Peter J. Millett, M.D., M.Sc., Brandon T. Goldenberg, B.A., William W. Schairer, M.D., Travis J. Dekker, M.D., and Lucca Lacheta, M.D.



The purpose of this study was to use a novel scoring system to evaluate the content and grade the quality of websites that patients may use to learn about rotator cuff repair.


Two search terms (“rotator cuff repair” and “rotator cuff surgery”) were entered into 3 Internet search engines (Google, Yahoo, and Bing). We scored the quality of information using a novel scoring system. Website quality was further assessed by the Journal of the American Medical Association (JAMA) benchmark criteria and Health on the Net Foundation (HON) code certification. The readability of the websites was evaluated with the Flesch-Kincaid score.


We evaluated 47 websites. The average quality for all websites was 6.47 ± 5.21 (maximum 20 points). There was a large difference in scores between the top 5 websites and the remaining websites (16.30 vs 5.51, P < .001). There was no difference in scores when comparing the 3 different search engines (P = .85). The mean reading level was 10.17 ± 2.24. Reading level was not significantly correlated with quality (rs = 0.14, P = .36). The average JAMA benchmark criteria score for all websites was 2.34 ± 1.11 (maximum 4 points). JAMA criteria score was not significantly correlated with quality (rs = 0.02, P = .91). Sites without HONcode certification had higher quality scores (8.33 ± 4.80) than sites with HONcode certification (6.18 ± 4.66), but this difference was not statistically significant (P = .15).


The quality of patient-level information on rotator cuff repair on the Internet is both incomplete and written at a reading level higher than current recommendations. Information quality is not significantly correlated with reading level or JAMA criteria, and does not depend on the search term used or HONcode certification.

Clinical Relevance

Patients having rotator cuff repair may seek information on the Internet; the information may require surgeon clarification.

For the complete study: Online Resources for Rotator Cuff Repair What are Patients Reading