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富血小板血浆(PRP)及注射疗法

What the evidence shows for platelet-rich plasma and related injection therapies in tendinopathy, osteoarthritis and rotator cuff disease — where they help and where the data is weak.

Updated Aug 2026
装有分离血浆的离心管。
PRP 从您自身的血液中浓缩血小板,用于某些肌腱和关节疾病,其疗效证据不一。 Kieran Hirpara 4.0

本页面由机器翻译,尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到膝盖、肘部或肩部疼痛。这种不适通常在您活动后加重。如果您侧卧在患侧睡觉,还可能在夜间痛醒。一些简单的日常活动,如伸手到背后扣内衣或把衬衫塞进裤子里,可能会变得困难。

对于膝关节退行性关节炎,您可能会感到僵硬或酸痛,从而限制您的活动范围。您的外科医生可能会建议至少进行两次富血小板血浆(PRP)注射以帮助缓解症状。这些注射使用的是您自身的血液血浆,旨在减轻炎症。这些注射带来的缓解效果通常至少持续24周。

如果您患有网球肘(肱骨外上髁炎),疼痛通常位于肘部外侧。您在抓握物体时可能会感到无力。您获得的症状缓解程度通常取决于所使用的PRP浓度。与其他治疗方法相比,较高剂量的PRP往往能提供更显著的缓解效果。

由肩袖问题引起的肩部疼痛会使抬臂变得疼痛。如果您曾接受过手术,您的外科医生可能会使用一种称为白细胞减少型PRP(leukocyte-poor PRP)的特定类型PRP。这种类型的PRP有助于降低肌腱修复后再次撕裂的风险。

对于跟腱疼痛或大转子疼痛综合征(髋部疼痛),目前的证据不支持使用PRP。对于这些病症,PRP的效果并不优于安慰剂。在新的高质量研究提供更明确的答案之前,您应避免接受这些治疗。

您的外科医生将根据您的具体损伤情况决定PRP是否适合您。PRP通常被考虑用于患有大关节关节炎或急性肌肉损伤的运动员。然而,结果因人而异。有些人会发现显著的缓解,而另一些人可能仍然不满意。在开始治疗之前,务必与您的医疗团队讨论潜在的益处和局限性。

实际发生了什么

您的身体利用血小板来修复损伤。这些细胞聚集在损伤部位并释放有助于组织修复的蛋白质。富血小板血浆(PRP)疗法采集您自身的血液,通过离心浓缩这些具有修复作用的细胞,并将其注射回问题区域。这为您的身体提供了更强的信号以修复损伤。

在膝关节骨关节炎中,骨端的光滑涂层磨损。这是磨损性关节炎。关节失去了其缓冲作用。您的外科医生可能会建议对此病症进行至少两次 PRP 注射。目标是减轻疼痛并改善功能。对于许多患者,这些效果可持续至少 24 周。然而,科学证据仍在不断发展。一些研究存在方法学问题,因此我们谨慎解读结果。我们需要更多的长期数据来确认该疗法对所有人的疗效。

对于肌腱问题,如肱骨外上髁炎(网球肘),绳索状的肌腱纤维受损。研究表明,所使用的 PRP 浓度与症状缓解程度之间存在直接联系。较高剂量通常比低剂量提供更好的结果。对于这种特定病症,该疗法可能比其他策略更有效。它也有助于反驳 PRP 仅对慢性腱鞘炎具有安慰剂效应的观点。

在肩部损伤中,肩袖肌腱像绳索一样将手臂固定在原位。手术后,这些肌腱可能会再次撕裂。在修复过程中使用白细胞减少型 PRP 可以降低再次撕裂的风险。白细胞是白细胞。去除部分白细胞可能创造更好的愈合环境。

对于其他病症,证据不一或为阴性。不推荐对跟腱病使用 PRP。对此问题,其疗效不优于安慰剂。常规用于大转子疼痛综合征也缺乏支持。在运动医学领域,PRP 可能有助于急性肌肉损伤,但方案需要标准化。对于运动员的大关节骨关节炎,应系统性地提供该疗法。

最终,您的外科医生将根据您的具体损伤和最新证据决定 PRP 是否适合您。

预期效果

您的预后在很大程度上取决于您所治疗的具体疾病。对于膝关节退行性关节炎,您的外科医生可能会建议至少进行两次富血小板血浆(PRP)注射。这些治疗有助于至少维持24周的症状缓解。这意味着在考虑进一步治疗之前,您可能会获得约六个月的缓解期。

如果您是一名患有大关节关节炎的运动员,PRP治疗可能是您管理计划中有用的一部分。它可以帮助您在比赛季节保持活跃。然而,对于急性肌肉损伤,证据尚不明确。虽然PRP在某些运动场景下可能有所帮助,但治疗方案尚未标准化。您应讨论这是否适合您的具体损伤类型。

对于其他常见问题,结果各不相同。在慢性腱鞘炎(腱鞘炎症)的情况下,PRP已被证明比安慰剂更有效。然而,对于肱骨外上髁炎(网球肘),证据存在矛盾。一些研究表明,较高剂量能提供更好的症状缓解,而另一些研究则不支持使用PRP。同样,目前的数据不支持常规使用PRP治疗大转子疼痛综合征(髋部疼痛)。

对跟腱病的治疗效果应保持谨慎的期望。目前的证据显示,PRP对此病的效果并不优于安慰剂。在提供不同结论的新的高质量研究出现之前,通常不建议使用PRP。如果您正在进行肩袖修复手术,您的外科医生可能会使用白细胞贫乏型PRP来帮助降低肌腱再次撕裂的风险。

总体而言,PRP并非保证治愈的方法。它是一种对某些人和某些疾病有效的治疗选择,但并非对所有情况都有效。您的外科医生将帮助您判断在您具体情况下,潜在益处是否超过成本和精力投入。


Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • At least two PRP injections are recommended for treating knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • Conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up [2].
  • Future studies should prioritize long-term outcomes to guide clinical decision-making more effectively [2].
  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) platelet-rich plasma are effective treatment options with comparable efficacy based on current evidence [3].
  • Findings refute claims of PRP equivalence to placebo and support its efficacy over placebo in chronic tenosynovitis [4].
  • PRP therapy should be systematically offered for competition sports practitioners [5].
  • The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].
  • Findings do not support PRP as a recommended treatment for lateral epicondylitis [7].
  • PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge [8].
  • Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease [9].
  • Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed [11].
  • Routine use of PRP for the treatment of greater trochanteric pain syndrome is not supported [13].
  • Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to MIBO guidelines [14].

How It Works

  • The clinical utility of PRP should be interpreted with caution due to major methodological concerns in some studies, including lack of PRP characterization and short-term follow-up [2].
  • Both leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (LP-PRP) are effective treatment options with comparable efficacy based on current evidence [3].
  • PRP therapy is recommended for competition sports practitioners [5].
  • Authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO [6].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection, with high-dose PRP showing significant efficacy over alternative treatment strategies [10].
  • Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [12].
  • The application of PRP following small-diameter core decompression results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to core decompression alone in early osteonecrosis of the femoral head [15].
  • The goal of characterization studies is to discern key molecular mediators between leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) derived from the same patient with equivalent platelet concentrations [16].
  • Optimizing osteoarthritis treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP preferred for advanced OA to promote tissue repair and regeneration [17].

What the Evidence Shows

Efficacy by Condition

  • At least two PRP injections are recommended for knee osteoarthritis, with effects lasting for at least 24 weeks [1].
  • Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary osteoarthritis, particularly in younger individuals [23].
  • PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis [22].
  • Current evidence supports the selective use of PRP in sports settings for acute muscle injuries, though standardization in protocols and outcomes is needed [11].
  • PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids [20].
  • Corticosteroids resulted in greater short-term improvement than PRP, while PRP demonstrated superior longer-term outcomes at 6 and 12 months for lateral elbow tendinopathy [12].
  • Current evidence is of insufficient quality to determine if anterior cruciate ligament reconstruction (ACLR) augmented with PRP provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP [26].

Product Composition and Preparation

  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) are effective treatment options with comparable efficacy for knee osteoarthritis based on current evidence [3].
  • Leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee osteoarthritis in a double-blind randomized controlled trial [19].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection for lateral epicondylitis, with high-dose PRP showing significant efficacy over alternative treatment strategies [10].
  • The findings refute claims of PRP equivalence to placebo and support its efficacy over placebo for chronic tenosynovitis [4].

Combination Therapies

  • For patients with knee osteoarthritis, PRP combined with hyaluronic acid (PRP + HA) therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy [21].
  • The combination of PRP with non-crosslinked hyaluronic acid in mono-injection was found to be non-inferior to crosslinked hyaluronic acid regarding the percentage of responders over 6 months for knee osteoarthritis [25].

Reporting Quality and Methodological Concerns

  • The authors' conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up; future studies should prioritize long-term outcomes to guide clinical decision-making more effectively [2].
  • Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP [24].
  • Studies evaluating the outcomes and procedures of the use of PRP in the setting of lateral epicondylitis have poor adherence to Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines [14].

Specific Recommendations

  • The authors recommend systematically offering PRP therapy for competition sports practitioners [5].

Practical Considerations

  • Both leukocyte-rich (L-PRP) and leukocyte-poor (LP-PRP) are effective treatment options with comparable efficacy based on current evidence [3].
  • A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection [10].
  • High-dose PRP shows significant efficacy over alternative treatment strategies [10].
  • Corticosteroids resulted in greater short-term improvement compared to PRP for lateral elbow tendinopathy [12].
  • PRP demonstrated superior longer-term outcomes at 6 and 12 months compared to corticosteroids for lateral elbow tendinopathy [12].
  • Leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair [18].
  • The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost [18].

Key Evidence

  • [L3] At least two PRP injections are recommended, with effects lasting for at least 24 weeks. [1] (10.1186/s13018-025-05756-6)
  • [L5] The authors' conclusions regarding the clinical utility of PRP should be interpreted with caution due to major methodological concerns, including lack of PRP characterization and short-term follow-up; future studies should prioritize long-term outcomes to guide clinical decision-making more effectively. [2] (10.1016/j.arth.2025.05.007)
  • [L1] Both L-PRP and LP-PRP are effective treatment options with comparable efficacy based on current evidence. [3] (10.1186/s13018-026-06689-4)
  • [L1] These findings refute claims of PRP equivalence to placebo and support its efficacy over placebo. [4] (10.1186/s12891-025-09339-8)
  • [L4] The authors recommend systematically offering PRP therapy for competition sports practitioners. [5] (10.1186/s12891-025-08663-3)
  • [Paper] The authors argue that they fulfilled the reporting requirements for the injected PRP product as defined by MIBO. [6] (10.1177/03635465231203202)
  • [L1] These findings do not support PRP as a recommended treatment for this condition. [7] (10.1177/03635465251383039)
  • [L1] PRP is no more effective than placebo for treating Achilles tendinopathy and should not be used for this indication until new, large, high-quality RCTs upend current knowledge. [8] (10.1097/corr.0000000000003478)
  • [Paper] Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease. [9] (10.1177/03635465251395284)
  • [L1] A direct, linear relationship was observed between the concentration factor of PRP used and the magnitude of patient-reported symptom relief after PRP injection, with high-dose PRP showing significant efficacy over alternative treatment strategies. [10] (10.1016/j.jisako.2025.100442)
  • [L2] Current evidence supports the selective use of PRP in sports settings, though standardization in protocols and outcomes is needed. [11] (10.1177/23259671251399907)
  • [L1] Corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. [12] (10.1177/23259671251386862)
  • [L1] As a result, we do not support the routine use of PRP for the treatment of this condition. [13] (10.2106/jbjs.24.00763)
  • [L2] This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. [14] (10.5397/cise.2024.01060)
  • [L3] The application of PRP following CD results in significant pain relief, improved short-term functional outcomes, and enhanced quality of life compared to CD alone. [15] (10.1186/s12891-024-08243-x)
  • [L5] The goal of the study was to discern key molecular mediators between leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) derived from the same patient with equivalent platelet concentrations. [16] (10.1177/03635465231206930)
  • [L1] Optimizing OA treatment involves tailoring PRP protocols to disease stage, with low platelet, high leukocyte PRP recommended for early OA due to its anti-inflammatory effects and high platelet, low leukocyte PRP preferred for advanced OA to promote tissue repair and regeneration. [17] (10.1186/s13018-025-06026-1)
  • [L1] The economic value of LP-PRP is conditional rather than uniform and depends on revision probability and preparation cost. [18] (10.1016/j.jse.2026.02.018)
  • [L1] This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. [19] (10.1177/03635465241283500)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. [20] (10.1186/s12891-025-08566-3)
  • [L1] This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy. [21] (10.1186/s13018-024-05429-w)
  • [L4] PRP injections are a safe and effective conservative treatment method for reducing pain symptoms and increasing functionality in patients with lateral epicondylitis. [22] (10.1177/2325967125s00169)
  • [L1] Intra-articular PRP injection is an effective treatment for improving overall function in patients with primary OA, particularly in younger individuals. [23] (10.1186/s12891-026-09486-6)
  • [L1] Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat knee osteoarthritis, with identified spin tending to favor the use of PRP. [24] (10.1002/arj.70027)
  • [L1] The combination of PRP with non-crosslinked HA in mono-injection was found to be non-inferior to crosslinked HA, with regards to the percentage of responders over 6 months (WOMAC pain). [25] (10.1186/s12891-026-09625-z)
  • [L1] Current evidence is of insufficient quality to determine if ACLR augmented with PRP application provides a clinically meaningful improvement in postoperative outcomes over ACLR without PRP. [26] (10.1186/s13018-026-06714-6)

References

[1] Efficacy of multiple autologous apheresis platelet-rich plasma injections for treating knee osteoarthritis and its influencing factors: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05756-6

[2] Letter Regarding “Platelet-Rich Plasma Injections are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial”. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.007

[3] Leukocyte-rich versus leukocyte-poor platelet-rich plasma and hyaluronic acid for knee osteoarthritis: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06689-4

[4] Time-dependent growth factor kinetics, platelet concentration, and clinical response following platelet-rich plasma versus saline in chronic tenosynovitis: a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09339-8

[5] Platelet-rich plasma treatment for large joint osteoarthritis: retrospective study highlighting a possible treatment protocol with long-lasting stimulation of the joint with an adequate dose of platelets. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08663-3

[6] Improving Injectable Orthobiologics Reporting Guidelines Adherence: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231203202

[7] Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251383039

[8] Editor’s Spotlight/Take 5: Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003478

[9] Platelet-Rich Plasma in the Treatment of Musculoskeletal Disease in 2025 and Beyond. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251395284

[10] Platelet Concentration Factor Explains Variability in Outcomes of Platelet-rich Plasma for Lateral Epicondylitis: High Dose Critical for Positive Response. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100442

[11] Platelet-Rich Plasma in Acute Muscle Injuries: An Umbrella Review and Meta-analysis of Return to Sport and Reinjury Outcomes. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399907

[12] A Randomized Controlled Trial of 1-Year Clinical Outcomes of a Single Platelet-Rich Plasma Injection Versus Corticosteroid for the Treatment of Lateral Elbow Tendinopathy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251386862

[13] Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00763

[14] Adherence rates to the Minimum Information for Studies Evaluating Biologics in Orthopedics guidelines for clinical studies on platelet-rich plasma for the treatment of lateral epicondylitis: a systematic review. Clinics in Shoulder and Elbow. 2026. DOI: 10.5397/cise.2024.01060

[15] Efficacy of small-diameter core decompression with platelet-rich plasma in early osteonecrosis of the femoral head: a retrospective study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08243-x

[16] The Accurate Characterization of Platelet-Rich Plasma Enables Its Classification and Comparison: Response. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231206930

[17] The efficacy of platelet-rich plasma preparation protocols in the treatment of osteoarthritis: a network meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06026-1

[18] Leukocyte-poor platelet-rich plasma reduces retear risk after arthroscopic rotator cuff repair: a meta-analysis with mechanistic and economic evaluation. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.02.018

[19] Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241283500

[20] Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08566-3

[21] RETRACTED ARTICLE: A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA). Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05429-w

[22] Poster 58: Decreased Pain After Platelet-Rich Plasma Injection in Lateral Epicondylitis Patients in the Early Follow-up Period. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00169

[23] Investigating the therapeutic impact of platelet-rich plasma on knee, hip, and traumatic osteoarthritis: a meta-analysis and systematic review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09486-6

[24] Statistically Significant Results Favored in Abstracts of Platelet Rich Plasma Treatment of Knee Osteoarthritis: A Systematic Review and Spin Analysis. Arthroscopy. 2026. DOI: 10.1002/arj.70027

[25] Efficacy and safety of a combination of platelet-rich plasma with non-crosslinked hyaluronic acid versus a crosslinked hyaluronic acid, in single-injection for knee osteoarthritis. Randomized, controlled, multicenter, non-inferiority trial. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09625-z

[26] The impact of platelet-rich plasma augmentation on postoperative clinical outcomes in patients undergoing anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06714-6

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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.


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