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干细胞与再生注射

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What stem-cell and bone-marrow-derived injections claim to do for joints and tendons, what the evidence actually shows, and the safety and regulatory caveats.

Updated Jul 2026
试管旁边有一支注射器。
干细胞和再生注射被广泛宣传；其在肌肉骨骼疾病中的应用仍缺乏强有力的证据支持。 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

您可能会感到膝盖疼痛，尤其是如果您患有磨损性关节炎。这种不适感通常在白天活动后加重。您早上刚醒来时可能会感到僵硬。疼痛可能在夜间加剧，使您难以找到舒适的睡眠姿势。

随着病情进展，日常活动可能会变得困难。简单的动作，如从椅子上站起来或爬楼梯，可能会引起剧烈疼痛。您可能会发现难以完全弯曲膝盖或将其伸直。有些人报告说膝盖感觉不稳定，或者可能会突然无力。

如果您患有滑膜炎（即关节内的肿胀和炎症），疼痛可能会更加剧烈。如果您的疼痛程度为中度至重度，这种情况尤为明显。肿胀会使膝盖感觉紧绷，触摸时发热。您可能会注意到膝盖看起来肿胀或比平时更大。

您的外科医生将评估这些症状，以了解您的具体情况。虽然干细胞注射正在针对这些问题进行研究，但目前尚无足够证据推荐其在常规临床实践中使用。对于创伤后关节炎，干细胞治疗的最佳效果通常在特定手术后的第 7 天和第 14 天观察到，但这仍然是正在进行的研究的一部分。

目前，您的外科医生将专注于通过成熟的方法来管理您的疼痛并改善您的功能。您可能会被建议休息、使用冰敷或服用药物以帮助减轻肿胀和不适。物理治疗也有助于加强膝盖周围的肌肉，以提供更好的支撑。

与您的外科医生清晰沟通您的感受非常重要。告诉他们疼痛何时最严重，以及哪些活动会使疼痛缓解或加重。这有助于他们为您量身定制有效的治疗方案。请记住，新疗法一直在研究中，但安全性和确凿的结果仍然是首要任务。

实际发生的情况

您的膝关节内衬有光滑的软骨。这种组织充当减震器和垫片。它使您的骨骼能够无摩擦地相互滑动。在骨关节炎中，这层涂层会磨损。关节变得发炎。这种肿胀称为滑膜炎。它会导致疼痛和僵硬。

干细胞是身体的修复团队。具体而言，间充质干细胞可以转化为骨骼、软骨或脂肪。它们有助于减轻炎症并促进愈合。您的外科医生可能会使用来自您自身骨髓或脂肪的细胞。他们也可能使用脐带来源的细胞。这些治疗旨在恢复关节的自然功能。

这些注射的时机很重要。对于创伤后骨关节炎，最佳效果是在受伤后第 7 天和第 14 天观察到的。治疗时间表与疗效显著相关。将干细胞与富血小板血浆结合可以增强治疗功效。这种混合物作为骨关节炎的治疗选项具有潜力。

然而，我们必须明确当前的护理状况。目前，临床实践中缺乏足够的证据来推荐膝关节骨关节炎的干细胞注射。间充质干细胞注射是一个不断发展的研究领域。它们应在严格的试验中继续进行研究。

一些研究显示出希望。关节内注射脐带来源的间充质干细胞对于伴有滑膜炎的中重度膝关节骨关节炎是安全且有效的。治疗在随访结束时显示出临床改善。中重度疼痛的患者看到了特别的改善。

但其他结果好坏参半。鉴于目前可用的相互矛盾的结果，无法评估骨髓抽吸浓缩物优于其他骨科生物制剂治疗的优越性。试验中也存在显著的报告偏倚风险。摘要通常比正文显示更好的结果。

这些细胞的应用应由目标疾病的病理生理学指导。它必须遵循监管框架，以确保安全有效的使用。虽然基于外泌子的策略显示出理论上的希望，但它们尚未成为标准护理。您的外科医生将根据今天已证明和安全的内容为您提供指导。

预期情况

干细胞注射治疗膝关节磨损性关节炎仍处于积极研究阶段。目前尚无足够证据支持将这些注射纳入常规临床实践。您的外科医生可能会在严格的试验中继续研究这些疗法，以更好地了解其作用。

间充质干细胞是骨科和创伤护理领域日益关注的焦点。这些细胞在临床实践中的应用需符合政府卫生法规。其使用应遵循严格的监管框架，以确保安全性和有效性。这些细胞的应用必须由您关节疾病的具体性质来指导。

如果您患有创伤后关节炎，治疗时机至关重要。注射时间与治疗效果之间存在显著相关性。对于部分患者，在受伤后第 7 天和第 14 天可观察到最佳疗效。一些研究将富血小板血浆与脂肪来源的间充质干细胞联合使用。这种组合显示出增强的治疗功效，并作为一种治疗选择具有潜力。

对于伴有炎症的中重度膝骨关节炎，脐带来源的间充质干细胞注射似乎安全且有效。在随访结束时，您可能会看到临床改善。中重度疼痛患者往往表现出尤为明显的改善。

其他方法，如骨髓抽吸浓缩物，其结果存在矛盾。目前尚无法判断其是否优于其他骨生物制剂疗法。研究还探索动员您自身的干细胞或使用外泌体。这些发现为未来疗法提供了理论依据。

请注意，当前试验存在显著的报告偏倚风险。这些试验的摘要通常比正文报告的结果更为积极。这意味着您需要谨慎管理预期。结果因人而异，且证据尚不足以保证成功。您的外科医生将帮助您根据具体需求权衡这些不确定性。

Reviewed by Kieran Hirpara · 13 June 2026.

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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

  • There is insufficient evidence to recommend stem cell injections in clinical practice for osteoarthritis of the knee at this time [1].
  • Stem cell injections for osteoarthritis of the knee should continue to be studied in rigorous trials [1].
  • Mesenchymal stem cell injections represent a growing area of research in traumatology and orthopaedics [2].
  • There is a significant risk of reporting bias in randomized controlled trials and clinical trials of mesenchymal stromal cells for the treatment of knee osteoarthritis, with abstracts showing a significantly higher proportion of significant P values compared to main texts [9].
  • The superiority of bone marrow aspirate concentrate over other orthobiologic treatments for knee osteoarthritis cannot be assessed given the conflicting results presently available [6].
  • Mesenchymal stem cells have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations [5].
  • The application of mesenchymal stem cells in clinical practice should be guided by the pathophysiology of the target disease [5].
  • The application of mesenchymal stem cells in clinical practice should follow regulatory frameworks to ensure safe and effective use [5].
  • The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for posttraumatic osteoarthritis, with the best effects observed on days 7 and 14 after anterior cruciate ligament transection in a rat model [3].
  • The combination of adipose-derived mesenchymal stem cells and platelet-rich plasma demonstrated enhanced therapeutic efficacy for the treatment of osteoarthritis [4].
  • Intra-articular injection of umbilical cord-derived mesenchymal stem cells is safe and effective for moderate to severe knee osteoarthritis with synovitis [7].
  • Treatment with umbilical cord-derived mesenchymal stem cells showed clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • Endogenous mesenchymal stromal cells can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1 [8].
  • Mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis [10].
  • Findings regarding mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes provide a theoretical rationale for the development of exosome-based therapeutic strategies against osteoarthritis [10].
  • These findings identify promising therapeutic targets for the development of exosome-based therapeutic strategies against osteoarthritis [10].

How It Works

  • There is insufficient evidence to recommend stem cell injections in clinical practice at this time [1].
  • Stem cell injections should continue to be studied in rigorous trials [1].
  • Mesenchymal stem cell (MSC) injections represent a growing area of research in traumatology and orthopaedics [2].
  • MSC application in clinical practice should be guided by the pathophysiology of the target disease [5].
  • MSC application in clinical practice should follow regulatory frameworks to ensure safe and effective use [5].
  • The superiority of bone marrow aspirate concentrate (BMAC) over other orthobiologic treatments cannot be assessed given conflicting results [6].
  • Treatment with umbilical cord-derived mesenchymal stem cells (UC-MSCs) is a viable therapeutic option for knee osteoarthritis (KOA) combined with synovitis [7].
  • UC-MSC treatment shows clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • The combination of platelet-rich plasma (PRP) and adipose-derived stem cells (ADSCs) demonstrates enhanced therapeutic efficacy for osteoarthritis [4].
  • Endogenous MSCs can be pharmacologically mobilized into peripheral blood [8].
  • Endogenous MSCs can be recruited to the site of rotator cuff repair via local delivery of MCP-1 [8].
  • MSC-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis [10].
  • Local delivery of MSC-derived extracellular vesicles (MSC-EVs) embedded within an injectable collagen scaffold enhances tendon regeneration in a rat model of collagenase-induced tendinopathy [11].
  • Local application of BMAC without appropriate carriers could not enhance bone-tendon interface healing in a rabbit model of chronic rotator cuff tear [12].
  • Adipose-derived stem cell (ASC) interactions with the immune system are complex [13].
  • ASC secretome may be a well-tolerated treatment for osteoarthritis, though further studies are needed to determine its potential therapeutic benefits [13].
  • Hypoxic MSCs might exert therapeutic effects mediated by stimulating TGF-β [16].
  • Hypoxic MSCs promote the expression of COL II [16].
  • Hypoxic MSCs inhibit the expression of COL X [16].

What the Evidence Shows

  • Spin bias was present in most mesenchymal stromal cell-related trials for knee osteoarthritis, with a higher frequency among trials that utilized adipose-derived mesenchymal stem cells [14].
  • Mesenchymal stem cells have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations, but their application should be guided by the pathophysiology of the target disease and follow regulatory frameworks to ensure safe and effective use [5].
  • The combination of platelet-rich plasma and adipose-derived stem cells demonstrated enhanced therapeutic efficacy for the treatment of osteoarthritis [4].
  • Treatment with umbilical cord-derived mesenchymal stem cells was shown to be a viable therapeutic option for knee osteoarthritis combined with synovitis, showing clinical improvement at the end of follow-up, especially in those with moderate to severe pain [7].
  • Local delivery of mesenchymal stem cell-derived extracellular vesicles embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy [11].
  • Local application of bone marrow aspirate concentrate without appropriate carriers could not enhance bone-tendon interface healing in a rabbit model of chronic rotator cuff tear [12].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation [15].
  • Arthroscopic surgical repair combined with mesenchymal stem cell augmentation reported better structural outcomes compared to isolated surgical repair for rotator cuff tears [17].

Practical Considerations

  • The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for posttraumatic osteoarthritis [3].
  • The best effects of stem cell treatment for posttraumatic osteoarthritis are observed on days 7 and 14 after anterior cruciate ligament transection [3].
  • The combination of platelet-rich plasma and adipose-derived mesenchymal stem cells demonstrated enhanced therapeutic efficacy for osteoarthritis [4].
  • The application of mesenchymal stem cells should be guided by the pathophysiology of the target disease [5].
  • The application of mesenchymal stem cells should follow regulatory frameworks to ensure safe and effective use [5].
  • The superiority of bone marrow aspirate concentrate over other orthobiologic treatments cannot be assessed given the conflicting results presently available [6].
  • Treatment with umbilical cord-derived mesenchymal stem cells is a viable therapeutic option for knee osteoarthritis combined with synovitis [7].
  • Umbilical cord-derived mesenchymal stem cell treatment showed clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • There is a significant risk of reporting bias in randomized controlled trials and clinical trials of mesenchymal stromal cells for the treatment of knee osteoarthritis [9].
  • Abstracts of mesenchymal stromal cell trials for knee osteoarthritis show a significantly higher proportion of significant P values compared to main texts [9].
  • Spin bias was present in most mesenchymal stromal cell-related trials for knee osteoarthritis [14].
  • Spin bias had a higher frequency among trials that utilized adipose-derived mesenchymal stem cells [14].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate appeared to be safe [15].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate produced favorable clinical outcomes up to 2 years postoperation [15].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate had no quantifiable effect on graft maturation [15].
  • Adipose-derived stem cell interactions with the immune system are complex [13].
  • The secretome of adipose-derived stem cells may be a well-tolerated treatment for osteoarthritis [13].
  • Further studies are needed to determine the potential therapeutic benefits of adipose-derived stem cell secretome [13].

Key Evidence

  • [L1] There is insufficient evidence to recommend stem cell injections in clinical practice at this time, but they should continue to be studied in rigorous trials. [1] (10.1097/corr.0000000000003593)
  • [L2] MSC injections represent a growing area of research in traumatology and orthopaedics. [2] (10.1186/s12891-025-09123-8)
  • [L5] The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for PTOA, with the best effects observed on days 7 and 14 after ACLT. [3] (10.1177/03635465251326499)
  • [L5] The combination of PRP and ADSCs demonstrated enhanced therapeutic efficacy, suggesting its potential as a treatment option for OA. [4] (10.1186/s13018-024-05396-2)
  • [L5] Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations, but their application should be guided by the pathophysiology of the target disease and follow regulatory frameworks to ensure safe and effective use. [5] (10.1530/eor-2026-0056)
  • [L2] However, the superiority of BMAC over other orthobiologic treatments cannot be assessed given the conflicting results presently available. [6] (10.1186/s13018-025-06509-1)
  • [L1] Treatment with UC-MSCs was shown to be a viable therapeutic option for KOA combined with synovitis, showing clinical improvement at the end of follow-up, especially in those with moderate to severe pain. [7] (10.1186/s12891-025-09440-y)
  • [L5] Endogenous MSCs can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1. [8] (10.1177/03635465251341439)
  • [L2] The study highlights a significant risk of reporting bias in RCTs and CTs of MSCs for the treatment of knee OA, with abstracts showing a significantly higher proportion of significant P values compared to main texts. [9] (10.1177/23259671251374306)
  • [L5] These findings provide a theoretical rationale and identify promising therapeutic targets for the development of exosome-based therapeutic strategies against OA. [10] (10.1186/s13018-026-06765-9)
  • [L5] Local delivery of MSC-EVs embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy. [11] (10.1177/03635465261421555)
  • [L5] Local application of BMAC without appropriate carriers could not enhance bone-tendon interface healing. [12] (10.1177/03635465241313124)
  • [L5] This study highlights the complexity of ASC interactions with the immune system, while secretome may be a well-tolerated treatment, further studies are needed to determine its potential therapeutic benefits. [13] (10.1186/s12891-025-08642-8)
  • [L2] Spin bias was present in most MSC-related trials for knee osteoarthritis, with a higher frequency among those that utilized adipose-derived MSCs. [14] (10.1177/03635465241274155)
  • [L4] This case series demonstrated that augmenting hamstring allograft ACL reconstruction with an amnion collagen matrix and injecting BMAC appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation. [15] (10.1016/j.asmr.2025.101209)
  • [L5] Hypoxic MSCs might exert therapeutic effects mediated by stimulating TGF-β and subsequently promote and inhibit the expressions of COL II and COL X respectively. [16] (10.1186/s13018-025-06184-2)
  • [L1] Arthroscopic surgical repair combined with MSC augmentation reported better structural outcomes compared to isolated surgical repair for RCT. [17] (10.1016/j.jseint.2025.03.017)

References

[1] Cochrane in CORR ®: Stem Cell Injections for Osteoarthritis of the Knee. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003593

[2] Mesenchymal stem cells injections in traumatology and orthopaedics: common practice or still a promising area with many uncertainties?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09123-8

[3] Days 7 to 14 May Represent an Optimal Window for Stem Cell–Based Treatment in a Rat Model of Anterior Cruciate Ligament Transection–Induced Posttraumatic Osteoarthritis. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251326499

[4] Adipose-derived mesenchymal stem cells combined with platelet-rich plasma are superior options for the treatment of osteoarthritis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05396-2

[5] Clinical application of mesenchymal stem cells in orthopaedics and traumatology in daily practice. EFORT Open Reviews. 2026. DOI: 10.1530/eor-2026-0056

[6] Progress in the clinical use of bone marrow aspirate concentrate for knee osteoarthritis: an expert opinion. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06509-1

[7] Intra-articular injection of umbilical cord–derived mesenchymal stem cells is safe and effective for moderate to severe knee osteoarthritis with synovitis: a double‑blinded and randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09440-y

[8] Pharmacologic Mobilization and Chemokine-Directed Recruitment of Mesenchymal Stromal Cells to the Surgically Repaired Rotator Cuff. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251341439

[9] Analysis of

        <i>P</i>
        Values in the Abstract Compared With the Main Text of Randomized Controlled Trials and Clinical Trials of Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis. *Orthopaedic Journal of Sports Medicine*. 2025. DOI: 10.1177/23259671251374306

[10] Mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06765-9

[11] Regenerative Effect of Injectable Collagen Loaded With Mesenchymal Stem Cell–Derived Extracellular Vesicles in a Collagenase-Induced Tendinopathy Rat Model. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261421555

[12] Bone Marrow Aspirate Concentrate Combined With an Appropriate Carrier Effectively Promotes Bone-Tendon Interface Healing in a Rabbit Model of Chronic Rotator Cuff Tear. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241313124

[13] Impact of adipose-derived mesenchymal stem cells and their secretome on osteoarthritis in a rat model. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08642-8

[14] Evaluation of Spin in Clinical Trials of Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241274155

[15] Augmenting an Allograft for Anterior Cruciate Ligament Reconstruction With a Collagen Matrix and Bone Marrow Aspirate Concentrate Injection Appears Safe and Produces Favorable Clinical Outcomes at 2‐Year Follow‐Up. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101209

[16] Roles of TGF-β in the therapeutic potential of hypoxic mesenchymal stem cells for treating osteoarthritis in a Rabbit model. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06184-2

[17] Combined arthroscopic rotator cuff repair with mesenchymal stem cell augmentation shows similar functional outcomes but a higher structural integrity rate compared with isolated repair: a meta-analysis of comparative studies. JSES International. 2025. DOI: 10.1016/j.jseint.2025.03.017

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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.