Background: Achilles tendon rupture is a serious musculoskeletal condition that affects movement and daily function, particularly in active individuals and athletes. Over the past decades, the frequency of this injury has risen, likely due to increased participation in recreational sports and aging athletic populations. Management remains clinically complex, as treatment approaches vary widely and evidence is continually evolving.

Aim of study: The purpose of this review is to thoroughly examine contemporary approaches to Achilles tendon rupture treatment, with an emphasis on comparing surgical and conservative strategies, evaluating diagnostic procedures, and assessing innovative therapies that support functional recovery.

Methods: This analysis is based on a comprehensive review of scientific literature, including recent clinical trials, observational studies, and meta-analyses. Emphasis was placed on evidence regarding treatment outcomes, rehabilitation protocols, and the integration of novel adjunctive techniques. Studies were selected for their relevance, methodological quality, and recency.

Findings: Recent evidence suggests that non-operative interventions, especially when incorporating early mobility and structured rehabilitation, may produce outcomes equivalent to surgery for select patients. Less invasive surgical options have shown favorable recovery profiles. Long-term function is most strongly associated with adherence to individualized, progressively loaded rehabilitation plans. Adjunct therapies show potential, though findings remain inconclusive.

Discussions: Clinical decision-making in Achilles tendon rupture treatment is increasingly personalized, guided by patient goals, activity levels, and healing response. Understanding tendon biomechanics and ensuring continuity in care are essential to minimizing complications and optimizing outcomes.

Conclusion: No universal standard exists for treating Achilles tendon rupture. Best outcomes are achieved when diagnosis, intervention, and rehabilitation are aligned with patient-specific needs and current clinical evidence.

Keywords: achilles tendon rupture, functional outcomes, non-surgical treatment, rehabilitation, return to play, surgery

ATR, achilles tendon rupture; NFL, national football league; MRI, magnetic resonance imaging ; PARS, percutaneous achilles repair system ; PRP, platelet-rich plasma

Achilles tendon rupture is a serious musculoskeletal injury that can impair mobility and lower the quality of life for those who suffer from it. It is a tear in the strong fibrous cord that bonds the muscles at the back of the calf to the heel bone. Although it can affect people at all activity levels, athletes are more likely to sustain this injury. It is crucial to have a comprehensive awareness of the various treatment approaches due to its prevalence and the functional constraints it imposes.  By utilizing recent research in the field, this report seeks to present a thorough analysis of the current state of Achilles tendon rupture treatment, including surgical and non-surgical methods, the development of treatment paradigms, the function of rehabilitation, and the appearance of adjunctive interventions. The material provided here is meant to be a useful tool for medical professionals managing this disease as well as educated patients looking to learn about their treatment. A thorough analysis of efficacious treatment approaches is crucial to promoting the best possible recovery and return to activity for all patient populations, as evidenced by the rising frequency of Achilles tendon ruptures reported.¹ To successfully address this emerging health risk, a careful examination of current and developing treatment strategies is required. This is because the increasing prevalence may be connected to greater sports engagement in an aged active population.²

The Achilles tendon, the strongest and thickest in the human body, is crucial for plantarflexion of the foot, essential for activities like walking, running, and jumping³ The Achilles tendon, formed by the gastrocnemius and soleus muscles in the calf, often ruptures due to sudden stress during athletic activities, such as rapid acceleration, deceleration, jumping, or sudden changes in direction. Non-contact injury mechanisms are common in sports like soccer, including sudden acceleration, cross-over cutting, and vertical jumping, which can lead to rupture.⁴ Achilles tendon ruptures incidence varies among populations, with an annual rate of 1.8 people per 100,000 in public.⁵ The annual rate of adiposity is significantly higher in athletic populations, ranging from 6,000 to 18,000 per 100,000 individuals.⁶ High-impact sports, particularly basketball, soccer, football, tennis, and running,⁶ are associated with a 15% incidence of Achilles tendon rupture among athletes in the United States.¹

The incidence of Achilles tendon ruptures in the National Football League (NFL) has significantly increased in recent years.⁷ Achilles tendon ruptures are prevalent in healthy, active men aged 20-39, with a male-to-female ratio of approximately 2:1 in the general population.⁵ The incidence of female athletes experiencing a significant increase, especially in their later career stages, is evident, while the incidence of weekend warriors, a term used to describe individuals who occasionally engage in high-impact sports or exercise, also experiences a second peak.⁶ The likelihood of an Achilles tendon rupture might be increased by several circumstances. A major contributing factor is age, with the highest incidence happening between the ages of 30 and 40. This injury also affects men more often than it does women. Running, jumping, and abrupt stops and starts are all part of recreational sports like basketball, tennis, and soccer, which raise the risk. Overexertion during exercising and inadequate physical preparation prior to exercise are other significant risk factors. Additionally, a history of tendinopathy or Achilles tendon injury may make a person more susceptible to rupture.⁷ Certain medications, obesity, foot problems, and limited flexibility can increase the risk of tendon rupture due to increased strain on the tendon. Furthermore, conditions such as diabetes and hypertension have been identified as risk factors.⁸ Biomechanical factors, such as inadequate movement patterns, excessive pronation, and leg-length discrepancies, significantly increase the risk of Achilles tendon injuries.⁷

Achilles tendon ruptures are more common in athletes participating in high-impact sports, such as basketball, soccer, and football, due to the unique biomechanical stresses imposed by these movements. Understanding these biomechanics is crucial for developing effective preventive strategies and rehabilitation programs. Despite professional football players' generally high level of physical conditioning, it has seen an increase in Achilles tendon ruptures. This raises significant questions regarding the impact of off-season training regulations and the intensity of professional competition. Inadequate conditioning may accidentally come from collective bargaining agreements that limit teams' access to players during the off-season, leaving them more susceptible to injury during the rigorous football season.⁹ This demonstrates the complex interplay among training regimens, the physical demands of professional sports, and injury risk. People who play rigorous sports on the weekends but lead mostly sedentary lives during the workweek may expose their Achilles tendons to stress levels for which they are not prepared, which increases the likelihood that they will rupture. This highlights how crucial it is to educate patients about the value of safe warm-up techniques, suitable activity levels, and moderate training development to reduce the risk of injury in this population.

This study aims to critically examine current and emerging treatment strategies for Achilles tendon rupture, encompassing surgical and non-surgical interventions, rehabilitation protocols, and adjunctive therapies. By synthesizing contemporary evidence, the study seeks to provide a comprehensive framework to guide clinical decision-making and support effective recovery in diverse patient populations.

This study is structured as a narrative review of contemporary literature regarding Achilles tendon rupture management. Sources were identified through targeted searches of PubMed, Scopus, and Google Scholar databases, with emphasis on publications between 2008 and 2025. Search terms included Achilles tendon rupture, treatment, surgery, non-operative management, rehabilitation, platelet-rich plasma, and return to play. Inclusion criteria prioritized peer-reviewed clinical trials, meta-analyses, systematic reviews, and high-quality observational studies. Preference was given to recent studies with strong methodological design and direct relevance to ATR outcomes. Articles addressing epidemiology, diagnostic modalities, operative and conservative treatments, rehabilitation approaches, and adjunctive therapies were considered. Sources focusing exclusively on chronic tendinopathy without rupture were excluded, except when directly relevant to adjunctive therapy discussions. Data were synthesized qualitatively, with attention to treatment efficacy, complication profiles, long-term functional outcomes, and return-to-sport rates. Reference management followed both author year citation style and numerical indexing to ensure clarity and traceability.¹

Epidemiology and mechanism

The Achilles tendon is the thickest and strongest, essential for walking and running. Rupture usually results from sudden stress during sports involving acceleration or jumping. Incidence varies by population, with increased prevalence in athletic individuals

Diagnosis of Achilles tendon rupture

The diagnosis of an Achilles tendon rupture typically begins with a thorough clinical examination. In many cases, patients have an abrupt onset of lower leg discomfort, typically accompanied by a "popping" or "snapping" sound at the site of the lesion. Several people say the feeling is like a hard kick to the calf. Physical examination frequently reveals a palpable depression or gap in the Achilles tendon's line, typically a few centimeters above the heel.¹⁰ Achilles tendon ruptures often cause swelling around the heel and difficulty in plantarflexion or standing on the injured leg. The Thompson test, or calf squeeze test, is a key diagnostic tool. A positive test indicates a complete rupture, while clinical examination is usually sufficient. Imaging techniques can confirm diagnosis and assess tear extent. One easily accessible and non-invasive imaging technique that can be used to see the Achilles tendon and determine the extent of a rupture is ultrasound. When analyzing chronic ruptures, determining the integrity of the tendon, and detecting any related problems, magnetic resonance imaging (MRI), which offers even more detailed images of the soft tissues, can be especially helpful.¹¹ Achilles tendon ruptures are often misdiagnosed as ankle sprains, highlighting the need for thorough clinical evaluation, including Thompson test interpretation¹² to ensure accurate and timely diagnosis. An early and accurate diagnosis is crucial since delaying the appropriate course of treatment could lead to less than perfect healing and less desirable functional outcomes.¹ Therefore, educating medical practitioners is essential on the warning signs and symptoms of Achilles tendon rupture to reduce the possibility of misdiagnosis and guarantee that patients receive the care they require as soon as possible.

Non-surgical management of acute Achilles tendon rupture

Acute Achilles tendon ruptures were traditionally treated mostly with non-surgical means. This strategy was frequently chosen to prevent the possible side effects of surgery, such as sural nerve damage and issues with wound healing.¹³ Non-surgical treatment for torn tendon ends has seen significant advancements, including early weight-bearing and functional rehabilitation protocols. Traditional methods involve immobilization, typically through a plaster cast, to allow healing and proximity between torn ends. Functional bracing, or boots, are specialized devices that hold the leg in a set position for tendon healing, allowing greater function and controlled movement compared to a rigid cast.¹³ The increasing awareness of the advantages of early weight-bearing has been a major development in non-surgical therapy. Recent studies suggest early weight-bearing protocols, allowing patients to bear weight on their injured leg immediately after injury, can lead to comparable or even better outcomes compared to prolonged non-weight-bearing immobilization.¹⁵ A randomized controlled trial found early weight-bearing in non-operative treatment did not negatively impact mid-term clinical outcomes, and well-managed cases had similar re-rupture rates compared to surgically treated cases.¹⁶ Recent research on the efficacy of non-surgical and surgical treatments for acute Achilles tendon ruptures has shown comparable results, particularly when non-operative treatment involves weight-bearing and early rehabilitation.³ This implies that non-surgical treatments may be a dependable therapeutic alternative for people who are carefully chosen. Non-surgical management may be a dependable therapeutic choice for people who are carefully chosen, according to this.

For an Achilles tendon rupture, a standard non-operative rehabilitation program is frequently divided into stages to aid in healing. Although procedures may differ, they usually go in the following order: safe healing, gradual loading, and increased activity. The main phases are as follows: Phase 1 (nearly 0-4 weeks) of a healing tendon injury involves protecting the tendon, controlling pain and swelling, and maintaining movement in the injured leg. This typically involves immobilization in an Aircast boot or similar device.¹⁶ To prevent stiffness, it is crucial to maintain movement in the hip, knee, and toes of the injured leg. Phase 2 (approximately 2-8 weeks) involves patients transitioning to increased weight-bearing and gentle ankle movement, gradually reducing heel wedges and initiating gentle active plantarflexion exercises to achieve plantigrade foot position.¹⁶ It is crucial to keep the other muscles in the lower limbs strong. The goal of Phase 3 (about 8-12 weeks) is to wean out of the boot and further strengthen the lower limbs and ankles. Patients gradually transition from using boots to walking without them, incorporating active resisted exercises, gentle calf stretches, and proprioceptive exercises for balance and coordination improvement.¹⁶ Phase 4 (beyond 12 Weeks) aims to restore normal walking patterns and progress to more demanding activities. It focuses on restoring walking patterns and increasing lower limb strength and endurance through activities like jogging, running, agility drills, and sports-specific exercises, guided by a physical therapist.¹⁶ Evidence suggests early weight-bearing in non-operative management can stimulate collagen synthesis and improve healing tendon organization, reducing the negative effects of prolonged immobilization.¹⁴ However, successful treatment relies on patient adherence to a structured rehabilitation protocol, as long-term success depends on patient compliance. To follow this program, weight-bearing and activity must be gradually increased while being closely monitored to accommodate the patient's tolerance and healing reaction. A physical therapist's active participation is essential in directing this process, making sure that the tendon is gradually loaded to increase strength and flexibility without running the danger of re-injury. Patient education is equally important because the best results can only be obtained by having a complete awareness of the rehabilitation plan and the significance of compliance.

Surgical management of acute Achilles tendon rupture

Acute Achilles tendon ruptures are frequently treated with surgery, which is especially advised for athletes and younger, more active people who want a better chance of getting back to their pre-injury activity levels.¹⁷ Open repair is a traditional surgical technique that involves a large incision on the lower leg to visualize and access to torn Achilles tendon ends, then suture them together. Tendon grafts from the patient's other body parts or from a donor may be used to enhance the healing in situations when the tendon tissue has been significantly damaged or retracted.¹⁷ Open repair is linked to a higher risk of postoperative wound complications, including infection and skin breakdown, as well as a potential for sural nerve injury because of the larger incision. However, it also gives the surgeon excellent visualization of the injury site and enables a strong and secure repair.³ Mini-open repair techniques use smaller incisions to access tendons, reducing risks of wound complications and nerve injury. These techniques are less invasive than open repair but carry similar risks. Percutaneous repair methods aim to minimize soft tissue disruption. One such technique is the Percutaneous Achilles Repair System (PARS).¹⁰ The PARS procedure involves small incisions, specialized anchors in the heel bone, and strong surgical tape to secure the ends of the torn Achilles tendon. To enable the percutaneous passage of suture tape without requiring a major incision, the PARS procedure frequently makes use of a minimally invasive tool, or jig.¹⁸ The use of these smaller incisions, which reduce scarring and soft-tissue damage and may result in a more aesthetically pleasing outcome as well as a lower risk of wound complications like infection, is one of the major advantages of PARS surgery.¹⁰ PARS surgery's minimal invasive nature offers quicker recovery and less postoperative pain, while minimizing blood supply disruption to the tendon, ensuring crucial healing. Percutaneous Achilles repair techniques, including PARS, may increase sural nerve injury risk due to less direct visualization during the procedure.¹⁰

The Kuwada classification system is used to categorize chronic Achilles tendon ruptures based on tendon retraction severity, including Type I (partial rupture), Type II (complete rupture with gap ≤ 3 cm), Type III (complete rupture with gap 3-6 cm), and Type IV (complete rupture > 6 cm).¹⁹ The Kuwada classification aids in selecting suitable surgical techniques for Type II ruptures, requiring simple anastomosis, while larger gaps in Type III and IV ruptures necessitate complex reconstructive procedures.¹¹ Post-surgical rehabilitation is crucial for optimal outcomes after surgical repair. It involves immobilization, weight-bearing, and physical therapy to restore range of motion and functional abilities. The program follows a phased approach, adjusting loading and exercises to the healing tendon's capacity and individual needs. The trend towards minimally invasive surgical techniques like PARS¹⁰ in Achilles tendon rupture repair aims to reduce complications and maintain repair effectiveness. These treatments seek to enhance healing speed, diminish postoperative discomfort, and reduce the likelihood of wound-related problems by decreasing incision size and limiting damage to adjacent tissues. It is essential that surgeons conducting these minimally invasive treatments have the requisite knowledge and training to address potential obstacles, including the heightened risk of sural nerve injury resulting from restricted visualization. The Kuwada classification¹⁹ emphasizes that treating chronic Achilles tendon ruptures is a more difficult surgical task, particularly when the tendon ends exhibit significant retraction. Direct repair might not be possible in these cases, and more complex reconstructive techniques, like tendon grafts or flap transfers, are required to close the gap caused by the rupture and restore the tendon's vital force transmission and continuity functions. Table 1 gives the characteristics of comparisons of some surgical techniques (Table 1).                                                                      

The evolution of Achilles tendon rupture treatment

Achilles tendon rupture treatment evolved from traditional immobilization in a non-weight-bearing cast for 6-8 weeks to allow healing by maintaining the torn tendon ends in a relaxed position.³ For both surgical and non-surgical treatment of acute Achilles tendon ruptures, there has been a noticeable change in emphasis in recent years toward early weight-bearing and functional rehabilitation programs.¹⁴ Research indicates that early controlled motion and mechanical loading can improve tendons' healing process by stimulating collagen synthesis, improving vascularity, and promoting fiber alignment, leading to stronger, more functional repairs. Early exercise also aids in preventing the detrimental consequences of extended immobilization, including excessive scar tissue formation, joint stiffness, and muscle atrophy.²⁰ The treatment protocol for Achilles tendon ruptures remains a topic of debate, and there is no universal agreement, despite growing support for early weight-bearing and functional rehabilitation, with the choice largely influenced by individual factors such as age, physical activity, rupture severity, and any underlying medical conditions.³ It is evident that the treatment of Achilles tendon ruptures has evolved to include more active rehabilitation techniques.¹⁴ This change is supported by a better knowledge of tendon physiology, specifically how mechanical stimulation aids in the healing process, as well as a heightened consciousness of the negative effects of prolonged immobility.²⁰ To restore the tendon's structural integrity and tensile strength, it is thought that carefully regulated early loading might activate mechano-transduction pathways inside tendon cells, causing the creation and organization of collagen.²¹ This strategy seeks to promote a quicker and more efficient return to function while also optimizing the healing process. The lack of a single, well-recognized strategy, however, emphasizes the difficulties in treating Achilles tendon ruptures. It emphasizes how important it is for medical practitioners to treat patients individually, considering their age, degree of activity, the particulars of their injury, and general health condition. Clinicians can work to get the greatest results for their patients by adjusting the treatment plan to each of these unique circumstances.

Emerging and adjunctive therapies

Several new and complementary therapies are being investigated for their potential to promote healing and enhance patient outcomes in addition to the well-established surgical and non-surgical treatments for Achilles tendon ruptures.

Platelet-rich plasma (PRP) injections

A concentrated form of platelets containing growth factors, are being explored as a potential treatment for musculoskeletal conditions like tendon injuries, promoting tissue repair and regeneration.²² Nonetheless, there is still some conflicting data about PRP's efficacy in treating acute Achilles tendon ruptures. PRP injections may help improve ankle dorsiflexion angle, dorsal extension strength, and calf circumference when compared to control groups, according to several meta-analyses.²³ However, when PRP injections are contrasted with placebo injections, it has not been shown to significantly enhance biomechanical and clinical outcomes, including plantarflexion strength, pain levels, and restoration to pre-injury activity levels.²⁴ Research on PRP's efficacy in treating chronic Achilles tendinopathy has also shown inconsistent findings.²² There is currently conflicting data on PRP injections' efficacy in treating acute Achilles tendon rupture. The use of PRP injections in the routine treatment of acute Achilles tendon ruptures is still up for debate due to the conflicting outcomes, and further research is necessary to validate its efficacy.²⁵

Dry needling

Dry needling is a popular adjunctive therapy for musculoskeletal injuries, particularly Achilles tendon problems.²⁶ It involves sterile needle insertion into trigger points, aiming to alleviate pain, reduce muscle tension, and improve function. Benefits include blood flow, pain reduction, improved ankle range of motion, and tendon healing stimulation. Dry needling, a complementary therapy used alongside physical therapy exercises, has been found to be as effective as PRP injections in providing short- to medium-term pain relief for tendinopathies, but further research is needed. This ambiguity emphasizes the necessity of further thorough scientific research using established procedures for PRP production, injection methods, and outcome evaluations to conclusively ascertain its function in the clinical treatment of this injury. The disparate findings seen in the literature could be largely attributed to the differences in methodology amongst the research that has already been conducted. To produce more accurate and dependable findings about the effectiveness of PRP in this situation, future studies should concentrate on resolving these methodological issues. Dry needling presents a promising avenue as an adjunctive therapy in the rehabilitation of Achilles tendon ruptures.²⁶ Its ability to ease pain, improve local blood flow, and relax tense muscles could make rehabilitation more successful overall. Further research is necessary to determine dry needling's direct effect on the structural healing of the torn tendon itself, even if it may provide symptomatic relief and enhance functional recovery. The best results from dry needling are probably obtained when it is incorporated within a thorough treatment plan that also incorporates evidence-based therapies like a systematic program of progressive strengthening exercises and properly monitored load progression.

Return to play and long-term outcomes

The recovery timeline for Achilles tendon ruptures can range from 4 to 6 months, with full recovery often taking a year or longer, influenced by factors like age, activity level, rupture severity, treatment, and rehabilitation program adherence.¹⁷ After returning to sports, many athletes who suffer an Achilles tendon rupture may see a decline in their ability, particularly in activities requiring quick movements like jumping and running.² Achilles tendon rupture rates in professional athletes range from 60% to 70%, indicating a significant portion may not return to competition, so the risk of re-rupture is a concern, varying across studies and influenced by management protocol.³ Notably, returning to play too early in the recovery process may increase the risk of sustaining a re-rupture.²⁷ Achilles tendon ruptures can cause persistent impairments in plantar flexor muscle performance and altered lower extremity movement patterns, potentially impacting functional abilities and increasing the risk of other musculoskeletal problems, highlighting the significant impact on athletes' careers and physical function.²⁸ It emphasizes how crucial it is to participate in an extensive and well-organized rehabilitation program in order to reduce the chance of long-term functional restrictions and to increase the chances of a successful return to sport. For the explosive motions that are essential to many sports, the Achilles tendon is essential. Even in cases where the tendon heals properly, an athlete's capacity to function at their pre-injury level may be adversely affected by lingering weakness, chronic discomfort, or minor changes in biomechanics. As a result, rehabilitation regimens need to be all-encompassing, addressing the recovery of power, agility, and sport-specific skills in addition to strength and flexibility.

A safe and successful return to athletic engagement requires a rehabilitation strategy that is progressive and well-tailored. The finding that well-managed non-operative and surgical treatment techniques¹⁵ have similar rates of re-rupture implies that choosing the best course of action should be a personalized choice. Clinicians should consider a variety of patient-specific circumstances and preferences when recommending treatment, rather than depending just on the belief that surgery is intrinsically better at preventing re-ruptures. Non-operative management, in conjunction with early functional rehabilitation and close clinical monitoring, can be a viable and effective alternative for some patients, even though surgical intervention may be the preferred option for some patient populations, such as elite athletes who may prioritize a potentially faster or more predictable return to high-intensity activity. Implementing a planned, gradual, and closely monitored rehabilitation program that is customized to each patient's needs and objectives is essential to optimal results in either case.

The management of Achilles tendon rupture (ATR) has under gone significant evolution over the past decades, reflecting improved understanding of tendon biomechanics and healing physiology. A central theme across the reviewed literature is the shift away from prolonged immobilization toward early mobilization and functional rehabilitation, irrespective of whether treatment is surgical or conservative.^14,20 This paradigm emphasizes the importance of controlled mechanical loading to stimulate tendon repair through mechanotransduction pathways, enhancing collagen organization and functional recovery.²¹

Operative versus non-operative management

The longstanding debate over surgical versus non-surgical care remains unresolved, though recent evidence suggests that outcomes are often equivalent when rehabilitation protocols are optimized. Non-operative treatment combined with structured, progressive loading yields comparable re-rupture rates and functional outcomes to surgical repair in carefully selected patients.^3,15 Surgery, however, may offer advantages for younger and highly active populations who prioritize rapid return to high-demand activities.¹⁷ Minimally invasive techniques such as the Percutaneous Achilles Repair System (PARS) reduce wound complication risks but necessitate careful surgical expertise due to increased sural nerve injury potential.^10,18 Ultimately, treatment choice must be individualized, balancing risks, benefits, and patient goals.

Role of rehabilitation

Rehabilitation is a critical determinant of long-term outcomes. Adherence to structured protocols encompassing progressive strengthening, proprioceptive training, and sport-specific conditioning strongly correlates with functional restoration and safe return to play.¹⁶ Importantly, inadequate compliance can compromise tendon healing, regardless of initial treatment modality. Clinicians must therefore emphasize patient education, adherence monitoring, and gradual progression to mitigate risks of re-injury and persistent impairments.

Adjunctive and emerging therapies

Adjunctive interventions such as platelet-rich plasma (PRP) and dry needling have generated considerable interest but remain controversial. Systematic reviews and meta-analyses provide conflicting evidence regarding PRP’s efficacy, with some improvements noted in strength and morphology, but limited impact on pain or re-rupture prevention.^23,24 Similarly, dry needling appears promising for pain relief and local vascularization,²⁶ yet its direct influence on tendon healing remains insufficiently proven. The heterogeneity of study designs and methodologies underscores the need for more standardized, high-quality trials to establish clear clinical recommendations.^22,25

Long-term functional implications

Despite advances in treatment, ATR continues to have long-lasting effects on physical performance. Persistent deficits in plantarflexion strength, altered gait mechanics, and reduced explosiveness in jumping and sprinting are frequently reported, even among professional athletes.^2,28 While both operative and non-operative approaches can achieve satisfactory tendon healing, residual impairments highlight the importance of comprehensive rehabilitation that extends beyond structural recovery to include neuromuscular control, agility, and psychological readiness. Premature return to sport has been consistently linked to elevated re-rupture risk,²⁷ emphasizing the necessity of individualized timelines for reintegration into competition. Overall, the findings highlight that ATR management is not defined by a single superior strategy but rather by a patient-centered approach integrating accurate diagnosis, individualized treatment selection, structured rehabilitation, and cautious reintroduction to physical activity.

In summary, both surgical and non-surgical care of Achilles tendon ruptures have seen substantial changes, with an increasing focus on early weight-bearing and functional rehabilitation. Even while surgical repair is still frequently chosen, especially for sportsmen and active people, non-operative therapy, when combined with organized rehabilitation, has frequently shown results that are equivalent. Considering the patient's features, the extent of the injury, and the intended functional results, the best course of treatment should be chosen on an individual basis. Though more research is required to determine their precise involvement in the treatment of Achilles tendon ruptures, emerging therapies like PRP injections and dry needling are being studied for their potential to enhance healing and improve recovery. Further study is necessary to improve rehabilitation techniques, optimize treatment regimens, and eventually improve long-term results for everyone impacted by this prevalent and potentially incapacitating injury, particularly those aiming to resume sports endeavors. In conclusion, optimal management of Achilles tendon rupture requires a patient-centered, individualized approach that considers age, activity level, and functional goals. Ongoing research is essential to refine rehabilitation strategies, evaluate adjunctive therapies, and establish standardized, evidence-based protocols that maximize long-term outcomes for diverse patient populations.

The primary limitation of this study is its reliance on previously published literature, which may be influenced by methodological variability and heterogeneity among studies. Additionally, long-term comparative data on newer adjunctive therapies remain limited, restricting the ability to draw definitive conclusions about their role in standard clinical practice.

This study contributes to the growing body of knowledge on Achilles tendon rupture management by synthesizing evidence on surgical, non-surgical, and adjunctive approaches. By emphasizing individualized treatment strategies and the importance of structured rehabilitation, it provides valuable insights for clinicians and supports the development of patient-centered care models that improve functional recovery and long-term outcomes.

Future studies should focus on high-quality randomized controlled trials comparing long-term outcomes of surgical versus non-surgical interventions, with particular attention to patient subgroups based on age, sex, and activity level. Additional research is needed to evaluate the effectiveness and safety of adjunctive therapies such as platelet-rich plasma (PRP) and dry needling. Furthermore, the refinement of rehabilitation protocols and the role of biomechanical assessments warrant further exploration.

The authors would like to express their sincere gratitude to all institutions and colleagues who provided valuable guidance throughout the preparation of this manuscript. Special appreciation is extended to the medical library staff for their assistance in accessing relevant literature. The authors also acknowledge that this work forms part of the doctoral program project at the Sports University of Tirana (SUT). Furthermore, the authors wish to express their appreciation to the journal for its support in facilitating the publication process.

The authors declare that there are no conflicts of interest regarding the publication of this manuscript.

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