60 patients with a complete Achilles tendon rupture were randomized to either open repair with a Krackow stitch followed by standardized rehabilitation or nonoperative treatment with standardized rehabilitation alone. The purpose of this study was to compare results on the Leppilahti score, calf strength, health-related quality of life and re-rupture rate between groups over an 18-month follow-up. No significant differences between groups were observed in Leppilahti scores over the duration of follow-up. Calf strength was significantly greater in the open repair group compared to the nonoperative group beginning at 6 months post-treatment and persisting at 18 months post-treatment.