Achilles tendon injuries are a widespread injury that often results in disability despite being the strongest and thickest tendon of the body. Treatment protocols for patients with acute Achilles tendon rupture are constantly being modified. Both surgical and nonsurgical therapies are followed by immobilization in a cast or a movable brace. However, despite several randomized studies, there is no consensus regarding the optimal treatment protocol. Meta-analyses generally agree that the re-rupture rate in patients treated non-surgically (12.6%) is higher than in patients treated surgically (3.5%). Surgically treated patients have an increased risk of other complications such as infections, wound problems, and nerve injuries. Furthermore, regardless of treatment type, patients often have residual weakness and decreased function after Achilles tendon rupture. There are great variations in the treatment protocols used for patients with acute Achilles tendon rupture. The initial decision is whether treatment should be surgical or nonsurgical. If surgery is chosen, the literature describes many different techniques that include both open and percutaneous repairs. Despite all well-known facts, it is still unclear which approach is optimal.