Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 6, pp 1356–1360

Cross cultural adaptation of the Achilles tendon Total Rupture Score with reliability, validity and responsiveness evaluation

  • Michael R. Carmont
  • Karin Grävare Silbernagel
  • Katarina Nilsson-Helander
  • Omer Mei-Dan
  • Jon Karlsson
  • Nicola Maffulli

DOI: 10.1007/s00167-012-2146-8

Cite this article as:
Carmont, M.R., Silbernagel, K.G., Nilsson-Helander, K. et al. Knee Surg Sports Traumatol Arthrosc (2013) 21: 1356. doi:10.1007/s00167-012-2146-8



The Achilles tendon Total Rupture Score (ATRS) was developed because of the need for a reliable, valid and sensitive instrument to evaluate symptoms and their effects on physical activity in patients following either conservative or surgical management of an Achilles tendon rupture. Prior to using the score in larger randomized trial in an English-speaking population, we decided to perform reliability, validity and responsiveness evaluations of the English version of the ATRS. Even though the score was published in English, the actual English version has not be validated and compared to the results of the Swedish version.


From 2009 to 2010, all patients who received treatment for Achilles tendon rupture were followed up using the English version of the ATRS. Patients were asked to complete the score at 3, 6 and 12 months following treatment for Achilles tendon rupture. The ATRS was completed on arrival in the outpatient clinic and again following consultation.


The outcomes of 49 (13 female and 36 male) patients were assessed. The mean (SD) age was 49 (12) years, and 27 patients had treatment for a left-sided rupture, 22 the right. All patients received treatment for ruptured Achilles tendons: 38 acute percutaneous repair, 1 open repair, 5 an Achilles tendon reconstruction using a Peroneus Brevis tendon transfer for delayed presentation, 1 gracilis augmented repair for re-rupture and 4 non-operative treatment for mid-portion rupture. The English version of ATRS was shown to have overall excellent reliability (ICC = 0.986). There was no significant difference between the results with the English version and the Swedish version when compared at the 6-month- or 12-month (n.s.) follow-up appointments. The effect size was 0.93. The minimal detectable change was 6.75 points.


The ATRS was culturally adapted to English and shown to be a reliable, valid and responsive method of testing functional outcome following an Achilles tendon rupture.


Cross cultural ATRS Achilles Score 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Michael R. Carmont
    • 1
  • Karin Grävare Silbernagel
    • 2
  • Katarina Nilsson-Helander
    • 3
  • Omer Mei-Dan
    • 4
  • Jon Karlsson
    • 5
  • Nicola Maffulli
    • 6
  1. 1.The Princess Royal HospitalTelfordUK
  2. 2.Department of Physical TherapySamson College of Health Professions, University of the SciencesPhiladelphiaUSA
  3. 3.Department of OrthopaedicsKungsbacka HospitalKungsbackaSweden
  4. 4.Department of Orthopaedic Sports MedicineThe University of Colorado HospitalDenverUSA
  5. 5.Department of OrthopaedicsSahlgrenska University HospitalMölindalSweden
  6. 6.Barts & the London School of Medicine and DentistryQueen Mary University of LondonLondonUK

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