Achilles tendon ruptures cause considerable morbidity and functionality reduction. There is lack of consensus regarding the best option for treatment following acute Achilles tendon rupture. Recent studies have failed to show substantial difference in outcome following conservative or operative treatment using an early active rehabilitation program. Meta-analyses have shown that conservative management has increased the risk of re-rupture, whereas operative intervention carries risks of complications related to the wound and iatrogenic nerve injury. This article reviews the updated literature-based guidelines for the treatment of Achilles tendon tears.