This multicenter RCT compared three treatments for acute Achilles tendon rupture in 526 adults aged 18–60. All groups followed the same standardized accelerated rehabilitation protocol. The central question: does surgery (open or minimally invasive) produce better 12-month functional outcomes than nonoperative management?
The functional equivalence of surgery and nonoperative care in this trial does not mean the choice is arbitrary — it means the tradeoff shifts entirely to complication risk.
For the active patient most worried about rerupture (athlete, manual laborer, high-demand job), surgery reduces that risk roughly 10-fold (0.6% vs. 6.2%). For the patient who wants to avoid an operation, nonoperative management delivers equivalent 12-month function with an acceptably low but real rerupture rate.
When nonoperative management is chosen, counsel patients explicitly that the first 10 weeks are the highest-risk window. Half of all reruptures occur here, and compliance with the rehabilitation protocol during this period is not optional.
When choosing between surgical options, open repair and minimally invasive surgery produce identical functional outcomes and identical rerupture protection. Minimally invasive surgery carries nearly double the nerve injury rate (5.2% vs. 2.8%), with the sural nerve most at risk. A meaningful consideration when counseling patients preoperatively.
This multicenter RCT compared three treatments for acute Achilles tendon rupture in 526 adults aged 18–60. All groups followed the same standardized accelerated rehabilitation protocol. The central question: does surgery (open or minimally invasive) produce better 12-month functional outcomes than nonoperative management?
The functional equivalence of surgery and nonoperative care in this trial does not mean the choice is arbitrary — it means the tradeoff shifts entirely to complication risk.
For the active patient most worried about rerupture (athlete, manual laborer, high-demand job), surgery reduces that risk roughly 10-fold (0.6% vs. 6.2%). For the patient who wants to avoid an operation, nonoperative management delivers equivalent 12-month function with an acceptably low but real rerupture rate.
When nonoperative management is chosen, counsel patients explicitly that the first 10 weeks are the highest-risk window. Half of all reruptures occur here, and compliance with the rehabilitation protocol during this period is not optional.
When choosing between surgical options, open repair and minimally invasive surgery produce identical functional outcomes and identical rerupture protection. Minimally invasive surgery carries nearly double the nerve injury rate (5.2% vs. 2.8%), with the sural nerve most at risk. A meaningful consideration when counseling patients preoperatively.