What is the Mean Achilles Tendon Total Rupture Score (ATRS) in a Healthy Population?

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The Achilles Tendon Total Rupture Score (ATRS) is a validated patient-reported outcome metric for assessing functional recovery following operative Achilles tendon repair. The reported value of 99.8 in the literature for a mean score among a healthy population was based on the scores of only 52 individuals. When evaluating Achilles rupture repair, reported ATRS scores range from 82-89, which is considerably lower than the healthy population mean. Yet, following surgical repair of the Achilles rupture, these patients score superior to the population mean on other validated metrics including Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Therefore, we aimed to determine what the mean ATRS score is in a healthy population to better understand outcomes following Achilles tendon repair. Methods: Patients seen in the orthopaedic sports medicine clinic at a single institution between December–February 2025 were screened for participation. Patients with a history of Achilles tendon injuries and patients at baseline who were non-ambulatory were excluded. Patients were asked to complete the ATRS survey based on their current state of health. For those with acute injuries, patients were asked to complete the survey based on their state of health prior to the injury for which they presented to clinic. 104 patients consented to participate by filling out a survey on REDCap containing the ATRS and additional questions regarding activity level (self-reported as “high,” “moderate,” and “sedentary-light"). Mean scores were calculated for the ATRS. Results: 104 patients (average age 47 years, 45% male, 55% female) consented to participate. Mean ATRS across the entire cohort was 71.6. By activity level, “sedentary-light” activity patients (n=37) had a mean of 71.4. “Medium” activity patients (n=57) reported a mean of 69.3. “High” activity patients (n=10) described a mean of 85.7. 12 patients responded with a score of 0 (indicating severe limitations). It is unclear whether these patients intended this score or misinterpreted the question (thinking 0 is no limitations). As a result, when excluding these patients (12 patients, n=92), the mean ATRS was 81.0. Conclusion: In a healthy population sample two-fold larger than previously reported, mean ATRS was found to be 71.6. This value is lower than reported ATRS means following Achilles rupture repair, which suggests that operative repair of Achilles tendon ruptures may indeed produce satisfactory outcomes superior to the population mean—consistent with PROMIS. It may be helpful to evaluate ATRS in context of activity level, as scores differed between self-reported activity levels. Future research should evaluate the ATRS further, as the reported value in the literature may overestimate a healthy population mean score.