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Acute Achilles tendon rupture has traditionally been managed surgically because earlier literature suggested lower rerupture rates. This multicentre randomized trial tested whether accelerated functional rehabilitation could narrow that difference. Patients were randomised to surgical repair or nonoperative treatment, with both groups following the same early weight-bearing and range-of-motion programme. Rerupture rates were very low and clinically similar, while strength, motion and functional scores were also broadly comparable. Surgical patients experienced more complications, particularly wound and soft-tissue problems. The study therefore supports nonoperative treatment as a legitimate option when it is paired with a well-structured early functional rehabilitation protocol. The key clinical lesson is that rehabilitation can modify the risk-benefit balance of treatment. Surgery may still be favoured in selected high-demand patients or specific rupture patterns, but the assumption that every acute rupture needs an operation is no longer supported by randomized evidence. For HCPs, patient selection, ultrasound or clinical confirmation of the rupture, early functional bracing and adherence to rehabilitation are central. Treatment discussions should include both the lower operative complication burden of nonoperative care and the need for disciplined follow-up.
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Acute Achilles tendon rupture has traditionally been managed surgically because earlier literature suggested lower rerupture rates. This multicentre randomized trial tested whether accelerated functional rehabilitation could narrow that difference. Patients were randomised to surgical repair or nonoperative treatment, with both groups following the same early weight-bearing and range-of-motion programme. Rerupture rates were very low and clinically similar, while strength, motion and functional scores were also broadly comparable. Surgical patients experienced more complications, particularly wound and soft-tissue problems. The study therefore supports nonoperative treatment as a legitimate option when it is paired with a well-structured early functional rehabilitation protocol. The key clinical lesson is that rehabilitation can modify the risk-benefit balance of treatment. Surgery may still be favoured in selected high-demand patients or specific rupture patterns, but the assumption that every acute rupture needs an operation is no longer supported by randomized evidence. For HCPs, patient selection, ultrasound or clinical confirmation of the rupture, early functional bracing and adherence to rehabilitation are central. Treatment discussions should include both the lower operative complication burden of nonoperative care and the need for disciplined follow-up.
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