The purpose of this study was to examine the outcome after surgery for an acute Achilles tendon rupture. In particular, we wanted to study whether persons who have suffered an Achilles tendon rupture are at greater risk of a contralateral tendon rupture. From September 1990 to April 1997, 168 acute Achilles tendon ruptures in 26 women and 142 men were treated operatively. In August 1998 (median: 4.2 years post injury), 154 of these patients (92%) responded to a follow-up questionnaire. Local symptoms (pain, decreased strength and/or reduced range of motion) were reported pre injury by 25% of the patients; at follow-up this had increased to 52%. Ten patients (6%) experienced a rupture on the contralateral side during the follow-up period (OR: 176 [70-282] vs. the expected rate based on the general population risk of this injury, P<0.001). Thus, this study suggests that patients with an Achilles tendon rupture are at significantly increased risk of a contralateral tendon rupture, as well. Also, as many as half of the patients suffered from post-injury problems at long-term follow-up.