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Patients with acute Achilles tendon rupture have a choice of operative or nonoperative treatment approaches. In a Norwegian multisite, randomized trial, researchers compared surgical approaches (either open or minimally invasive) to nonoperative treatment in 532 adults (mean age, 40) with first acute tendon ruptures. Patients were excluded if they had taken quinolones, received local glucocorticoid injections, had previous ruptures or walking disabilities, or were classified as a high anesthesia risk. All patients received equinus casts with plantar flexion for 2 weeks after injury and then had 6 weeks of progressive dorsiflexion with weight bearing as tolerated.
At 12 months, patients in all three groups had similar mean declines from pre-i…