Abstract: [Objective] To compare the clinical efficacy of percutaneous and open suture in the treatment of acute Achilles tendon rupture. [Methods] The clinical data of 35 patients with acute Achilles tendon rupture treated in our hospital from October 2017 to October 2021 were retrospectively analyzed. According to the results of preoperative doctor-patient communication, 16 cases were closed and sutured with suture anchors (via skin group), 19 cases were treated with incision and suture (open group). The perioperative and follow-up results were compared between the two groups.[Results] All patients successfully completed the surgery without any obvious intraoperative complications. The percutaneous group had significantly better surgical time [(56.6 ± 10.4) min vs (81.7 ± 28.7) min, P<0.05], incision length [(1.9 ± 0.6) cm vs (7.7 ± 3.5) cm, P<0.05], intraoperative blood loss [(10.6 ± 6.0) ml vs (26.0 ± 15.8) ml, P<0.05], and hospital stay [(8.2 ± 1.6) d vs (11.1 ± 3.5) d, P<0.05] compared to the open group (P<0.05). There was no statistically significant difference in walking time and incision healing between the two groups (P<0.05). The average follow-up time was (21.8 ± 7.1) months, and the complete weight-bearing activity time in the percutaneous group [8.4 ± 1.0 weeks vs 12.8 ± 3.1 weeks, P<0.05] was significantly earlier than that in the open group (P<0.05). Over time, the VAS, AOFAS, ATRS scores, and plantar flexion dorsiflexion activity of both groups of patients improved significantly (P<0.05). There was no statistically significant difference in VAS scores between the two groups before surgery (P>0.05). At 1 and 6 months after surgery, the VAS scores in the percutaneous group [1 month after surgery: (1.6 ± 0.4) vs (2.3 ± 0.7), P<0.05; 6 months after surgery: (0.9 ± 0.3) vs (1.3 ± 0.4), P<0.05;] were significantly better than those in the open group. At the corresponding time points, there was no statistically significant difference in AOFAS, ATRS scores, and plantar flexion dorsiflexion activity between the two groups (P>0.05) [Conclusion]: Compared with open suture therapy, closed suture with thread anchor has smaller incisions, less intraoperative bleeding, shorter surgical time, hospital stay, and postoperative to full weight bearing time, and does not increase postoperative complications for patients. It is worth promoting.