BACKGROUND: Unilateral double-level Achilles tendon tear is a rare presentation that has not been previously reported in the English literature. Diagnosis and management of these cases are challenging, and outcomes are not well described in the literature.

CASE REPORT: A 46-year-old man presented to us with ankle pain following a football sports injury. Clinical examination and ultrasound scan showed unilateral Achilles tendon double-level partial tears that were managed conservatively. The patient presented again with another trauma and progression to full-thickness tear, managed operatively with open Achilles tendon repair technique.

CONCLUSIONS: Management of these cases is complex and challenging. In the literature, both operative and non-operative management have been described. However, the recent literature shows no major difference between these 2 methods of treatment. Our case was quite unique, so we decided to use the open repair technique. Awareness about this rare presentation and the need for further research is necessary for proper management of such cases.

Keywords: Achilles Tendon, Ankle Injuries, Athletic Injuries, Rupture, Tendon Injuries, Recurrence, Tendinopathy, Ultrasonography