BACKGROUND: Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative. HYPOTHESIS: Nonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique. STUDY DESIGN: Randomized controlled clinical trial; level of evidence, 2. METHOD: Using concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year. RESULTS: Complications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21%) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio 0.59; 95% confidence interval 0.29 to 1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio 0.59; 95% confidence interval 0.15 to 2.29). The mean time to work was 59 days (SD 82) after surgical treatment and 108 days (SD 115) after nonoperative treatment (difference, 49 days; 95% confidence interval 4 to 94; p < 0.05). The difference between treatments for return to sports (risk ratio 0.55; 95% confidence interval 0.23 to 1.29), pain, and treatment satisfaction did not reach statistical significance. CONCLUSION: There appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.

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