YouTube A Poor Source of Information About Cartilage Restoration

Previous research has shown that patients often use online content to guide their treatment decisions, with up to 75% of individuals with chronic conditions reporting that their last internet search affected their treatment choices. One of the most popular platforms for patients is YouTube.

A team of researchers at Rush led by Brian J. Cole, MD, MBA, Acting Chair of the Department of Orthopaedic Surgery, assessed the accuracy, reliability and educational value of YouTube content on cartilage restoration.

“In the context of cartilage restoration — a field involving technically demanding and nuanced surgical procedures and decision making— patient understanding can significantly impact not only their expectations but also their clinical outcomes,” Dr. Cole says.

Building on previous health literacy research

Prior work from Dr. Cole’s team and other Rush investigators laid critical groundwork for this study by identifying gaps in patient health literacy, expectations and satisfaction regarding procedures like anterior cruciate ligament (ACL) reconstruction and articular cartilage injuries. A 2017 study by Cole, et al, highlighted misalignment between patient expectations and actual outcomes following ACL reconstruction. Later, a 2021 study by Cole, et al, explored knowledge deficits in patients considering cartilage surgery.

“These insights emphasized the need for accurate, accessible education to align patient understanding with reality, setting the stage for this more focused examination of digital content,” Dr. Cole says. “The transition from controlled clinical communication to open-access platforms like YouTube was a natural extension of this work.”

The study’s aim and methodology

Dr. Cole and his co-authors (including Zachary D. Meeker, Jason H. Kim, Alexander C. Weissman, Allen A. Yazdi, Kyle R. Wagner, Jared P. Sachs, Sarah A. Muth, Yusuf Mufti and Eric J. Cotter from Rush) analyzed 50 YouTube cartilage restoration videos using objective grading criteria: the Journal of the American Medical Association (JAMA) Benchmark Score, the Global Quality Scale (GQS) and a novel cartilage restoration-specific score developed by the Cole team (CR-SS). To assess the videos’ quality, the team examined variables such as video views, duration, source and content type.

Results

Cartilage restoration videos were popular, with an average of 86,980 views and cumulative totals of more than 4.3 million views, underscoring YouTube’s reach. When assessed using objective grading criteria, the videos were found to contain poor academic reliability and limited educational value. The mean JAMA score was 1.9/4, the Global Quality Score (GQS) was 2.4/5, and the CR-SS (content-specific score) was only 4.4/20.

Longer video duration was positively associated with higher GQS and CR-SS scores (P = .002 and P < .001, respectively). The mean duration was ~6 minutes (370.7 seconds), with better scores seen in longer videos (15 minutes or more). This extended duration likely allowed for a deeper dive into complex topics like indications, techniques and recovery, Dr. Cole explains.

Academic videos scored the highest in educational quality (mean GQS 2.8), outperforming commercial and general medical sources. “Surprisingly, videos from health websites or corporations were associated with worse quality, possibly due to over-commercialization or lack of depth,” Dr. Cole says.

However, even physician-produced videos had gaps. While physician videos performed relatively well (mean CR-SS 3.9), they missed about half of the 20 key elements deemed critical by CR-SS standards. “This suggests room for improvement in communicating full-spectrum care — especially recovery timelines, candidacy criteria and rehab protocols,” Dr. Cole says.

Key takeaways for orthopedic surgeons

According to Dr. Cole, the findings support the idea that orthopedic surgeons should take an active role in patient education by:

• Creating high-quality video content with clear, evidence-based messaging.
• Directing patients to reputable sources and cautioning against unverified content.
• Collaborating with academic institutions and societies to develop centralized video libraries.
• Emphasizing key elements often missed, such as candidacy for surgical vs. nonsurgical treatment, imaging details, rehab expectations and long-term outcomes.

To reduce patient misconceptions about orthopedic procedures like cartilage restoration, surgeons should also consider integrating video content into their clinical workflow and enhancing preoperative education.

Next steps

Dr. Cole says several important questions remain about online content and orthopedic patient education, including:

• How does YouTube content influence patient decision-making and satisfaction?
• What is the effect of misinformation on surgical consent and adherence to postoperative protocols?
• How can algorithms be used to promote higher-quality content?
• Can orthopedic societies or institutions help standardize video content or create verified channels?

As for future research at Rush, Dr. Cole says the paper opens the door for prospective studies evaluating patient understanding before and after exposure to curated or peer-reviewed digital content. His team also aims to develop a standardized educational video protocol or certification system for cartilage-related online content. They are also exploring approaches for tracking outcomes based on preoperative patient education modalities, including digital vs in-office counseling.

“It’s imperative for orthopedic surgeons to improve the quality of educational content, including informational videos, available to the public,” Dr. Cole says. “As patients increasingly rely on these platforms for information, we can help reduce misinformation that contributes to unrealistic expectations and suboptimal outcomes.”