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肱二头肌远端腱修复术

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肱二头肌远端肌腱断裂手术修复后的早期保护性活动康复计划，允许从第一天起进行舒适的活动，同时在力量分阶段重建之前，保护修复部位免受抗阻提举的影响。

肱二头肌远端肌腱通过皮质按钮重新固定于肘部桡骨粗隆的示意图。
远端二头肌腱已重新附着于肘部桡骨上的骨性附着点。 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。

本方案由基兰·希尔帕拉（Kieran Hirpara）医生指导，用于您在 Mater Private Hospital Rockhampton 接受断裂远端肱二头肌腱手术修复后的康复。方案首先介绍您的家庭锻炼计划，随后是为您的物理治疗师或手部治疗师制定的结构化临床方案。请在首次治疗访视时携带此页面或其 PDF 文件，以确保您的康复过程协调一致。您的治疗师可能会根据您的康复进展调整该计划。

如果您对术后伤口有任何疑虑，请联系诊所。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。

预期情况

肱二头肌远端肌腱是将肱二头肌锚定在肘前下方桡骨上的索状结构。当该肌腱断裂时，会重新固定于其在桡骨上的骨性附着点。Hirpara 医生使用皮质按钮（cortical button）进行修复，这是一种小型且牢固的固定装置，可在肌腱愈合过程中将其牢固地固定在骨面上。

由于这是一种强固的修复，康复计划侧重于舒适的早期活动，而非严格的制动。您将佩戴简单的悬吊带约 6 周（而非铰链式肘部支具），并从第一天起鼓励将肘关节活动至完全舒适的范围，包括伸直肘关节。早期活动可防止肘关节僵硬，这是该手术后主要的问题之一。

修复的强度特意用于支持这种早期活动。但这并不意味着可以早期负重。肌腱在生物学上仍需重新长回骨面，正是这种愈合过程能防止再次断裂。因此，手臂负重（提举、用力握持及抗阻力量训练）需推迟至约 4 个月，然后以轻微负荷开始并逐渐增加。悬吊带主要用于舒适及提醒避免手臂过度用力；在进行锻炼和洗漱时可取下。

关于伤口、肿胀和瘢痕管理，请参阅诊所的伤口护理指南。

注意事项与限制

应做

  • 从术后第一天起，在舒适范围内活动肘部、前臂、手腕和手部，包括屈曲、伸展及前臂旋转。
  • 进行锻炼和保持卫生时取下吊带；在其余时间佩戴吊带以提供舒适和保护，持续约6周。
  • 在舒适范围内，使用患肢进行极轻的日常活动（如进食、轻度自我护理）。

不应做

  • 在术后约4个月经医生许可前，禁止用患肢提举、搬运、紧握或进行任何抗阻力量训练。这是最重要的注意事项。
  • 禁止在负重情况下突然、剧烈地伸直肘部，并避免用力或猛烈的动作。
  • 早期禁止将肩关节过度伸展至过伸位，因为这会牵拉肘前侧正在愈合的伤口。

您的锻炼

这些是您讲义中的锻炼方法，用于在早期几周保持肘部、前臂和手部的活动。做这些锻炼时请取下吊带。仅在不引起不适的范围内活动，并按照Hirpara医生和治疗师的指导开始。两项力量强化锻炼将在稍后阶段引入：只有在约4个月时经批准可以开始负重后才进行。

您的临床方案

本页面其余部分为皮质纽扣式远端肱二头肌腱修复术后的康复临床方案。本节内容将提供给您的物理治疗师或手治疗师，以下每个阶段均以通俗易懂的语言解释当前阶段的治疗目的。

指导原则是早期无痛活动，延迟负重：皮质纽扣系统足够坚固，允许从第一天起进行无限制的活动，因此无需使用铰链式支具或伸展限制装置。利用该系统的坚固性来防止关节僵硬，而非作为早期负重的理由；为保护肌腱-骨愈合并最大限度地降低再断裂风险，抗阻强化训练和提重物被刻意推迟。

第一阶段——保护性舒适活动（第0周至第6周）

佩戴简易吊带以提供舒适感并提醒避免过度使用；在进行锻炼和卫生清洁时需取下。目标是维持舒适且接近全范围的活动度，同时保护修复部位免受任何负荷。

供您物理治疗师参考：

  • 固定： 使用简易吊带固定6周，进行锻炼和卫生清洁时取下。不使用铰链式支具；不使用伸展限制块。
  • 活动度： 从第1天起，在舒适范围内进行所有活动：主动和被动肘关节屈曲、伸展及前臂旋转。无活动弧限制，无伸展限制块。
  • 目标： 维持舒适的全范围活动度；保护修复部位免受负荷；保持手、腕和肩部的活动性。
  • 锻炼： 主动肘关节屈曲/伸展至舒适范围；辅助（被动）肘关节屈曲；肘部紧贴身体侧面进行前臂旋前/旋前主动活动；手、腕及握力活动；肩胛骨和肩关节活动度训练。禁止进行肱二头肌或旋后肌的抗阻负荷训练。
  • 注意事项： 禁止提举、抓握或抗阻力量训练；避免在负荷下突然进行强制性的离心性伸展；避免肩关节过伸。
  • 进阶标准： 伤口愈合，获得舒适且接近全范围的活动度，第6周时脱离吊带。

第二阶段——完全活动度，无负重（第6周至约4个月）

停止使用悬吊带。手臂可自由用于日常轻度活动，但禁止抗阻负荷或提举：肌腱仍在向骨骼愈合成熟，此阶段虽活动度安全，但需格外注意避免负荷。

物理治疗师须知：

  • 目标： 达到完全对称且无痛的活动度；手部及手臂恢复正常轻度功能使用。
  • 活动度/使用： 在舒适范围内实现完全活动度；日常轻度使用，不进行抗阻负荷或提举。
  • 练习： 继续进行活动度训练；手部、腕部及握力练习；肩胛骨及肩部强化训练。目前禁止进行肱二头肌或旋后肌的抗阻负荷训练。
  • 进阶标准： 完全无痛的活动度；伤口及修复处愈合稳定→约4个月时开始分级负荷训练。

第三阶段——强化与渐进负荷（约4至6个月）

开始负荷训练。引入肘关节屈曲和前臂旋前的轻度抗阻强化训练，并逐步增加负荷，直至满足功能性需求，进而达到工作或运动专项需求。

致您的物理治疗师：

  • 目标： 重建屈曲和旋前力量；重返工作和运动。
  • 练习： 在约4个月时开始轻度抗阻强化和负重训练；逐步进阶（等张弯举和抗阻旋前→功能性模式→工作和运动专项负荷）。
  • 进阶标准： 无痛性抗阻屈曲和旋前；力量接近对侧。

重返工作与活动

在最初的6周内，请仅使用吊带保护下的手臂进行轻松、舒适的日常任务。早期通常可以进行轻量的桌面工作或单手作业；较重的或需要双手的体力劳动需等到开始负重并逐步增加后才能进行。

关键里程碑如下：

  • 早期数月内禁止提举和抗阻负重： 这是刻意为之，以使肌腱愈合于骨面。
  • 约4个月时开始轻负荷提举和强化训练： 从轻柔开始，每周逐步推进。
  • 约6个月时活动不受限并恢复运动： 前提是满足以下条件：无痛的全范围关节活动度，力量达到健侧的至少90–100%，并能耐受您工作或运动的具体需求。

佩戴吊带期间严禁驾驶。经复查确认您已摘下吊带并能舒适、安全地操控车辆后，方可恢复驾驶。请始终遵循Hirpara医生的具体建议，因为时间安排可能因您工作和运动的需求而异。

您的康复方案之后

本方案与诊所的一般术后恢复建议配合使用；请参阅术后疼痛管理和伤口护理。上述分阶段计划与肱二头肌远端肌腱修复术后康复的已发表证据一致，您的持续康复将由您的物理治疗师或手治疗师根据您肘部的进展情况个体化指导。

Reviewed by Dr Kieran Hirpara · 18 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Distal Biceps Tendon Repair — Post-operative Rehabilitation (Evidence)

Topic scope: Post-operative rehabilitation after surgical repair of a ruptured distal biceps tendon reattached to the radial tuberosity with cortical-button fixation. The protocol here reflects Dr Hirpara's practice — a sling-only, early-comfort-motion approach with deliberately delayed loading — set against the published spectrum of distal-biceps rehabilitation protocols.

Defining principle: Cortical-button fixation is the strongest available construct, and biomechanical and clinical evidence show it tolerates immediate motion safely. Dr Hirpara's stance is to spend that strength on early movement, not early loading: a simple sling for 6 weeks (no hinged brace, no extension block) with all motion to comfort from day 1 including extension, but with resisted strengthening and lifting held back until ~4 months to protect tendon-to-bone healing and minimise re-rupture, and unrestricted activity / return to sport at ~6 months on criterion-based clearance. This sits at the protective end of loading while matching the most current thinking on early motion for stiffness prevention.

Where this protocol sits in the evidence

Published distal-biceps protocols span a wide range, from rigid hinged-brace extension-block schemes to immediate unrestricted motion. Dr Hirpara's plan diverges from the "traditional" template in two deliberate ways:

  1. Immobilisation: A simple sling for comfort, not a hinged ROM brace, and no extension block. Motion is unrestricted to comfort from day 1. The mainstream BWH/MGB protocols instead use a posterior splint at 90° for 5–7 days, then a hinged brace with a 45°→30° extension block opened ~10°/week to full extension by ~6 weeks (or ~3 weeks in the accelerated variant). Dr Hirpara's approach is at the early-motion end and is justified by the strength of the cortical-button construct.
  2. Loading: Resisted strengthening and lifting are deferred to ~4 months. This is more conservative than the published loading timelines (accelerated resisted work at week 6; standard/MGB at weeks 8–10–12; light weights weeks 12–14). Crucially, this conservatism is a choice made despite having the construct that would permit earlier loading.

The endpoint — unrestricted activity / return to sport at ~6 months, criterion-based — is the single most commonly cited endpoint across protocols and matches the mainstream consensus.

Key evidence and controversies

  1. Early/immediate motion is safe with modern fixation. (Moderate) Biomechanical work supports immediate motion: Bisson et al (AJSM 2007) found aggressive rehabilitation safe after the modified 2-incision approach, and Rose et al (KSSTA 2010) showed single-incision EndoButton/FiberWire repairs survive 2,000 immediate-motion cycles. Several series report no increased re-rupture with immediate post-operative motion. This underpins the sling-only, motion-to-comfort approach.

  2. Cortical-button strength enables early motion. (Moderate) Cortical-button (± interference screw) fixation has the highest load-to-failure of the available constructs (Olsen JSES 2014; Spang JSES 2006; Lang OTSR 2018 — comparable functional outcomes across constructs but higher load-to-failure for cortical button). Spencer/Edwin (HAND 2008) argued EndoButton fixation strength may allow earlier ROM. This fixation strength is the explicit rationale for permitting immediate movement.

  3. Mobilisation timing may not change outcome. (Moderate) A retrospective comparison found no clinically significant difference in failure, complications, ROM or patient-reported outcomes for early versus delayed mobilisation after primary distal biceps repair. This undercuts the urgency of accelerating loading and supports a measured progression.

  4. Conservative rehab may lower re-rupture. (Consensus / survey) Rosenthal/Ting/Sher (JSES 2023), a survey of fellowship-trained elbow surgeons, suggests more conservative post-operative rehab may be associated with lower re-rupture risk — a direct counterweight to the accelerated-loading trend and the rationale for deferring loading to ~4 months. Phelps et al (JSES Int 2025, Level IV systematic review) found no consensus on the optimal return-to-sport protocol, with protocols ranging from immobilisation to immediate motion.

  5. Tendon elongation in the mid window. (Moderate) Marshall et al (OJSM 2016, radiostereometric) showed the repaired tendon elongates mostly at 4–8 weeks post-op with minimal change at 8–16 weeks — a biomechanical argument for caution against aggressive loading in that mid window even when motion itself is safe.

  6. Incision and complications. (Moderate) Grewal et al RCT (JHS 2010): no overall functional difference single vs double incision (flexion strength slightly greater with two-incision, more minor complications with single-incision). Amarasooriya systematic review (AJSM 2020): synostosis occurred only with double incision; fixation technique did not significantly affect re-rupture. Incision choice mainly drives complication-avoidance precautions, not the ROM timeline. Re-rupture rates overall are low (0–5.6%; Garon & Greenberg 2016).

Phased rehabilitation timeline (this protocol)

Phase Window Sling / brace ROM / use Strengthening / loading Criteria to progress
I — Protected comfort motion Week 0 → 6 Simple sling 6 wk, off for exercises/hygiene. No hinged brace, no extension block All motion to comfort from day 1 — active + passive flexion, extension and forearm rotation. No arc restriction None. No resisted biceps/supination loading; hand/wrist/grip and scapular/shoulder ROM maintained Wound healed; comfortable near-full ROM; out of sling at 6 wk
II — Full motion, unloaded Week 6 → ~4 mo Sling off Full symmetric pain-free ROM; light everyday use None yet — light functional use without resisted loading or lifting Full painless ROM; wound/repair settled → begin loading ~4 mo
III — Strengthening & graded loading ~4 → 6 mo — Full ROM maintained Start LIGHT resisted strengthening / lifting at ~4 mo; progress gradually (isotonic curls + resisted supination → functional → job/sport-specific) Pain-free resisted flexion/supination; strength approaching the other side
Return to activity ~6 mo — Unrestricted Unrestricted activity / return to sport, criterion-based Full painless ROM; strength ≥90–100% of the other side; tolerance of job/sport-specific demands

One-line summary: simple sling 6 weeks with all motion to comfort from day 1 (no brace, no extension block) → full unloaded motion to ~4 months → light resisted loading from ~4 months → unrestricted activity / sport at ~6 months, criterion-based.

Evidence strength flags

  • MODERATE (biomechanical + cohort): safety of immediate/early motion with cortical-button fixation (Bisson 2007; Rose 2010; Olsen 2014; Spang 2006; Lang 2018); no clinically significant difference early vs delayed mobilisation; low overall re-rupture rates.
  • MODERATE (biomechanical): tendon elongation concentrated 4–8 weeks (Marshall 2016) — supports caution on mid-window loading.
  • CONSENSUS / survey-level: more conservative rehab may lower re-rupture (Rosenthal 2023); no consensus on optimal return-to-sport protocol (Phelps 2025, Level IV). The specific phase timings of this protocol are expert/consensus-derived, not trial-derived.

Overall evidence strength: Moderate. Phased timelines rest on consistent institutional protocol consensus reinforced by biomechanical studies and retrospective cohorts; few prospective RCTs of the rehabilitation progression itself, and no consensus on the optimal return-to-sport protocol.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Grewal R, Athwal GS, MacDermid JC, et al. Single vs. double incision technique for the repair of distal biceps tendon ruptures: a randomized clinical trial. J Hand Surg Am. 2010.
  • Amarasooriya M, Bain GI, Roper T, et al. Complications after distal biceps tendon repair: a systematic review. Am J Sports Med. 2020.
  • Keener JD. Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Shoulder Elbow Surg. 2011;20(2):S113–S125.
  • Dunphy TR, Hudson J, Batech M, et al. Surgical treatment of distal biceps tendon ruptures: an analysis of complications in 784 surgical repairs. Am J Sports Med. 2017;45(13):3020–3029.
  • Bisson LJ, Gurske-de Perio J, Weber AE, et al. Is it safe to perform aggressive rehabilitation after distal biceps tendon repair using the modified 2-incision approach? A biomechanical study. Am J Sports Med. 2007.
  • Rose DM, Archibald JD, Sutter EG, et al. Biomechanical analysis suggests early rehabilitation is possible after single-incision EndoButton distal biceps repair with FiberWire. Knee Surg Sports Traumatol Arthrosc. 2010;19(6).
  • Marshall NE, Keller RA, Okoroha K, et al. Radiostereometric evaluation of tendon elongation after distal biceps repair. Orthop J Sports Med. 2016.
  • Phelps BM, Birnbrich A, Singer W, et al. Postoperative rehabilitation and return to sport criteria following distal biceps tendon rupture surgery. JSES Int. 2025. (Level IV systematic review: no consensus on optimal RTS rehabilitation.)
  • Rosenthal R, Ting RS, Sher D. Management of distal biceps tendon ruptures: a survey of fellowship-trained subspecialist elbow surgeons. J Shoulder Elbow Surg. 2023;32(10).
  • Olsen JR, Shields E, Williams RB, et al. A comparison of cortical button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs. J Shoulder Elbow Surg. 2014;23(11):1607–1611.
  • Spang JT, Weinhold PS, Karas SG. A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elbow Surg. 2006.
  • Lang NW, Bukaty A, Sturz GD, et al. Treatment of primary total distal biceps tendon rupture using cortical button, transosseous fixation and suture anchor: a single center experience. Orthop Traumatol Surg Res. 2018.
  • Edwin ES (Spencer EE Jr), Tisdale A, Kostka K, Ivy RE. Is therapy necessary after distal biceps tendon repair? HAND. 2008;3(4).
  • Rubinger L, Solow M, Johal H, et al. Return to work following a distal biceps repair: a systematic review of the literature. J Shoulder Elbow Surg. 2020;29(5):1002–1009.
  • Ford SE, Andersen JS, Macknet DM, et al. Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. J Shoulder Elbow Surg. 2018;27(10):1898–1906.
  • Cuzzolin M, Secco D, Guerra E, et al. Operative versus nonoperative management for distal biceps brachii tendon lesions: a systematic review and meta-analysis. Orthop J Sports Med. 2021.
  • Garon MT, Greenberg JA. Complications of distal biceps repair. Orthop Clin North Am. 2016. (Re-rupture 0–5.6%.)

Published rehabilitation protocols (web)

  • Brigham & Women's Hospital — Distal Biceps Tendon Repair Rehabilitation Protocol (standard). https://www.brighamandwomens.org/assets/BWH/patients-and-families/pdfs/elbow---distal-biceps-repair-protocol.pdf
  • Brigham & Women's Hospital — Distal Biceps Tendon Repair Accelerated Protocol. https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-accelerated-distal-biceps-repair-protocol-bwh.pdf
  • Mass General Brigham Sports Medicine — Rehabilitation Protocol for Distal Biceps Tendon Repair (rev. 10/2021). https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-distal-biceps-repair.pdf

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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.