Achilles tendon (TA) rupture is a common injury. However, there is limited evidence on the long-term outcomes following surgical repair. This systematic review aims to evaluate the efficacy and complications associated with surgical management of TA rupture with a minimum five-year follow-up duration. A literature search of Medline OVID, EMBASE, and Cochrane databases was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcomes measured focused on postoperative complications, rates of re-rupture, contralateral rupture, and revision surgery. Six studies including 806 patients were included. Surgical repair demonstrated low re-rupture rates (4.2%) and revision rates (3.7%) at five years follow-up. Contralateral ruptures were uncommon (N=5), and 30 patients required revision surgery. However, complications such as deep vein thrombosis (6.3%) and wound infections (3.6%) were observed. Surgical repair of TA rupture demonstrates excellent long-term outcomes, including low rates of re-rupture and revision over a minimum of five years. While complications such as deep vein thrombosis and wound infections are observed, this systematic review highlights the reliability, durability, and overall success of surgical intervention in effectively treating this condition.