After Achilles tendon rupture, the optimal management remains unclear. Studies comparing operative and nonoperative treatment have failed to show a clinically significant difference in outcome. This study was designed to better understand these treatment options.

This cohort study included 200 patients presenting for treatment of an Achilles tendon rupture. The treatment decisions were individualized based upon patient factors including age, activity level, comorbidities and surgeon′s preference. Of those presenting, 99 were treated surgically, and 101 nonsurgically. Both groups were kept nonweightbearing in a cast for four weeks, and then placed in a controlled ankle movement walker boot at 20° equinus. Physical therapy was initiated, with the equinus progressively decreased to neutral by weeks six to eight. Weightbearing progressed from partial to full as patient tolerance and range of motion allowed. The orthotic was removed at week eight, with therapy continuing until week 12. The primary outcome variable was patient reported functional outcome, assessed with the Achilles Tendon Total Rupture Score (ATRS).

No significant difference was found between the groups in the rate of rerupture. There was also no significant difference between the groups in ATRS functional scores (P＝0.55). A logistic regression analysis did not reveal significant effects of age at rupture, gender or mode of treatment on ATRS scores.

This non-randomized study of patients with Achilles tendon rupture failed to demonstrate a better outcome for those treated surgically compared to those treated nonsurgically.