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Category: Arthroscopy Introduction/Purpose: Open repair of acute Achilles tendon rupture is considered as a standard surgical treatment while percutaneous technique has gained increasing popularity especially under endoscopic control. However, there is a lack of currently research reporting outcomes and complications following this technique. Methods: The retrospective chart reviews with prospectively collecting data were performed in 32 patients with 32 legs who underwent endoscopically-assisted percutaneous Achilles tendon repair using 6-portal technique between 2008 and 2015. The minimum follow-up to be included in the study was 6 months (mean, 49.3 months; range, 6 to 76 months). The primary outcome was Foot and Ankle Ability Measure (FAAM); Activity and Sport, Short Form-36 (SF-36); physical and mental component scores, and Visual Analogue Scale (VAS). The secondary outcomes included tourniquet time, recovery time, and complications. Pre- and post-operative FAAM, SF-36, and Visual Analog Scale were obtained and compared using pair t-test. Results: There were 32 patients (26 male and 6 female) with a mean age of 36.7 years. An average of tourniquet time was 39.6 minutes (range, 23-67 minutes). There was significant improvement of VAS (7.1/10 to 0.1/10), SF-36 (PCS (38.8 to 49.9) and MCS (49.0 to 51.8)), FAAM (Activity, 19.0 to 88.4 and Sport, 0 to 65.6). An average time to return to activity of daily living, works, and sports were 6 weeks, 7 weeks, 3.6 months respectively. The complications included hypertrophic scar without pain (6.7%), superficial wound infection (3%). There was no re-rupture, deep vein thrombosis, sural nerve injury, and painful scar in this study. Conclusion: Endoscopically assisted percutaneous Achilles tendon repair demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS. acute rupture of Achilles tendon. This technique is safe and feasible for treatment patients with acute rupture of Achilles tendon.