Discordance Between Patient-Reported Outcomes and Heel-Rise Limb Symmetry After Surgical Repair of Acute Achilles Tendon Rupture

Background/Objectives: The extent to which patient-reported outcome measures (PROMs) reflect objective functional recovery after surgical repair of acute Achilles tendon rupture remains unclear. This study aimed to evaluate the relationship between PROMs and objective functional performance, particularly the heel-rise test-based limb symmetry index (LSI). Methods: This retrospective cohort study included male patients who underwent primary open repair for acute Achilles tendon rupture between 2015 and 2023 and had a minimum follow-up of 12 months. Subjective outcomes were assessed using the Achilles Tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Score. Objective functional performance was evaluated using a single-leg heel-rise test, and LSI was calculated as the percentage performance of the injured limb relative to the uninjured limb. Patients were stratified into two groups according to LSI: ≥ 90% and < 90%. Correlations between PROMs and LSI were analyzed using Spearman’s rank correlation coefficient. Results: A total of 76 male patients were included. The median age was 42 years (IQR, 35–46; range, 27–74), and the median follow-up duration was 41 months (IQR, 26–53; range, 12–80). The median ATRS was 97 points (IQR, 94–99), and the median AOFAS score was 98 points (IQR, 90–100). The median LSI was 87.5% (IQR, 81.4–93.3), and only 31 patients (40.8%) achieved an LSI ≥ 90%. Injured-side heel-rise performance was significantly higher in the LSI ≥ 90% group than in the LSI < 90% group (24.4 ± 5.4 vs. 21.6 ± 5.9 repetitions, p = 0.039). However, ATRS and AOFAS scores did not differ significantly between the groups. No significant correlation was found between LSI and either ATRS (Spearman’s rho = 0.190, p = 0.100) or AOFAS score (Spearman’s rho = 0.218, p = 0.058). Conclusions: Although PROM scores were high following surgical repair of acute Achilles tendon rupture, objective functional assessment revealed persistent limb-symmetry deficits in a substantial proportion of patients. ATRS and AOFAS scores showed no significant correlation with heel-rise LSI, suggesting that PROMs may not fully capture objective functional recovery. Therefore, PROMs should be interpreted alongside performance-based measures, particularly in patients with high functional demands.