About the Achilles Tendon Total Rupture Score (ATRS)
The Achilles Tendon Total Rupture Score (ATRS) is a disease-specific patient-reported outcome measure designed to evaluate symptoms and physical activity in patients recovering from Achilles tendon rupture. Developed and validated in Sweden, it assesses limitations related to strength, fatigue, stiffness, pain, and progressively demanding activities from daily living through running, jumping, and hard physical labour. The ATRS is widely used in orthopaedic and sports medicine research, including post-surgical and non-operative rehabilitation pathways, and is a common primary endpoint in Achilles rupture outcome studies.
Medical Specialties
Anatomic Areas
Clinical Indications
Developer Information
The ATRS was developed by Katarina Nilsson-Helander, Roland Thomeé, Karin Grävare-Silbernagel, Pia Thomeé, Eva Faxén, Bengt I. Eriksson, and Jon Karlsson at the University of Gothenburg, Sweden. The instrument was published in 2007 following item generation, reduction, and comprehensive psychometric testing in patients with acute Achilles tendon rupture.
Copyright & Licensing
The ATRS is freely available for clinical and research use. Proper citation of the original validation study (Nilsson-Helander et al., 2007) is requested when using the tool in research or publications.
Administration Instructions
All questions refer to your limitations related to your injured Achilles tendon. Please select one response for every question, grading your limitations from 0 (major limitations) to 10 (no limitations).
Scoring Methodology
The ATRS comprises 10 items, each rated on an 11-point Likert scale from 0 to 10. A score of 0 indicates major limitations or symptoms for that item; a score of 10 indicates no limitations. The total ATRS score is calculated by summing all 10 item scores, yielding a range of 0 to 100. Higher scores indicate better function and fewer symptoms. All 10 items must be completed for a valid total score. The questionnaire evaluates a single construct of symptoms and physical activity without separate subscale scores.
Meaningful Change Threshold
Minimal detectable change at individual level is approximately 30 points (Dutch validation). At group level, a change of approximately 3.5 points is considered detectable. Effect sizes of 0.87 to 2.21 have been reported during recovery.
Score Interpretation
Understanding what your score means
major limitations
0 - 50Major functional limitations with significant symptoms affecting daily and sporting activities
moderate limitations
51 - 75Moderate limitations with ongoing symptoms; typical range for patients mid-rehabilitation
mild limitations
76 - 90Mild limitations with good functional recovery; approaching normal activity levels
minimal limitations
91 - 100Minimal to no limitations; comparable to healthy controls (validation mean ~99.8)
Subscales
This questionnaire measures multiple dimensions
ATRS Total Score(0-100)
Overall measure of symptoms and physical activity limitations after Achilles tendon rupture
Clinical Limitations & Considerations
The ATRS is a self-reported questionnaire and may be influenced by recall bias and subjective perception. It assesses perceived limitations rather than objective physical performance. The original validation was conducted in a Swedish population aged 20-70 years with acute ruptures. Some items (running, jumping, hard physical labour) may be less relevant for sedentary or older populations. The questionnaire does not distinguish between surgical and non-operative treatment pathways.
Supporting Literature
Key validation and development studies for the Achilles Tendon Total Rupture Score (ATRS)
- 1
The Achilles Tendon Total Rupture Score (ATRS): Development and Validation
Nilsson-Helander K, Thomeé R, Silbernagel KG, Thomeé P, Faxén E, Eriksson BI, Karlsson J
American Journal of Sports Medicine, 2007
- 2
The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures
Kearney RS, Achten J, Lamb SE
Health and Quality of Life Outcomes, 2012
- 3
Reliability and validation of the Dutch Achilles tendon Total Rupture Score
Meijer F, Reiman MP, Zwerver J, Otten E, van der Worp H, van Ark M, Weir A, Tol JL
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
- 4
Validity and reliability of the Norwegian translation of the Achilles tendon Total Rupture Score
Myhrvold SB, Sandnes Ø, Hoelsbrekken SE
Knee Surgery, Sports Traumatology, Arthroscopy, 2018
Related Outcome Measures
Other clinical questionnaires for similar specialties and conditions
VISA-A (Sedentary)
A modified version of the VISA-A questionnaire designed specifically for sedentary/non-sporting patients with Achilles tendinopathy. Replaces sport-specific questions (hopping, sporting activity) with daily functional activity questions. Two dimensions: Symptoms (Q1-5, 0-50) and Activity (Q6-8, 0-50). Total Score: 0-100.
Foot and Ankle Ability Measure (FAAM)
A patient-reported outcome measure assessing physical function in foot and ankle disorders. Includes two subscales: activities of daily living and sports.
Cumberland Ankle Instability Tool
A validated 9-item questionnaire designed to measure the severity of functional ankle instability in individuals with chronic ankle instability.
VISA-A
An index assessing the severity of Achilles tendinopathy. Evaluates pain, function, and ability to participate in activities and sports. Scoring Breakdown: Questions 1-7 are scored out of 10 each (total 70). Question 8 (activity/pain) is scored out of 30. Total Score: 0-100.
FAOS - Foot and Ankle Outcome Score
A comprehensive questionnaire assessing foot and ankle function across five domains: pain, symptoms, activities of daily living, sport/recreation, and quality of life.
Manchester-Oxford Foot Questionnaire (MOXFQ)
A validated questionnaire assessing foot and ankle function across three domains: pain, walking/standing, and social interaction.
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