Skip to content

Arthroscopy and Surgical Techniques

Wrist arthroscopy for intra-articular pathology, focusing on TFCC repair (Palmer I vs II) and surgical techniques for DRUJ stabilization.

Overview

Arthroscopic and open surgical approaches demonstrate comparable outcome profiles regarding recurrence and complications [5]. However, additional long-term comparative studies are needed to accurately differentiate the efficacy of these techniques [1]. More prospective studies comparing open and arthroscopic excision are required to delineate if there is a true functional benefit [6]. Smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of combined procedures [2].

Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis yielded limited diagnostic benefit [4]. In contrast, arthroscopic treatment of talus bipartitus can be a safe and effective option with excellent short- and long-term outcomes [7]. Arthroscopic debridement and microfracture as primary treatment for osteochondral lesions of the talar dome consistently achieve good to excellent outcomes in greater than 80% of patients [13].

Arthroscopy was associated with a shorter hospital stay compared to open surgery in ankle arthrodesis for osteoarthritis [11]. This approach was also associated with significantly lower overall complication rates compared to open surgery in the same context [11]. Postless hip arthroscopy may adequately be performed with a variety of techniques [21]. Arthroscopic Bankart suture repair offers advantages of less morbidity, lower cost, less pain, and preservation of motion [49].

Surgical indication for undersurface and full-thickness gluteus medius tears is in symptomatic patients having failed a primary nonoperative protocol [22]. Randomized controlled trials are needed to develop a nonoperative strategy for undersurface and full-thickness gluteus medius tears [22].

Anatomy & Pathophysiology

Osseous Deformity and Fracture Management

Long-term follow-up of forearm shortening and volar radiocarpal capsulotomy for wrist flexion deformity in children with amyoplasia demonstrates that initial improvement in wrist position is not maintained [14]. Isolated wedge osteotomy of the ulna for mild Madelung’s deformity improves the appearance of the wrist and relieves pain without compromising function [42]. Satisfactory wrist function can be achieved with operative treatment for fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation in most patients [29]. Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius and is often not an isolated pathoanatomical problem [50].

Ligamentous and Arthrodesis Outcomes

Triquetral impingement ligament tear (TILT) repair results in improved wrist motion and strength in all cases [32]. Proximal row carpectomy results in slightly better wrist movement, fewer surgical complications, and no need for hardware removal compared to four-corner arthrodesis over a mean follow-up of 17 years [52]. Significant differences in range of motion and grip strength between differing methods of osteosynthesis for four-corner arthrodesis are unlikely to be clinically relevant [39]. Arthroscopic management of dorsal wrist impingement is associated with a lower risk of flexion loss compared to open dorsal wrist capsulectomy [43].

Kinematics and Dynamic Assessment

Midcarpal motion of rheumatoid wrists in the flexion-extension plane is better preserved than previously thought [40]. Flexible electrogoniometry is accurate and reliable for measuring the velocity, range, and smoothness of wrist circumduction [33]. Real-time magnetic resonance imaging (MRI) during active wrist motion demonstrates the initial performance of active-MRI, which may be useful in investigating dynamic wrist instability in vivo [36]. Smartphone-based measurements of wrist range of motion are feasible and highly accurate, serving as a powerful tool for outcome studies after wrist surgery [41]. Camera-tracking gaming control devices demonstrate high test-retest reliability for wrist extension and moderate reliability for flexion [44].

Clinical Examination and Postoperative Rehabilitation

A thorough wrist examination remains integral to any arthroscopic assessment [45]. Self-taken photographs and line tracings are unreliable for remote assessment of wrist ROM, potentially yielding falsely lower results due to submaximal effort from task distraction [47]. Starting early range of motion (ROM) after surgery enables patients to regain functional wrist and forearm ROM earlier with fewer therapy visits required following volar plating of a distal radius fracture [46]. Endoscopic carpal tunnel release during distal radial fracture fixation may reduce the incidence of finger stiffness in patients with type C distal radial fractures [51]. A sensorimotor control-based exercise program (SMoC-Wrist) for patients with chronic wrist pain was modified based on recent insights into sensorimotor control principles and wrist kinematics [38].

Classification

Arthroscopic Efficacy and Utility: Arthroscopic dorsal ganglion excision demonstrates comparable recurrence and residual pain rates to open excision [1]. Routine arthroscopic use has identified previously unrecognized pathological conditions and provided significant new information regarding traditional problems [3]. Subtalar arthroscopy is a standardized and reproducible procedure offering new diagnostic and minimally invasive therapeutic options [8]. Diagnostic arthroscopy yields limited diagnostic benefit when performed in the setting of an unclear preoperative diagnosis [4]. Smaller studies incorporating second-look arthroscopy provide the most convincing evidence for the efficacy of combined procedures [2].

Imaging and Anomaly Definition: Computerized tomographic arthrography and arthroscopy enable accurate definition of unusual anomalies, such as those of the scapula [12].

Specific Pathology Classifications: A surgically relevant classification system for medial meniscus ramp tears, based on tear morphology, allows for the evaluation of differing repair patterns and their effects on postoperative clinical outcomes [26].

Surgical Navigation and Expertise Metrics: Computer aided orthopedic surgery (CAOS) classifies surgical navigation systems by their virtual representation as image-free or image-based [34]. The validity of metrics used by the ArthroVR scoring system in evaluating surgeon expertise and its use as a measurement device is questioned [35].

Clinical Presentation

Arthroscopic surgery has led to the identification of previously unrecognized pathological conditions and significant new information about traditional problems [3]. Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis yielded limited diagnostic benefit [4]. Subtalar arthroscopy provides new diagnostic options [8]. Computerized tomographic arthrography and arthroscopy enabled accurate definition of an unusual scapular anomaly [12]. Needle arthroscopy has promise as a diagnostic tool in rheumatic diseases [16]. Wrist arthroscopy serves as a crucial tool for diagnosing intra-articular pathology [27].

Surgeons must be vigilant during arthroscopy to avoid overlooking concomitant peripheral triangular fibrocartilage complex tears, as physical examination and MRI provide little diagnostic information [19].

Investigations

Plain radiography: Diagnostic arthroscopy performed for an unclear preoperative diagnosis yields limited diagnostic benefit [4]. Arthroscopic findings prior to high tibial osteotomy have little, if any, predictive value in evaluating patients for this procedure [56].

MRI: Advances in 3-dimensional MRI techniques improve understanding of articular morphology and joint biomechanics, potentially enhancing preoperative planning and arthroscopic effectiveness [37]. Magnetic resonance imaging may help evaluate other pathologies in dorsal wrist capsular impingement, which remains a clinical diagnosis [60]. The diagnostic test accuracy of X-ray arthrography for triangular fibrocartilaginous complex (TFCC) injury is limited [53]. Surgeons must remain vigilant for concomitant peripheral TFCC tears during arthroscopy, as physical examination and MRI provide little diagnostic information [19].

CT: Computerized tomographic arthrography combined with arthroscopy enables accurate definition of unusual scapular anomalies [12].

Other Considerations: Arthroscopic surgery has identified previously unrecognized pathological conditions and generated significant new information about traditional problems [3]. Subtalar arthroscopy is a standardised, reproducible procedure offering new diagnostic and minimally invasive therapeutic options [8]. The arthroscopic approach focuses on patient symptoms and is feasible for alleviating them in late calcaneal fracture complications [15]. Lesser metatarsal phalangeal joint arthroscopy demonstrates high overall anatomic accuracy (96%), establishing it as a valuable diagnostic and therapeutic tool [57]. Wrist arthroscopy requires accurate portal placement and small instrumentation to examine, probe, and treat intra-articular abnormalities [59].

Treatment

Non-Operative

Surgical intervention for gluteus medius tears is indicated for symptomatic patients who have failed a primary nonoperative protocol [22].

Operative

Indications: Arthroscopic TFCC treatment is indicated for paediatric and adolescent patients, where it yields favourable subjective and objective outcomes alongside high patient and parent satisfaction [30]. For gluteus medius tears, surgery is reserved for symptomatic individuals who have not responded to conservative management [22].

Surgical Approach / Technique: Arthroscopic and open approaches for dorsal ganglion cyst excision demonstrate comparable outcome profiles regarding recurrence and complications [5]. Arthroscopic treatment of talus bipartitus serves as a safe and effective option, providing excellent short- and long-term outcomes [7]. Subtalar arthroscopy is a standardised and reproducible procedure that offers new diagnostic and minimally invasive therapeutic options [8]. Arthroscopic debridement and microfracture as primary treatment for osteochondral lesions of the talar dome consistently achieve good to excellent outcomes in greater than 80% of patients [13]. Arthroscopic management also serves as a minimally invasive alternative to open surgery for the diagnosis and treatment of early-stage tuberculosis of the ankle [61].

Setting of Care: Arthroscopic ankle arthrodesis is associated with a shorter hospital stay and significantly lower overall complication rates compared to open surgery in patients with ankle osteoarthritis [11]. Simultaneous bilateral hip arthroscopy for symptomatic, bilateral femoroacetabular impingement is a safe and effective treatment option with outcomes comparable to staged procedures [24].

Other Considerations: Arthroscopic arthrolysis for stiffness after total knee replacement provides moderate improvements in range of motion and functional knee scores, comparing well with other treatment methods [31]. Patients with prior knee arthroscopy had some inferior patient-reported outcome scores after medial opening-wedge high tibial osteotomy, but overall clinical improvements were similar to those in the control group [10]. Additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques for dorsal ganglion excision [1]. More prospective studies comparing open and arthroscopic excision of ganglion cysts are needed to delineate if there is a true functional benefit [6].

Complications

Other Considerations: Comparative efficacy between open and arthroscopic techniques for dorsal ganglion cysts demonstrates comparable outcome profiles regarding recurrence and complications [5]. For talus bipartitus, arthroscopic treatment is a safe and effective option with excellent short- and long-term outcomes [7]. Arthroscopic ankle arthrodesis is associated with a shorter hospital stay and significantly lower overall complication rates compared to open surgery [11]. Similarly, arthroscopic subtalar arthrodesis is associated with fewer complications compared to open surgery [63]. However, additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques regarding recurrence and residual pain [1]. Smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of combined procedures [2]. More prospective studies comparing open and arthroscopic excision are needed to delineate if there is a true functional benefit [6].

Regarding distal radius fractures treated with volar locking plates, arthroscopy improved joint surface reduction, although the difference was not statistically significant; further studies are needed to determine the true clinical impact of step-offs in the long term [20]. In patients with prior knee arthroscopy undergoing medial opening-wedge high tibial osteotomy, patient-reported outcome scores were somewhat inferior, although overall clinical improvements were similar to the control group [10]. Long-term follow-up of forearm shortening and volar radiocarpal capsulotomy for wrist flexion deformity in children with amyoplasia shows that the initial improvement in wrist position is not maintained [14].

For hip arthroscopy, full recognition of potential pitfalls and complications should be acknowledged prior to attempting the first case [17]. The average quality of literature regarding age and outcomes is only fair, making it difficult to determine if age 40 is a definitive cutoff for successful outcomes due to the complex interaction of multiple patient factors [62]. In the context of elbow heterotopic ossification, aggressive early arthroscopic debridement after discovery of moderate to severe disease, with the addition of postoperative radiation therapy, has proved effective in addressing this potentially serious complication [23].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return across the cited studies. However, patients with prior knee arthroscopy undergoing medial opening-wedge high tibial osteotomy (MOWHTO) demonstrated overall clinical improvements similar to controls, despite some inferior patient-reported outcome scores [10].

Full activity (months): Specific month ranges for full activity return are not defined in the available evidence. Long-term follow-up indicates that good clinical results after radial shortening osteotomy for Kienböck disease are likely to remain stable at 20 years after surgery [66]. Similarly, arthroscopic treatment of talus bipartitus yields excellent short- and long-term outcomes [7].

Complete recovery / outcome plateau (months): Outcome stabilization timelines vary by procedure. At an average follow-up of 4.5 years, 28% of hands had persistent symptoms after carpal tunnel release by the Agee endoscopic technique, with results scarcely different from the conventional technique [65]. Long-term follow-up of forearm shortening and volar radiocarpal capsulotomy for wrist flexion deformity in children with amyoplasia shows that initial improvement in wrist position is not maintained [14]. Periacetabular osteotomy provides pain relief and improved hip function in most patients over short- to midterm follow-up [54]. Arthroscopic thermal shrinkage is effective for the majority of patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up [55].

Rehabilitation protocol: The evidence does not specify detailed rehabilitation protocols, immobilisation durations, or weight-bearing progressions for the cited procedures.

Functional milestones: Validated PROM trajectories are not explicitly detailed in the provided evidence. However, a change in treatment plan was made in 47% of cases during staging arthroscopy for chondral defects of the knee, indicating it is an important step in determining the most appropriate treatment plan [64].

Other Considerations: Additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques for dorsal ganglion excision [1]. Smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of combined procedures [2]. The routine use of arthroscopy has led to the identification of previously unrecognized pathological conditions and significant new information about traditional problems [3]. Arthroscopic and open approaches have comparable outcome profiles regarding recurrence and complications for dorsal ganglion cysts [5]. More prospective studies comparing open and arthroscopic excision are needed to delineate if there is a true functional benefit [6]. While arthroscopy improved joint surface reduction for distal radius fractures, the difference was not statistically significant, and further studies are needed to determine the true clinical impact of step-offs in the long term [20]. Aggressive early arthroscopic debridement after discovery of moderate to severe heterotopic ossification of the elbow, with the addition of postoperative radiation therapy, has proved effective in addressing this complication [23].

Key Evidence

  • [L1] Additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques. (10.1016/j.jhsa.2008.01.009)
  • [L5] The authors believe that smaller studies that include second-look arthroscopy provide the most convincing evidence for the efficacy of these combined procedures. (10.1016/j.arthro.2017.01.005)
  • [L5] The routine use of arthroscopy has led to the identification of previously unrecognized pathological conditions and significant new information about traditional problems. (10.2106/00004623-198365030-00027)
  • [L4] Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis yielded limited diagnostic benefit. (10.1177/1558944716661993)
  • [L2] Arthroscopic and open approaches have comparable outcome profiles regarding recurrence and complications. (10.1177/1753193417734428)
  • [L4] More prospective studies comparing open and arthroscopic excision are needed to delineate if there is a true functional benefit. (10.1016/j.hcl.2013.08.020)
  • [L4] Arthroscopic treatment can be a safe and effective option with excellent short- and long-term outcomes. (10.1007/s00167-017-4613-8)
  • [L4] Subtalar arthroscopy is a standardised and reproducible procedure with new diagnostic and minimally invasive therapeutic options. (10.1007/s001670050084)
  • [L3] Although patients with prior arthroscopy had some inferior patient-reported outcome scores after MOWHTO, the overall clinical improvements were similar in the arthroscopy and control groups. (10.1177/23259671231175457)
  • [L1] However, arthroscopy was associated with a shorter hospital stay and significantly lower overall complication rates compared to open surgery. (10.3390/jcm12103574)
  • [L4] Computerized tomographic arthrography and arthroscopy enabled accurate definition of the anomaly. (10.2106/00004623-198870030-00021)
  • [L4] Good to excellent outcomes can be consistently reached in greater than 80% of patients with arthroscopic debridement and microfracture. (10.1016/j.arthro.2012.04.055)
  • [L4] Long-term follow-up of the procedure shows that the initial improvement in wrist position is not maintained. (10.1016/j.jhsa.2011.10.013)
  • [L4] The arthroscopic approach focuses on the patient's symptoms and is a feasible approach to alleviate them. (10.1007/s00167-012-2086-3)
  • [L4] The needle arthroscopy is a simple, safe, and well tolerated technique, with promise as a diagnostic, scientific, and possibly therapeutic tool in rheumatic diseases, but arthroscopic experience is necessary for this procedure. (10.1007/s00167-002-0329-4)
  • [L5] Full recognition of the potential pitfalls and complications during hip arthroscopy should be acknowledged prior to attempting the first case. (10.1016/j.arthro.2017.01.052)
  • [L4] Surgeons must be vigilant during arthroscopy to avoid overlooking concomitant peripheral tears, as physical examination and MRI provide little diagnostic information. (10.1177/1753193413479479)
  • [Letter] The authors state that while arthroscopy improved joint surface reduction, the difference was not statistically significant, and further studies are needed to determine the true clinical impact of step-offs in the long term. (10.1016/j.arthro.2023.08.070)
  • [L2] Postless hip arthroscopy may adequately be performed with a variety of techniques. (10.1016/j.asmr.2022.09.013)
  • [L5] The article highlights the importance of patient selection, noting surgical indication in symptomatic patients having failed a primary nonoperative protocol, and identifies the need for randomized controlled trials to develop a nonoperative strategy. (10.1016/j.arthro.2017.08.238)
  • [L4] Aggressive early arthroscopic debridement after discovery with the addition of postoperative radiation therapy has proved effective in addressing this potentially serious complication. (10.1016/j.arthro.2013.03.050)
  • [L3] Simultaneous bilateral hip arthroscopy for FAI is a safe and effective treatment option with outcomes comparable to staged procedures. (10.1016/j.arthro.2016.03.065)
  • [L4] This classification system allows for the ability to evaluate differing repair patterns and their effects on postoperative clinical outcomes. (10.1177/2325967125s00101)
  • [L4] Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients. (10.2106/jbjs.e.00930)
  • [L4] Arthroscopic TFCC treatment in paediatric patients is safe and yielded favourable subjective and objective outcomes and patient/parent satisfaction. (10.1177/1753193418825070)
  • [L4] Arthroscopic arthrolysis compares well with other methods of treatment for stiffness with regard to improvements in range of motion and functional knee scores. (10.1007/s00167-009-0878-x)
  • [L4] In all cases, TILT repair resulted in improved wrist motion and strength. (10.1054/jhsb.1999.0070)
  • [L3] This technique was accurate and reliable in measuring the velocity, range, and smoothness of wrist circumduction. (10.1016/j.jhsa.2012.08.025)
  • [L5] The article introduces the basic principles of computer aided orthopedic surgery (CAOS), classifying surgical navigation systems by their virtual representation (image-free vs. image-based) and outlining the technical components required for clinical application. (10.1016/j.injury.2004.05.005)
  • [L4] This study questions the validity of the metrics used by the ArthroVR scoring system in its role in evaluation of the surgeon and its use as a measurement device in future studies. (10.1016/j.arthro.2013.03.068)
  • [L4] This study demonstrates the initial performance of active-MRI, which may be useful in the investigation of dynamic wrist instability in vivo. (10.1371/journal.pone.0084004)
  • [L5] Advances in 3-dimensional MRI techniques create the opportunity to improve understanding of articular morphology and joint biomechanics, with the potential to enhance preoperative planning and the effectiveness of arthroscopic techniques. (10.1016/j.arthro.2019.06.001)
  • [L5] The authors modified and substantiated a widely used exercise program for patients with nonspecific chronic wrist pain based on recent insights into sensorimotor control principles and wrist kinematics. (10.1016/j.jht.2018.11.002)
  • [L4] While there are some significant differences in range of motion and grip strength, these differences are unlikely to be clinically relevant. (10.1016/j.jhsa.2021.06.002)
  • [L4] Midcarpal motion of rheumatoid wrists in the flexion-extension plane was better preserved than previously thought. (10.1016/j.jhsa.2007.11.012)
  • [L4] This study suggests that smartphone-based measurements of wrist range of motion are feasible and highly accurate, making it a powerful tool for outcome studies after wrist surgery. (10.1177/17531934211004454)
  • [L4] The procedure improves the appearance of the wrist and relieves pain without compromising function. (10.1016/j.jhsa.2007.05.015)
  • [L4] The procedure is associated with a lower risk of flexion loss compared to open dorsal wrist capsulectomy. (10.1016/j.jhsa.2008.06.020)
  • [L3] The Camera Wrist Tracker demonstrated high test-retest reliability for wrist extension and moderate reliability for flexion. (10.1016/j.jht.2016.07.002)
  • [L5] A thorough wrist examination remains integral to any arthroscopic assessment. (10.1016/j.jhsa.2008.07.015)
  • [L3] Starting early ROM after surgery enables patients to regain functional wrist and forearm ROM earlier with fewer therapy visits required. (10.1016/j.jht.2009.06.003)
  • [L3] Self-taken photographs and line tracings are unreliable, perhaps falsely lower owing to submaximal effort from task distraction, and we question their current use for remote assessment of wrist ROM. (10.1016/j.jhsa.2019.05.017)
  • [L4] The authors stated that if the results stood over time, the advantages of this arthroscopic technique, namely less morbidity, lower cost, less pain, and preservation of motion, would show that an arthroscopic shoulder stabilization would have great potential for the future. (10.1016/j.arthro.2010.04.009)
  • [L4] Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius and is often not an isolated pathoanatomical problem. (10.1177/1558944720966707)
  • [L1] The procedure may reduce the incidence of finger stiffness in patients with type C distal radial fractures. (10.1177/17531934241288216)
  • [L3] Proximal row carpectomy seems to result in slightly better movement of the wrist with fewer surgical complications and no need for hardware removal. (10.1016/j.jhsa.2014.12.035)
  • [L1] The diagnostic test accuracy of X-ray arthrography is limited. (10.1177/1753193411402762)
  • [L4] Periacetabular osteotomy provides pain relief and improved hip function in most patients over short- to midterm followup. (10.1007/s11999-009-0842-6)
  • [L4] Arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. (10.1177/1753193420927882)
  • [L3] The arthroscopic findings prior to osteotomy appeared to have little, if any, predictive value in evaluating patients for this procedure. (10.2106/00004623-198365010-00006)
  • [L5] The high overall level of anatomic accuracy (96%) allows consideration of this resource as a valuable tool in the diagnosis and treatment of these joints. (10.1016/j.arthro.2014.03.018)
  • [L5] The procedure requires accurate placement of portals and small instrumentation to examine, probe, and treat intra-articular abnormalities. (10.2106/00004623-199908000-00015)
  • [L4] Dorsal wrist capsular impingement is a clinical diagnosis; magnetic resonance imaging may be helpful in evaluating for other pathologies. (10.1016/j.jhsa.2016.12.012)
  • [L4] It serves as a minimally invasive alternative to open surgery for diagnosis and treatment. (10.1186/s13018-018-1048-y)
  • [L5] The editorial commentary notes that while hip arthroscopy use is growing, the average quality of literature regarding age and outcomes is only fair, and it remains difficult to determine if age 40 is a definitive cutoff for successful outcomes due to the complex interaction of multiple patient factors. (10.1016/j.arthro.2016.12.002)
  • [L4] Arthroscopic subtalar arthrodesis is gaining in popularity based on evidence of bone fusion in over 90% of cases, with a shorter time to healing, a simpler postoperative course, and fewer complications compared to open surgery. (10.1016/j.otsr.2016.08.002)
  • [L4] A change in treatment plan was made in 47% of cases, indicating that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects. (10.1016/j.arthro.2019.11.049)
  • [L4] At an average follow-up of 4.5 years, 28% of hands had persistent symptoms, but results were scarcely different from the conventional technique with no patient requiring reoperation. (10.1054/jhsb.1999.0226)
  • [L4] Good clinical results observed in patients 10 years after radial shortening osteotomy are likely to remain stable at 20 years after surgery. (10.1016/j.jhsa.2025.04.018)

See Also

References

[1] Arthroscopic Versus Open Dorsal Ganglion Excision: A Prospective, Randomized Comparison of Rates of Recurrence and of Residual Pain. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.009

[2] Authors' Reply. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.01.005

[3] Arthroscopic surgery.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365030-00027

[4] Diagnostic Wrist Arthroscopy for Nonspecific Wrist Pain. HAND. 2016. DOI: 10.1177/1558944716661993

[5] Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417734428

[6] Arthroscopic Excision of Ganglion Cysts. Hand Clinics. 2014. DOI: 10.1016/j.hcl.2013.08.020

[7] Talus bipartitus: a systematic review and report of two cases with arthroscopic treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4613-8

[8] Subtalar arthroscopy – indications and surgical technique. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050084

[10] Effect of Prior Knee Arthroscopy on Midterm Outcomes After Medial Opening-Wedge High Tibial Osteotomy: A Propensity Score–Matched Analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231175457

[11] Arthroscopic vs. Open-Ankle Arthrodesis on Fusion Rate in Ankle Osteoarthritis Patients: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2023. DOI: 10.3390/jcm12103574

[12] Unusual anomaly of the scapula defined by arthroscopy and computerized tomographic arthrography. Report of a case.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870030-00021

[13] Outcome of Arthroscopic Debridement and Microfracture as the Primary Treatment for Osteochondral Lesions of the Talar Dome. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.055

[14] Long-Term Results of Forearm Shortening and Volar Radiocarpal Capsulotomy for Wrist Flexion Deformity in Children With Amyoplasia. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.013

[15] Arthroscopic management of late complications of calcaneal fractures. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2086-3

[16] Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope. Knee Surgery, Sports Traumatology, Arthroscopy. 2002. DOI: 10.1007/s00167-002-0329-4

[17] Editorial Commentary: Fluid Extravasation in Hip Arthroscopy—A Tough Case Just Got Much Worse. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.01.052

[19] Incidence and diagnosis of ‘the double lesion’ of the triangular fibrocartilage complex. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413479479

[20] Author Reply to “Regarding ‘Adjuvant Arthroscopy Does Not Improve the Functional Outcome of Volar Locking Plate for Distal Radius Fractures: A Randomized Clinical Trial’”. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.08.070

[21] Postless Arthroscopic Hip Preservation Can be Adequately Performed Using Published Techniques. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.09.013

[22] Editorial Commentary: Pioneering the Gluteal Interval: Understanding and Treating Undersurface and Full‐Thickness Gluteus Medius Tears of the Hip. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.238

[23] Early Arthroscopic Management Strategies for Patients Developing Moderate to Severe Heterotopic Ossification of the Elbow (SS‐43). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.050

[24] A Comparison of Staged vs Simultaneous Hip Arthroscopy for Selected Patients With Symptomatic, Bilateral Femoroacetabular Impingement. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.065

[26] Paper 44: Medial Meniscus Ramp Tears: An Internationally Developed Surgically Relevant Classification System Based on Tear Morphology. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00101

[27] Chapter 39 Wrist Arthroscopy. 2019.

[29] Fractures of the Dorsal Articular Margin of the Distal Part of the Radius with Dorsal Radiocarpal Subluxation. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00930

[30] Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418825070

[31] Arthroscopic arthrolysis for the treatment of stiffness after total knee replacement gives moderate improvements in range of motion and functional knee scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0878-x

[32] Triquetral Impingement Ligament Tear (Tilt). Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0070

[33] Assessment of Velocity, Range, and Smoothness of Wrist Circumduction Using Flexible Electrogoniometry. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.08.025

[34] Basic principles of CAOS. Injury. 2004. DOI: 10.1016/j.injury.2004.05.005

[35] Arthroscopic Shoulder Simulation: Can a Computer Perceive Expertise? (SS‐61). Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.03.068

[36] Real-Time Magnetic Resonance Imaging (MRI) during Active Wrist Motion—Initial Observations. PLoS ONE. 2013. DOI: 10.1371/journal.pone.0084004

[37] Editorial Commentary: Advances in 3‐Dimensional Imaging are the Key to Improving our Surgical Precision in Hip Arthroscopy and Beyond. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.001

[38] SMoC-Wrist: a sensorimotor control-based exercise program for patients with chronic wrist pain. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2018.11.002

[39] Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.06.002

[40] Analysis of Radiocarpal and Midcarpal Motion in Stable and Unstable Rheumatoid Wrists Using 3-Dimensional Computed Tomography. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.11.012

[41] Validation of a smartphone application and wearable sensor for measurements of wrist motions. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211004454

[42] Isolated Wedge Osteotomy of the Ulna for Mild Madelung’s Deformity. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.05.015

[43] Arthroscopic Management of Dorsal Wrist Impingement. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.06.020

[44] Camera-tracking gaming control device for evaluation of active wrist flexion and extension. Journal of Hand Therapy. 2017. DOI: 10.1016/j.jht.2016.07.002

[45] Wrist Arthroscopy: Current Concepts. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.07.015

[46] A Retrospective Pilot Study Comparing the Number of Therapy Visits Required to Regain Functional Wrist and Forearm Range of Motion following Volar Plating of a Distal Radius Fracture. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2009.06.003

[47] Remote Assessment of Wrist Range of Motion: Inter- and Intra-Observer Agreement of Provider Estimation and Direct Measurement With Photographs and Tracings. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.05.017

[49] Arthroscopic Bankart Suture Repair: Technique and Early Results. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.04.009

[50] Extensor Retinaculum Reconstruction of the Distal Radioulnar Joint in Adolescents. HAND. 2020. DOI: 10.1177/1558944720966707

[51] Does endoscopic carpal tunnel release during distal radial fracture fixation improve outcomes? A randomized controlled trial. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241288216

[52] Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.035

[53] The diagnostic accuracy of X-ray arthrography for triangular fibrocartilaginous complex injury: a systematic review and meta-analysis. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193411402762

[54] Periacetabular Osteotomy: A Systematic Literature Review. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-009-0842-6

[55] Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420927882

[56] High tibial osteotomy in the treatment of osteoarthritis of the knee. The role of preoperative arthroscopy.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365010-00006

[57] Lesser Metatarsal Phalangeal Joint Arthroscopy: Anatomic Description and Comparative Dissection. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.03.018

[59] Techniques of Wrist Arthroscopy . The Journal of Bone and Joint Surgery-American Volume*. 1999. DOI: 10.2106/00004623-199908000-00015

[60] Diagnosis and Arthroscopic Management of Dorsal Wrist Capsular Impingement. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.12.012

[61] Arthroscopic management for early-stage tuberculosis of the ankle. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-018-1048-y

[62] Editorial Commentary: 40 the New 30? Maybe Not for the Hip. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2016.12.002

[63] Arthroscopic subtalar arthrodesis. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.08.002

[64] The Importance of Staging Arthroscopy for Chondral Defects of the Knee. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.049

[65] Carpal Tunnel Release by the Agee Endoscopic Technique. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0226

[66] Long-Term Outcomes of Radial Shortening Osteotomy for Kienböck Disease: Minimum 20-Year Follow-Up Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.04.018

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

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.

Creative Commons may be contacted at creativecommons.org.