Content Score General Aspects Management Complications Age Observation Infection Sex Physical therapy Graft failure Mechanisms Bracing Knee pain Functional disability Reconstruction : hamstring Degenerative knee Functional requirements Reconstruction : patellar tendon Meniscal injury Reconstruction

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 reconstructionespecific 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. hysicians should be cognizant of the information Ptheir patients are likely to be accessing online and be able to steer them to high-quality websites. The Internet’s exponential growth has triggered an information revolution, and it has evolved into a major source of health information for the public. More than 273 million Americans, representing 78.6% of the population, now have Internet access. More than half use the World Wide Web to obtain health or medical information, and the majority of them seek health information online at least once a month. However, although the Internet represents an unprecedented method of sharing and accessing knowledge, there are growing concerns about the quality and currency of the medical information available. Several studies have From the Department of Orthopaedic Surgery, St. James’s Hospital (R.A.B-B, F.B., N.A.H., T.M.); and Department of Orthopaedic Research, Orthopaedic esearch & Innovation Foundation (D.P.B), Dublin, Ireland. The authors report that they have no conflicts of interest in the authorship nd publication of this article. Received November 6, 2012; accepted February 1, 2013. Address correspondence to Robert A. Bruce-Brand, M.R.C.S.I., St James’s ospital, James’s St, Dublin 8, Ireland. E-mail: robbrucebrand@gmail.com 2013 by the Arthroscopy Association of North America 0749-8063/12726/$36.00 http://dx.doi.org/10.1016/j.arthro.2013.02.007 Arthroscopy: The Journal of Arthroscopic and Related S shown that many health sites contain misleading, inaccurate, and inappropriate information. Injury of the anterior cruciate ligament (ACL) is common in athletes, with an annual incidence of about 35 per 100,000 of the general population. It is one of the most commonly treated conditions of the knee. Estimated rates of ACL reconstruction exceed 175,000 per year in the United States. The Internet is an important source for patients seeking information about ACL reconstruction surgery. Cailliez et al. investigated patient knowledge ahead of ACL reconstruction and found that 40% of patients had researched on the Internet for surgery-related information. Koh et al. examined factors affecting patients’ graft choice in ACL reconstruction and found that the Internet was the most important contributor in 21.7% of cases. However, we are not aware of any study that has determined the quality of information about ACL reconstruction found on the Internet. The aim of this study, therefore, was to assess the quality of information about ACL reconstruction on the Internet using recognized scoring systems, identification of quality markers, and a novel specific score. Scoring systems included the Journal of the American Medical Association (JAMA) benchmark and DISCERN criteria. Initiatives such as the Health On the Net code (HONcode) identify websites that agree to comply with a code urgery, Vol 29, No 6 (June), 2013: pp 1095-110