A network meta-analysis shows operative repair—open or minimally invasive—cuts re-rupture risk compared with conservative care, though differences between surgical techniques are negligible and absolute risks are now small with modern functional protocols. Yet high-performance athletes face distinct pressures: quicker return is desired, but evidence shows up to one-quarter never return and those who do often need ~11 months and rarely regain prior performance. Early functional rehab matters more than the procedure itself, while timelines, career length, position demands, and re-rupture risk all complicate decision-making for elite players.