Nilsson-Helander et al reported the Achilles Tendon Total Rupture Score (ATRS) for evaluating an athlete who has had a total rupture of the Achilles tendon. This can help to monitor the athlete during recovery and to decide if the athlete can return to sport. The authors are from Sahlgrenska University Hospital and Goteborg University in Sweden.


Patient selection: athlete with total rupture of the Achilles tendon


Does the athlete have any of the following affecting the injured calf, Achilles tendon or foot:

(1) decreased strength

(2) fatigue

(3) stiffness

(4) pain


Is the patient impacted as a result of Achilles tendon-related limitations:

(5) during activities of daily living (ADL)

(6) when walking on uneven surfaces

(7) when walking quickly (up hill, up stairs, etc)

(8) during activities that include running

(9) during activities that include jumping

(10) in performing hard physical labor


Each item is scored on a 10 cm VAS scale from extreme (0) to none (10).


total score =

= SUM(VAS scores for each item)



• minimum score: 0 (extreme disability)

• maximum score: 100 (normal)

• The higher the score the better the patient's status.

• Hansen et al found that the ATRS at 3 months correlated with status at 1 year and could be used to identify an athlete who might benefit from more aggressive management.

• An ATRS less than 40 at 3 months was associated with a poor chance of being active in sport at 1 year after injury. An ATRS greater than 90 at 3 months had a good chance of being active in sports at 1 year after injury.


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