Seven randomized controlled trials evaluating operative and nonoperative management of Achilles tendon ruptures were included in this meta-analysis. The purpose was to determine if the two treatment options differed in functional outcome over 2 years postintervention. The results indicated that while functional outcome was significantly better following surgery at 3 months, there was no significant difference between operative and conservative management at 6, 12, and 24 months. There also was no significant difference observed between groups regarding range of motion. The incidence of re-rupture was significantly lower following surgical intervention than conservative treatment.