: A case-vignette study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101087

This study utilized case-vignettes to investigate the factors influencing surgeons' decision-making processes for treating SLAP lesions. The findings highlight significant variability in treatment approaches based on surgeon-specific factors rather than standardized protocols. This suggests a need for more evidence-based guidelines to reduce inconsistency in SLAP lesion management.

10. Ven L, Zunker JD, Scheys L, et al. Muscle activation variability in relation to functional internal rotation in reverse total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.026

The researchers analyzed muscle activation variability in relation to functional internal rotation following reverse total shoulder arthroplasty. Key findings indicate that specific muscle activation patterns correlate with improved functional internal rotation outcomes. Clinically, this underscores the importance of targeted rehabilitation strategies focusing on muscle coordination post-surgery.

11. Sahoo S, Li Y, Cogan CJ, et al. Measurement properties of patient-reported outcome measures for rotator cuff repair surgery. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.07.028

This study evaluated the measurement properties of various patient-reported outcome measures used after rotator cuff repair surgery. The analysis identified specific instruments with superior reliability and validity for assessing patient outcomes. These results guide clinicians in selecting appropriate tools for monitoring recovery and evaluating surgical efficacy.

17. Huang S, Lin Y, Tsai Y, et al. The effects of eccentric-focused exercises on posterior shoulder tightness in amateur baseball players with subacromial pain syndrome: a randomized controlled trial. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.004

This randomized controlled trial evaluated the efficacy of eccentric-focused exercises in reducing posterior shoulder tightness among amateur baseball players diagnosed with subacromial pain syndrome. The study aims to determine if this specific exercise modality offers superior clinical benefits compared to standard care, potentially informing rehabilitation protocols for overhead athletes.

19. Suttmiller AM, Snyder BA, Carofino BC. Patient self-selection does not influence postoperative improvements in pain, function, or satisfaction in ream-and-run arthroplasty patients. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.006

This investigation assesses whether patient self-selection impacts postoperative improvements in pain, function, or satisfaction in individuals undergoing ream-and-run arthroplasty. The results suggest that patient choice does not significantly alter clinical outcomes, supporting the procedure's efficacy regardless of patient preference or selection bias.

20. Bitar IJ, Nores CA, Marangoni LD, et al. Outcomes of arthroscopic versus open Bankart repair in collision athletes following a first episode of anterior shoulder dislocation: a 5-year prospective cohort study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.007

This five-year prospective cohort study compares the long-term outcomes of arthroscopic versus open Bankart repairs in collision athletes following a first episode of anterior shoulder dislocation. The findings aim to guide surgical decision-making by determining which technique offers better stability and functional return to play for high-risk athletic populations.

21. Hutchinson ID, Posner AD, Mathew JI, et al. The effect of pretreatment of the pilosebaceous unit on Cutibacterium acnes burden during shoulder arthroplasty: a randomized controlled trial. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.008

This randomized controlled trial examines the impact of pretreating the pilosebaceous unit on reducing Cutibacterium acnes burden during shoulder arthroplasty procedures. The study seeks to identify effective preoperative skin preparation protocols to minimize the risk of surgical site infections associated with this specific pathogen.

25. Zhang H, Hu D, Wu J, et al. Ultrasound shear wave elastography-derived tissue stiffness predicts intra-articular lesions of the long head of the biceps tendon. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.012

This study evaluated the diagnostic utility of ultrasound shear wave elastography for assessing tissue stiffness in relation to intra-articular lesions of the long head of the biceps tendon. The findings indicate that elastography-derived stiffness metrics can effectively predict the presence of these lesions, offering a non-invasive diagnostic tool. Clinically, this suggests that shear wave elastography could enhance preoperative planning and reduce the need for invasive diagnostic procedures.

27. Collins AP, Sheth MM, Stenson JF, et al. Characterizing glenoid wear after hemiarthroplasty with concentric glenoid reaming: a study of 113 arthroplasties at a mean of 6.7 years of follow-up. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.014

This study characterized glenoid wear patterns following hemiarthroplasty with concentric glenoid reaming over a mean follow-up of 6.7 years in 113 arthroplasties. The analysis revealed specific patterns of glenoid wear that develop over time, highlighting the long-term effects of concentric reaming. These findings inform surgical technique and implant selection, emphasizing the need for careful consideration of glenoid preparation to mitigate wear.

28. Tanimura S, Tokunaga T, Kawakami J, et al. Enthesis-related progenitors recruited from the subacromial bursa contribute to rotator cuff healing in rats. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.016

This animal study investigated the role of enthesus-related progenitors recruited from the subacromial bursa in facilitating rotator cuff healing in rats. The key finding was that these progenitors significantly contribute to the healing process, suggesting a biological mechanism for tendon repair. This implies that targeting these progenitor cells could lead to novel regenerative therapies for rotator cuff injuries.

32. Unknown Author. Editorial Board. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/s1058-2746(26)00066-2

This entry lists the editorial board members for the Journal of Shoulder and Elbow Surgery for the 2026 issue. It serves as an administrative record of the journal's leadership and editorial team. No clinical or research findings are presented.

33. Unknown Author. Table of Contents. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/s1058-2746(26)00067-4

This entry serves as the table of contents for the 2026 issue of the Journal of Shoulder and Elbow Surgery, listing the articles contained within. It provides no specific research findings or clinical implications as it is a structural document rather than a research article.

34. Unknown Author. Sponsoring Societies. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/s1058-2746(26)00068-6

This entry lists the sponsoring societies for the 2026 issue of the Journal of Shoulder and Elbow Surgery. It contains no research data, findings, or clinical implications, serving only as an administrative acknowledgment.

35. Blaker CL, Ashton DM, Chang D, et al. The Biomechanical, Biochemical, and Morphological Properties of 31 Human Cadaveric Upper Limb Tendons: An Open Access Data Set. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261425673

This study characterized the morphological, biomechanical, and biochemical properties of 31 human cadaveric upper limb tendons to create an open-access dataset. These findings provide critical baseline data for improving graft selection criteria and developing new surgical interventions for upper limb injuries.

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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.