One hundred eleven patients with acute rupture of the Achilles tendon were included in a prospective trial and randomly assigned to groups for operative (56 patients) or nonoperative (55 patients) treatment. All of the patients were followed with clinic evaluations at 4 months and 1 year after the rupture. The major complications in the operative treatment group were three reruptures and two deep infections as compared with seven reruptures, one second rerupture, and one extreme residual lengthening of the tendon in the nonoperative group. There were fewer minor complications in the nonoperative group than in the operative group. The operatively treated patients had a significantly higher rate of resuming sports activities at the same level, a lesser degree of calf atrophy, better ankle movement, and fewer complaints 1 year after the accident. The conclusion we reached through this randomized prospective study is that operative treatment of ruptured Achilles tendons is preferable, but nonoperative treatment is an acceptable alternative.