Sixty patients with acute Achilles tendon rupture were randomized to treatment using CARTA (n=21), nonsurgical management (n=20), or surgical repair (n=19). Outcomes were calf muscle volume and Achilles tendon elongation, measured by MRI after 12 months. Secondary measures included limb symmetry index and subgroup comparisons of surgical vs nonsurgical treatments. Overall, the study found no statistically significant differences in calf muscle volume or tendon elongation between CARTA-guided treatment and either control group, nor between surgical and nonsurgical treatment. All groups demonstrated significant muscle atrophy (24–30%) and tendon elongation (59–76% soleus; 8–14% gastrocnemius) in the affected limb compared to the unaffected side. These findings suggest CARTA did not improve structural outcomes compared with standard approaches, and surgery did not outperform nonsurgical care.