Achilles Tendon Total Rupture Score (ATRS)

Objective

The Achilles Tendon Total Rupture Score (ATRS) has become an important tool for assessing functional outcomes after interventions in patients who have sustained a complete Achilles tendon rupture.¹ ² ³

Interpretation

A lower score indicates more symptoms and greater limitation of function, whereas a score of 100 means that the patient has fully recovered.¹ ⁴

Execution

The ATRS consists of 10 items reflecting patients’ opinions of their symptoms, limitations in daily activities, and physical activities after a complete Achilles tendon rupture.¹ ² ⁵ Each item is rated on an 11-point Likert scale ranging from 0 to 10, where 0 corresponds to more severe symptoms and limitations, and 10 indicates the absence of symptoms and limitations. The final score is the sum of the responses to each item and ranges from 0 to 100.¹ ⁴ ⁵

Duration

A few minutes.³

Equipment

None.

Clinical Value

The ATRS is the only self-administered questionnaire validated specifically for the management of Achilles tendon rupture.² ³ ⁵ A minimal detectable change (MDC) of 18.5 points has been proposed.²

Excellent test-retest reliability (intraclass correlation coefficient = 0.98) and excellent internal consistency (Cronbach’s alpha = 0.96) have been reported.³

Acknowledgements

Published with the permission of the author, Prof. Karin Grävare Silbernagel.

The ATRS was developed in the original publication: Nilsson-Helander K., Thomeé R., Grävare Silbernagel K., Thomeé P., Faxén E., Eriksson BI., Karlsson J. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med. 2007;35(3):421–426.

1. Buckinx, F., G. Lecoq, S. Bornheim, J. Van Beveren, A. Valcu, C. Daniel, O. Bruyère, J. Y. Reginster, P. D’Hooghe, and J. F. Kaux. “French Translation and Validation of the Achilles Tendon Total Rupture Score ‘ATRS.’” Foot and Ankle Surgery 26, no. 6 (August 1, 2020): 662–68.

2. Ganestam, Ann; Barfod, Kristoffer; Klit, Jakob; Troelsen, Anders (2013). Validity and Reliability of the Achilles Tendon Total Rupture Score. The Journal of Foot and Ankle Surgery, 52(6), 736–739.

3. Nilsson-Helander, K.; Thomeé, R.; Grävare-Silbernagel, K.; Thomeé, P.; Faxén, E.; Eriksson, B. I.; Karlsson, J. (2007). The Achilles Tendon Total Rupture Score (ATRS): Development and Validation. The American Journal of Sports Medicine, 35(3), 421–426.

4. Nordenholm, Anna, Niklas Nilsson, Eric Hamrin Senorski, Katarina Nilsson Helander, Olof Westin, and Nicklas Olsson. “Patients with Chronic Achilles Tendon Rupture Have Persistent Limitations in Patient-Reported Function and Calf Muscle Function One Year after Surgical Treatment—a Case Series.” Journal of Experimental Orthopaedics 9, no. 1 (February 9, 2022): 15.

5. Kearney, Rebecca S., Juul Achten, Sarah E. Lamb, Nicholas Parsons, and Matthew L. Costa. “The Achilles Tendon Total Rupture Score: A Study of Responsiveness, Internal Consistency and Convergent Validity on Patients with Acute Achilles Tendon Ruptures.” Health and Quality of Life Outcomes 10 (February 29, 2012): 24.