AO Surgery Reference—past, present, and future

Since its inception in 2004, AO Surgery Reference (AO SR) has become the premier online resource for orthopedic surgeons. With over 800,000 active users annually, it is a comprehensive guide for practicing, teaching, and learning fracture management. Over the past two decades, AO SR has expanded its scope into various specialties, including craniomaxillofacial (CMF), spine, pediatric, and veterinary surgery, solidifying its role as a multidisciplinary resource.

AO SR’s success can be attributed to the editorial college, which collaborates with authors from around the world to ensure the quality and relevance of the content. This team of executive editors works closely with subject matter experts to maintain high standards. Each procedure and recommendation is reviewed and updated regularly to reflect the latest advancements in surgical techniques. This peer-reviewed process remains essential to the platform’s reputation for delivering reliable and cutting-edge information to the surgical community.

When the first AO SR modules were made available on the internet in 2006, users had free access, making content available to the global surgical community. Most of AO SR’s content remains freely accessible, enabling surgeons to benefit from high-quality educational resources without barriers. This commitment to open access aligns with the AO Foundation’s global mission of improving patient care.

The history of AO Surgery Reference

 The journey began in 2003 when the AO Foundation sought a way to manage its vast knowledge base. It started a project to consolidate explicit knowledge (literature, videos, and research) and surgeons’ hands-on expertise online. By 2004, the project was focused on developing prototype modules for fracture management of the distal radius and proximal femur, which were presented to the AO Trustees. This led to the official creation of AO SR in the same year.

Five anatomical modules were ready by 2005, and AO SR entered the public domain in early 2006. An editorial process was introduced, ensuring high standards of accuracy and clarity. Over time, further anatomical areas were added and by 2015, the appendicular skeleton was completed. The platform continued to evolve with the addition of materials from other AO divisions.

The first AO CMF materials were added to the platform in 2009, AO Spine materials followed in 2013, and AO Vet content in 2014. The orthopedic trauma section was expanded with areas covering pediatric trauma (in 2016) and periprosthetic fractures (in 2020).

Since its launch, AO SR’s user base has increased significantly, with more than 21 million page views in 2023. Continuous updates, the addition of new modules, and the integration of AO videos support this. The mobile app was developed in 2010, and surgeons now consult AO SR mainly through mobile devices. This means surgeons can access critical information immediately, whether in the operating room, at a seminar, or while preparing for a procedure.

AO Surgery Reference today

In 2020, AO SR implemented a new content management system (CMS) that significantly improved the platform’s functionality and integration with other educational offerings from the AO, such as OSapp, which connects interactive surgical simulations with AO SR’s instructional content, fostering an experiential learning environment for users. Another important addition is the integration of AO SR with myAO. With its CaseFolio tool, surgeons can augment case descriptions with selected pages from AO SR, eg, patient positioning, approach, and chosen treatment. This connection supports case-based learning and decision-making, helping surgeons compare cases, access best practices, and plan surgeries.

AO SR is a widely valued resource thanks to its clear presentation and structured guidance, which make the content accessible to speakers of all languages. Most browsers provide a translation function that helps to present AO SR content in different languages. Users can also conduct tailored searches of the 9000 pages of AO SR content.

Looking ahead

The future promises innovations in both content and technology, positioning AO SR as the keystone of the AO’s digital educational offerings. Content creation and revision will continue, introducing new modules, expanding pediatric trauma, periprosthetic fractures, and veterinary surgery content. The editorial team remains committed to frequent content updates, ensuring that AO SR reflects the latest advancements in surgical techniques and best practices.

While developing the platform further, the AO SR team is inspired by the many suggestions and feature requests from our users. Click here to leave a suggestion or vote for an existing idea.

An essential benefit of AO SR remains its accessibility through mobile devices; therefore, its app is continuously improved to meet user needs better. Enhanced video functionality is planned that will provide quicker access to the relevant steps.

The AO SR will be part of the AO Foundation’s strategy to use generative AI to support learners and clinicians (watch the AO TV interview about generative AI at the AO). AO SR will play an even more central role in shaping orthopedic surgery in the future. By integrating new technologies like generative AI, the platform is poised to continue transforming surgical education and improving patient outcomes worldwide.

For the AO Surgery Reference team:
Elena Spadini (Senior Product Owner) and Thomas Kolitzus (Project Manager)

Current and former team members of AO Surgery Reference:
Medical illustrators: Tamara Aepli, Ruth Angliker, Andrea Baechtold, Marcel Erismann, Sabine Freiermuth, Anja Giger, Priska Inauen, Michèle Haller, Manuel Ruoss, Dario Stadelmann
Project managers and content developers: Sandipan Chatterjee, Linda Domeisen, Katalin Fekete, Katrin Lüssi, Jecca Reichmuth, Carolina Salenius-Stanek, William Smith, Maria Velasco, Jane Wiedler
Managers: Tobias Hövekamp, Michael Redies, Lars Veum