Online Patient Education Resources for Anterior Cruciate Ligament Reconstruction: An Assessment of the Accuracy and Reliability of Information on the Internet Over the Past Decade

Purpose: The purpose of this study is to evaluate the quality of patient education materials accessible through popular online search engines regarding anterior cruciate ligament (ACL) injuries and anterior cruciate ligament reconstruction (ACLR). Methods: Two search terms ("ACL surgery" and "ACL reconstruction") were entered into three search engines (Google, Yahoo, and Bing). The quality of information was scored using a novel scoring system developed and overseen by sports medicine orthopedic clinical research fellows and fellowship-trained orthopedic surgeons. Website quality, credibility, and readability were further assessed by the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria, and Flesch-Kincaid Reading Grade Level (FKRGL), respectively. The Health On the Net Code of Conduct (HONcode) certification was also utilized to assess the transparency of health information for each website. Results: We evaluated 39 websites. The average score for all websites was 11.2 +/- 5.6 out of 28 total points. Six out of the 39 websites (41%) were HONcode certified. The websites that contained HONcode certification had a higher average JAMA benchmark score (3.5 +/- 0.7) and DISCERN score (44.6 +/- 14.7) when compared to the websites without the certification, 2.2 +/- 1.2 and 37.6 +/- 15.9 for JAMA and DISCERN, respectively. The mean JAMA benchmark score was 2.7 +/- 1.2 (67.5%) for all websites out of a possible four points. The average FKRGL for all 39 websites was 10.0 +/- 2.0 (range: 5.4-13). Conclusion: The quality of patient education materials accessible on the internet regarding ACL injuries and ACLR can be misleading and directly impact the patient's decision-making process essential to the patient physician relationship over the past decade. Clinical Relevance: The internet can be a helpful online resource, however, surgeon clarification and consultation with qualified healthcare professionals are strongly recommended prior to clinical decision making regarding potential treatment options.