Curr Rev Musculoskelet Med (2008) 1:161–164 re-rupture rate of 3.5% in the operatively treated group and 12.6% in the non-operative group. Complications such as adhesions, altered sensation, and wound infection, how- ever, were more common in operatively treated patients with 34.1% in the operative group versus 2.1% in the non- operative group [6, 13, 14]. In a large prospective study of 196 consecutive patients with acute Achilles tendon ruptures that were treated with 8 weeks of casting and immediate postoperative weight- bearing, the re-rupture frequency was 7% [15]. This is only slightly higher than most results in operatively treated groups [2–4, 6, 15]. Due to the similar percentage of re- rupture between most studies advocating surgery and their promising results with non-operative management, Ingvar et al. question the necessity for surgical repair of Achilles tendons, with all of its risks and high cost [15]. Open versus percutaneous repair In 1977, Ma and Grifﬁth introduced percutaneous Achilles tendon repair. This technique involves passing a suture through small stab wounds above and below the tendon tear. The original article reported on 18 patients with only two minor complications [16]. Subsequent groups have reported similar results. Cretnik et al. prospectively studied 134 percutaneous repairs and found a rerupture rate and return to pre injury activities comparable to open proce- dures. Complications included complete and partial reruptures, sural neuritis, and superﬁcial wound infection [17]. Percutaneous repair has the added beneﬁt of being done under local anesthesia without a tourniquet. Lim et al. showed no signiﬁcant difference between open compared to percutaneously repaired tendons, but a signiﬁcantly higher rate of wound infection in the open group compared to the percutaneous group [18]. Postoperative management Postoperative management is also controversial. Histori- cally, patients were immobilized in a rigid cast for at least 4–6 weeks to allow for presumed tendon healing. Current trends, however, favor minimizing postoperative immobi- lization and focus on early weightbearing with excellent results. In a rat model of tendon rupture using wheel run- ning for early tendon motion, Bring et al. were able to show that physical activity speeds up tendon healing as compared to plaster immobilization. This suggests that that there may be some stimulatory effect of mechanical load- ing on tendon healing [19]. In a clinical prospective study with full postoperative weight bearing in a controlled ankle motion walker accompanied by active stretching, Jacob and Paterson showed few minor complications, high patient 163 satisfaction, and no re-ruptures. Patients with both acute and chronic tears repaired with an open technique did equally well under this treatment protocol [20]. In their meta-analysis of randomized trials comparing early post- operative weightbearing with cast immobilization, Suchak et al. found no difference in re-rupture rates and more excellent rated subjective patient responses. Patients pre- ferred the early function protocol with a mobile cast for multiple reasons including a decrease in leg edema, the ability to bear weight, and easier and faster ability to obtain normal gait after removal of the cast [21]. Impact of time until surgery Sorrenti et al. divided their treatment groups into three sections based on the number of days between Achilles tendon rupture and surgery: acute tears (\7 days), sub chronic tears ([7 days but \4 weeks), and chronic tears ([4 weeks). All patients resumed their normal activities within 100 days of operative repair, regardless of time until surgery. Thus, according to this study, there does not appear to be an advantage of early operative repair over delayed surgical treatment [22]. The main concern to prolonged treatment delay after Achilles tendon rupture is weakness of plantar ﬂexion. Conclusion Surgical repair of the ruptured Achilles tendon is a con- troversial topic. Many authors advocate surgical repair, mostly citing decreased re-rupture rates and improved functional outcome. No studies show a clear advantage to early surgical intervention over delayed repair. Waiting for surgical repair for longer than 1 month may show worse functional results postoperatively. Non-operative treatment has shown similar re-rupture rates as compared to surgi- cally repaired tendons. Any patient undergoing Achilles tendon repair should understand the inherent risks of an invasive procedure including bleeding, infection, and pain at the surgical site. In our practice, we offer surgical repair of the ruptured Achilles tendon for those patients who wish to return to an active lifestyle. While for many years, patients were rigidly immobilized for 6–8 weeks postop- eratively, new studies have shown excellent results with early weightbearing, and this is quickly becoming the standard of care amongst many physicians. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.