AOCID – History


Early in the history of the AO it became apparent to the AO group of surgeons that they would need to save records of their work, eg, radiographs and patient data, if they were to evaluate the results of newly developed operative techniques and materials. To this end the AO Documentation Center was established in 1959.

Documentation is closely related to instrumentation since it was also a very early idea and the two developed in parallel. The result of a treatment can only be evaluated by follow-up, which is a commandment of medical ethics. It leads to critical assessment of the success of treatment. Lambotte, Danis and Böhler followed up their patients.

Between 1951-1952 Maurice Müller recorded his osteosynthesis in Fribourg with clinical controls and radiographs. For the reproductions in his doctoral thesis in 1957 he photographed the radiographs with a Leica camera. In the following year, he had the idea of recording his operations using miniature copies of negatives. In Davos, Martin Allgöwer with Ernst Frei, whom he had recruited from Basel as chief laboratory assistant, the radiographs of the accident and the osteosynthesis were photographed with the Leica camera and miniature copies of these stuck onto the back of cards, which had the patient’s personal details and data on the front. After 4 and 12 months the miniature pictures of the follow-up assessments were added. Thus, for a completely documented fracture there were eight pictures on the card after one year. If complications occurred, additional cards were required for the record. In June 1962 Müller took over direct management of the documentation center from the Davos laboratory management and transferred it in 1967 from Davos to Bern. That same year, the institute was registered with the Bernese cantonal authorities under the name Dokumentationszentrale der Arbeitsgemeinschaft für Osteosynthese (AO).

The essentially new aspect of AO Documentation was that it was a collection of material from a whole group of independent surgeons. The files of each member were open to all the other members. Criticism and central evaluation led to optimization of indications and techniques. In this way, large numbers of cases were soon available for statistical evaluation, for lectures and for publications. The producers were also interested in it. At the end of the first year (June 1960) about 1,000 osteosynthesis cases had been recorded. By 1964 about 5,000 more had been added. To provide the data of one's success but also failures needed openness and cooperation and was unique at that time. It was only possible on the basis of mutual confidence, which was characteristic for the AO group.

With the documentation a double control was obtained. On one hand the control of success and failures of those who performed osteosynthesis, on the other hand it provided the possibility to influence the scientific discussion on osteosynthesis.

Before the first course in 1960 the AO was faced with opposition and mistrust. The extensive documentation and publication of the results made it possible to counteract the mistrust.

One of the central challenges in introducing the new procedures was maintaining standardization. The aim of making the AO technique universally valid and applicable required standardization. Since propagation of osteosynthesis by single expert surgeons seemed to have proved impracticable (Lambott and Danis), the AO surgeons pursued another strategy: they built up a controlled network of practitioners working in different places but all using the same technique. The AO attempted to uphold standardization of procedures in its own ranks not only by holding regular meetings so that practices could be discussed but also by maintaining a system of strict documentation. Instruction sheets, textbooks and courses were additional means of standardization. Standardization was to be the key that secured the effective spread of the AO technique.

Even though the AO could not achieve completely its goal of comprehensive and complete documentation, they did derive various benefits from what they had collected. Thus the data constituted a vast repository of clinical experience. As Müller pointed out, by 1983 130,000 fractures had been documented; 80,000 of them were complete with code sheets and x-ray pictures. In the first 25 years of the document center’s existence 550,000 photographic copies of x-ray pictures and 60,000 slides had been produced.

From 1980 to 1983 alone, the collection had helped to answer more than 300 complex questions and had provided the basis for more than 40 publications or dissertations.

Data and radiographs pertaining to fractures and their stabilization have been recorded at the AO Documentation Center ever since. By the 1990s it was evident that retrospective studies could not answer all clinical questions. On 12 December 1995, the AO Documentation and Publishing Foundation (AOCID's legal name) was registered with the cantonal authorities in Grisons, replacing the original body registered in 1967. The movement toward the conduct of prospective studies was cemented by a decision taken by the Board of the AO Documentation and Publishing Foundation on 6 March 1999 to transform AO Documentation into AO Clinical Investigation and Documentation.

The beginnings of clinical investigation in the AO

Ruedi Moser was the first director of AO Clinical Investigation and Documentation (AOCID) at the end of the 1990s and so the move from a documentation center to a clinical investigation center began in earnest. Beate Hanson accepted an offer in 2002 from the then AOCID Chairman David Helfet and became AOCID director, a position she held until 2014.

The AOCID mission is to provide evidence-based knowledge through inde­pend­ently conducted clinical studies, education and methodological services. AOCID has grown beyond all expectations in terms of both size and capabilities. From just a handful of clinical trials in the early years, AOCID by 2015 was involved in approximately 45 multicenter international studies of every type of study design. In addition to this, around 10 Focused Registry projects are either running or in development. The internationalization of AOCID is also evident. Over 330 different clinics scattered around the globe have participated in clinical investigations. Since assuming its current form, well over 9,000 patients have been recruited to an AOCID study.

Careful planning and processes are key to success in clinical trials. AOCID is ISO 9001 certified and an increasing amount of outside vendors have audited and appointed AOCID a "Preferred 3rd Party Provider" in recognition of the expertize housed within.