Management of acute Achilles tendon rupture

With the introduction of functional rehabilitation and early weight bearing, the management of acute midsubstance Achilles tendon ruptures has seen a paradigm shift in conservative methods. The re-rupture rates for non-surgical treatment are similar to those for surgical treatment with the advantage of a decrease in complications. The treatment should be tailored to each individual patient with a shared decision-making process between the surgeon and patient, taking into consideration their occupation, lifestyle, sporting aspirations and expectations. Generally, most patients can be treated non-operatively in centres offering functional rehabilitation. However, surgical repair should be preferred at centres that do not employ functional rehabilitation as it decreases the re-rupture risk in such patients. High-demand, active individuals and athletes should be considered for surgery as non-operative treatment can lead to statistically significant deficits in high-speed plantar flexion strength and hopping ability in the absence of robust sports-oriented functional rehabilitation. If surgical treatment is considered, minimally invasive techniques should be employed to alleviate the risk of wound complications.