Current Concepts| Volume 29, ISSUE 6, P1095-1100, June 2013

Assessment of the Quality and Content of Information on Anterior Cruciate Ligament Reconstruction on the Internet


      The Internet has become a major source of health information for the public. However, there are concerns regarding the quality, accuracy, and currency of medical information available online. We assessed the quality of information about anterior cruciate ligament (ACL) reconstruction on the first 60 websites returned by the 4 most popular search engines. Each site was categorized by type and assessed for quality and validity using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel ACL reconstruction–specific content score. The presence of the Health On the Net Code (HONcode), a purported quality assurance marker, was noted. The quality of information on ACL reconstruction available online is variable, with many websites omitting basic information regarding treatment options, risks, and prognosis. Commercial websites predominate. Academic and allied health professional websites attained the highest DISCERN and JAMA benchmark scores, whereas physician sites achieved the highest content scores. Sites that bore the HONcode seal obtained higher DISCERN and ACL reconstruction content scores than those without this certification. The HONcode seal is a reliable indicator of website quality, and we can confidently advise our patients to search for this marker.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Internet World Stats. Usage and population statistics. Available from: Accessed 4 Aug 2012.

      2. Fox S, Rainie L, Horrigan J, et al. The online health care revolution: How the Web helps Americans take better care of themselves. Pew Internet & American Life Project. Available from: Accessed August 4, 2012.

        • Stinson J.N.
        • Tucker L.
        • Huber A.
        • et al.
        Surfing for juvenile idiopathic arthritis: Perspectives on quality and content of information on the Internet.
        J Rheumatol. 2009; 36: 1755-1762
        • Bichakjian C.K.
        • Schwartz J.L.
        • Wang T.S.
        • Hall J.M.
        • Johnson T.M.
        • Biermann J.S.
        Melanoma information on the Internet: Often incomplete—a public health opportunity?.
        J Clin Oncol. 2002; 20: 134-141
        • Biermann J.S.
        • Golladay G.J.
        • Greenfield M.L.
        • Baker L.H.
        Evaluation of cancer information on the Internet.
        Cancer. 1999; 86: 381-390
        • Kaicker J.
        • Debono V.B.
        • Dang W.
        • Buckley N.
        • Thabane L.
        Assessment of the quality and variability of health information on chronic pain websites using the DISCERN instrument.
        BMC Med. 2010; 8: 59
        • Kunst H.
        • Groot D.
        • Latthe P.M.
        • Latthe M.
        • Khan K.S.
        Accuracy of information on apparently credible websites: Survey of five common health topics.
        BMJ. 2002; 324: 581-582
        • Lee C.T.
        • Smith C.A.
        • Hall J.M.
        • Waters W.B.
        • Biermann J.S.
        Bladder cancer facts: Accuracy of information on the Internet.
        J Urol. 2003; 170: 1756-1760
        • Meric F.
        • Bernstam E.V.
        • Mirza N.Q.
        • et al.
        Breast cancer on the World Wide Web: cross sectional survey of quality of information and popularity of websites.
        BMJ. 2002; 324: 577-581
        • Nason G.J.
        • Baker J.F.
        • Byrne D.P.
        • Noel J.
        • Moore D.
        • Kiely P.J.
        Scoliosis-specific information on the internet: Has the “information highway” led to better information provision?.
        Spine. 2012; 37: E1364-E1369
        • Silberg W.M.
        • Lundberg G.D.
        • Musacchio R.A.
        Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor—Let the reader and viewer beware.
        JAMA. 1997; 277: 1244-1245
        • Starman J.S.
        • Gettys F.K.
        • Capo J.A.
        • Fleischli J.E.
        • Norton H.J.
        • Karunakar M.A.
        Quality and content of Internet-based information for ten common orthopaedic sports medicine diagnoses.
        J Bone Joint Surg Am. 2010; 92: 1612-1618
        • Schindler O.S.
        The story of anterior cruciate ligament reconstruction—Part 1.
        J Perioper Pract. 2012; 22: 163-171
        • Lyman S.
        • Koulouvaris P.
        • Sherman S.
        • Do H.
        • Mandl L.A.
        • Marx R.G.
        Epidemiology of anterior cruciate ligament reconstruction: Trends, readmissions, and subsequent knee surgery.
        J Bone Joint Surg Am. 2009; 91: 2321-2328
        • Gottlob C.A.
        • Baker Jr., C.L.
        • Pellissier J.M.
        • Colvin L.
        Cost effectiveness of anterior cruciate ligament reconstruction in young adults.
        Clin Orthop Relat Res. 1999; 367: 272-282
        • Cailliez J.
        • Reina N.
        • Molinier F.
        • Chaminade B.
        • Chiron P.
        • Laffosse J.M.
        Patient information ahead of anterior cruciate ligament reconstruction: Experience in a university hospital center.
        Orthop Traumatol Surg Res. 2012; 98: 491-498
        • Koh H.S.
        • In Y.
        • Kong C.G.
        • Won H.Y.
        • Kim K.H.
        • Lee J.H.
        Factors affecting patients' graft choice in anterior cruciate ligament reconstruction.
        Clin Orthop Surg. 2010; 2: 69-75
        • Charnock D.
        • Shepperd S.
        • Needham G.
        • Gann R.
        DISCERN: an instrument for judging the quality of written consumer health information on treatment choices.
        J Epidemiol Community Health. 1999; 53: 105-111
        • Boyer C.
        • Baujard V.
        • Geissbuhler A.
        Evolution of health web certification through the HONcode experience.
        Stud Health Technol Inform. 2011; 169: 53-57
      3. Search engine market share. Available from: Accessed 4 Aug 2012.

        • Delince P.
        • Ghafil D.
        Anterior cruciate ligament tears: Conservative or surgical treatment? A critical review of the literature.
        Knee Surg Sports Traumatol Arthrosc. 2011; 20: 48-61
        • Tjoumakaris F.P.
        • Herz-Brown A.L.
        • Bowers A.L.
        • Sennett B.J.
        • Bernstein J.
        Complications in brief: Anterior cruciate ligament reconstruction.
        Clin Orthop Relat Res. 2011; 470: 630-636
        • Bernstein J.
        • Ahn J.
        • Veillette C.
        The future of orthopaedic information management.
        J Bone Joint Surg Am. 2012; 94: e95
        • White R.W.
        • Horvitz E.
        Experiences with web search on medical concerns and self diagnosis.
        AMIA Annu Symp Proc. 2009; : 696-700
        • Tavare A.N.
        • Alsafi A.
        • Hamady M.S.
        Analysis of the quality of information obtained about uterine artery embolization from the internet.
        Cardiovasc Intervent Radiol. 2012; 35: 1355-1362
        • Beredjiklian P.K.
        • Bozentka D.J.
        • Steinberg D.R.
        • Bernstein J.
        Evaluating the source and content of orthopaedic information on the Internet. The case of carpal tunnel syndrome.
        J Bone Joint Surg Am. 2000; 82-A: 1540-1543
      4. American Academy of Orthopaedic Surgeons. Orthoinfo. Your connection to expert orthopaedic information. Available from: Accessed August 10, 2012.

        • Badarudeen S.
        • Sabharwal S.
        Assessing readability of patient education materials: Current role in orthopaedics.
        Clin Orthop Relat Res. 2010; 468: 2572-2580

      Linked Article

      • Evaluation of Information Available on the Internet Regarding Anterior Cruciate Ligament Reconstruction
        ArthroscopyVol. 29Issue 6
        • Preview
          Searching the Internet is one of the most popular methods for acquiring information related to health. The Internet offers physicians and patients easy access to a wide range of medical material from anywhere in the world. For many patients, this information helps formulate decisions related to their health and health care. An important caveat is that virtually anything can be published on the Internet. Although academic publications require rigorous peer review, Internet websites have no regulatory body monitoring quality and content.
        • Full-Text
        • PDF