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Category: Other Introduction/Purpose: Surgical repair of symptomatic chronic Achilles tendon (TA) rupture is a challenging problem due to the presence of large defect between tendon edges. We report the results of surgical repair of symptomatic chronic TA rupture by synthetic graft augmentation. Methods: Seven consecutive patients with a symptomatic chronic TA rupture underwent surgical repair by VY plasty and augmentation with bio-absorbable synthetic graft (Artelon®). In all patients, the intraoperative tendon gap after debridement was more than 5 cm (Myerson Grade 3). Postoperatively, weight bearing on plantigrade foot was allowed at 4 weeks in a plaster cast. The total duration of plaster immobilization was 10 weeks. The complications were recorded prospectively and functional outcome was assessed by AOFAS score and Achilles tendon Total Rupture Score (ATRS). Results: At a mean follow up of 29 months there was no re-rupture or deep infection. All patients reported good functional outcome as shown by AOFAS and ATRS scores. There were no graft related complications. One patient had an early superficial infection which was treated by a course of oral antibiotic. Two patients reported numbness in the sural nerve territory after surgery,of which one patient developed scar sensitivity and paraesthesia. At final follow up, six patients were able to do single stance heel raise however, calf wasting was noted in all patients. Conclusion: Symptomatic chronic TA repair augmented by synthetic graft is a safe and effective technique in Myerson Grade 3 chronic TA ruptures where gap between two tendon edges is more than 5 cm.