title: Internet resources for Tommy John injuries: what are patients reading?
abstract: BACKGROUND
  The quality of medical information on the Internet has come under scrutiny. This study investigates the quality, accuracy, and readability of online information regarding ulnar collateral ligament (UCL) injuries.
  
  
  METHODS
  Three search terms ("elbow ulnar collateral ligament injury," "tommy john injury," and "pitcher's elbow") were entered into 3 Internet search engines. Three independent reviewers evaluated the content and accuracy of the information with a set of predetermined scoring criteria. Website quality was further assessed by the Journal of the American Medical Association benchmark criteria and Health on the Net Foundation certification. Website readability was ascertained with the Flesch-Kincaid score.
  
  
  RESULTS
  We evaluated 113 unique websites. The average quality for all websites was 8.88 ± 6.8 (maximum, 32 points). Website quality and accuracy were lower with use of the search term "pitcher's elbow" as compared with "elbow ulnar collateral ligament injury" or "tommy john injury" (P ≤ .001). Sites certified by the Health on the Net Foundation had higher quality scores than non-certified sites (P = .034). The mean reading grade level was 10.7. Reading level was significantly correlated with website accuracy and quality (P ≤ .001) and physician authorship (P = .012). Forty-three websites (38.1%) described surgical reconstruction; of these, 16 (37.2%) mentioned improved pitching performance postoperatively.
  
  
  CONCLUSIONS
  Online information on UCL injuries is often inaccurate and written at an inappropriate reading level. Information quality depends on the search term used, website authorship, and commercial bias. Clinicians must be aware of factors influencing website quality in order to direct patients to appropriate resources.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA. Electronic address: johnsonc@hss.edu.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Johnson
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Garcia
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Liu
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Stepan
authors.affiliation: Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Ronak M
authors.initials: RM
authors.lastname: Patel
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
mesh_terms: D000070637:Collateral Ligament, Ulnar / Q000293:injuries*; D032882:Comprehension; D054626:Consumer Health Information; D057220:Health Literacy; D006801:Humans; D020407:Internet; D011786:Quality Control; D057386:Search Engine
keywords: Internet; Tommy John; health literacy; online education; patient education; readability; ulnar collateral ligament