Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making

Patients increasingly turn to online search engines to learn about orthopedic procedures. Matrix-Induced Autologous Chondrocyte Implantation (MACI) is an increasingly popular treatment for cartilage lesions. However, the visibility, range, and credibility of online information about MACI remain unclear. As MACI's clinical use grows, understanding what patients are encountering online is essential to guiding informed discussions.

To (1) identify frequently asked questions about MACI and their thematic categories, and (2) evaluate the types and credibility of linked websites in order to inform a patient-friendly handout with frequently asked questions (FAQs) and high-quality sources.

We conducted a cross-sectional analysis of 1620 MACI-related entries from Google's "People Also Ask" feature. Questions were categorized using the Rothwell framework, and scored for credibility using JAMA Benchmark Criteria. Kruskal-Wallis tests compared credibility across groups; logistic regression identified predictors of high-credibility content.

Most included questions (n = 1107) concerned technical details (n = 285), evaluation of surgery (n = 220), and cost (n = 138). Commercial websites were most common (40.9 %) and, while they often offered patient-friendly content, they had lower average JAMA credibility scores (1.54) compared to government (3.95) and academic (1.97) sources (p < 0.01).

Online information about MACI is dominated by commercial websites. While many offer helpful information, key patient concerns, such as pain, are underaddressed in online resources. Surgeon-led efforts, including recommending trusted sources and creating patient-friendly online content (e.g. using keywords, images, structured headings), may improve the visibility and credibility of MACI information, supporting patient understanding and shared decision-making.