Operative vs. Non-Operative Treatment of Acute Ruptures of the Achilles Tendon

Inclusion Criteria: * Complete mid-substance rupture of the Achilles tendon as diagnosed on clinical exam * Present for initial assessment and treatment with application of a plantar-flexed cast within 48 hours of their injury. * Referred to one of the participating orthopaedics surgeons in a timely fashion so as to allow for further treatment (operative repair or initiation of the rehabilitation protocol) within 14 days of their injury. Exclusion Criteria: * Open Achilles injury * Achilles injury that is not a mid-substance tendon injury * Any additional injury to the ipsilateral lower extremity * Contraindication to surgery or anesthetic * (Physical or mental) that may interfere with compliance with the rehabilitation protocol * Any known factor for increased risk of Achilles tendon rupture (i.e. diabetes mellitus, immunosuppressive therapy including local or systemic steroids, and fluoroquinolone use).