The treatment of acute of Achilles tendon rupture experienced a dynamic dev
elopment in the last ten years. Decisive for this development was the appli
cation of MRI and above all the ultrasonography in the diagnostics of the p
athological changes and injuries of tendons. The question of ruptue morphol
ogy as well as different courses of healing could be now evaluated objectiv
ely. These advances led consequently to new modalities in treatment concept
s and rehabilitation protocols. The decisive input for improvements of the
outcome results and particularly the shortening of the rehabilitation perio
d came with introduction of the early functional treatment in contrast to i
mmobilizing plaster treatment. In a prospective randomized study (1987-1989
) at the Trauma Dept. of the Hannover Medical School could show no statisti
cal differences comparing functional non-operative with functional operativ
e therapy with a special therapy boot (Variostabil/Adidas(R)). The crucial
criteria for therapy selection results from the sonografically measured pos
ition of the tendon stumps in plantar flexion (20 degrees). With complete a
daptation of the tendons' ends surgical treatment does not achieve better r
esults than non-operative functional treatment in term of tendon healing an
d functional outcome. Regarding the current therapeutic standards each meth
od has is advantages and disadvantages. Both, the operative and non-operati
ve functional treatment enable a stable tendon healing with a low risk of r
erupture (1-2 %). Meanwhile there is consensus for early functional after-t
reatment of the operated Achilles' tendons. There seems to be a trend towar
ds non-operative functional treatment in cases of adaquate sonografical fin
dings, or to minimal invasive surgical techniques.