Return to Play After Achilles Tendon Rupture: Comparing Operative and Nonoperative Approaches in Athletes

Abstract

Achilles tendon rupture is a debilitating injury with significant implications for athletic performance and career longevity. Historically, operative repair was considered the gold standard, but advances in early functional rehabilitation have challenged this paradigm, with non-operative management demonstrating comparable rerupture and functional outcomes. This narrative review synthesizes evidence comparing operative and nonoperative strategies in athletes, emphasizing rehabilitation, return-to-play (RTP) outcomes, and long-term sequelae. Operative repair offers marginal advantages in preserving tendon length and explosive power but carries surgical risks such as adhesions and wound complications. Nonoperative management, utilizing modern functional protocols, achieves comparable rerupture rates and patient satisfaction while minimizing operative morbidity. It appears that the quality of rehabilitation and early management offers promising results in RTP, comparable to those of surgery.