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Introduction Achilles tendon rupture’s (ATR) are increasing globally and are commonly managed non-surgically. We aimed to understand recovery using ultrasound imaging, strength testing and patient reported outcomes.Materials and Methods Longitudinal cohort study consisting of 60 participants post-ATR managed non-surgically. Assessments were performed at week 0, 8, 10, 16, 26, and 52. Outcomes included Ultrasound Tissue Characterisation (UTC): Cross-Sectional Area (CSA) of Aligned Fibrillar Structure (AFS) and Disorganised Fibrillar Structure (DFS). Plantarflexor strength was measured using maximal voluntary isometric contraction (MVIC) and the calf raise test. Patient-reported outcomes included the Achilles Tendon Rupture Score (ATRS), EQ-5D-5L and Tampa Scale for Kinesiophobia (TSK). Achilles tendon resting angle (ATRA) indirectly measured tendon elongation.Results Thirty-six participants completed 52 week follow up (mean age 49 years, 85% male, body mass index 30). Primary ATR mechanism was sport (75%)At all assessments, the ruptured tendon CSA and DFS was significantly greater than the non-ruptured side (p<0.001). At 52 weeks, DFS represented 28% of the ruptured tendon in comparison to 14% on the non-ruptured side.MVIC on the ruptured limb at 52 weeks was 93kg or 1xbody weight (BW) and non-ruptured limb was 127kg or 1.4xBW. Leg symmetry index (LSI) at 12 months was 73%. Calf raise test LSI at 52 weeks was 60%. Relative ATRA was 7°.ATRS at 52 weeks was 77, EQ-5D-5L index 0.9, EQ-5D-5L VAS 80, TSK 35.Conclusion At 52 weeks following non-surgical management of ATR there was persistent fibrillar disorganisation, isometric plantarflexor weakness, tendon elongation and reduced function.