Excellent results are reported from both nonoperative and operative treatment of Achilles tendon rupture.

To describe a new nonoperative treatment protocol for Achilles tendon ruptures and compare outcomes with operative treatment.

Retrospective cohort study.

We treated 23 patients nonoperatively with an equinus ankle cast and boot and compared their outcome with that of a group of 24 patients previously treated operatively. Muscle strengthening and walking with full weightbearing were started as soon as tolerated in both groups. Follow-up examinations were performed for 18 nonoperatively treated patients after 23 months and for 15 operatively treated patients after 49 months.

Subsidence of pain, return to unaided walking, and return to work was faster in the nonoperatively treated group. Patient satisfaction, return to sports, and ultimate strength was the same for both groups. The complication rate was similar, except for reruptures: four early in the nonoperative group and one late in the operative group. Two types of reruptures occurred in the nonoperative group: 1). normally healing tendon subjected to new trauma, rerupturing in the healing zone, and achieving a good result with continued nonoperative treatment; and 2). tendon failing proximal to the initial rupture at the muscle-tendon junction, without trauma, requiring operative repair and augmentation.

Results of operative and nonoperative treatment were equivalent.

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