Evidence brief
Operative vs Nonoperative Treatment of Acute Achilles Tendon Rupture
No significant difference in re-rupture rates with functional rehabilitation
Operative: 2.3% re-rupture vs non-operative: 2.6%
Wound complications higher with surgery (5% vs 0%)
Functional rehabilitation protocol critical for non-operative success
Similar functional outcomes at 2 years
Non-operative treatment with functional rehabilitation is a valid option for acute Achilles tendon ruptures, challenging traditional preference for surgical repair.
Key trial for Achilles management. Non-op requires: early weight-bearing, functional bracing, compliant patient. Surgery preferred for: athletes, re-ruptures, delayed presentation, gap on ultrasound. Know the functional rehabilitation protocol.
Level I
Systematic review of RCTs or high-quality RCT