Background The Achilles tendon is the strongest tendon in the human body. The incidence of Achilles tendon ruptures appears to be increasing. Objectives The aim of this review was to systematically summarize predictors influencing Achilles tendon rupture (ATR) risk. Methods A systematic literature search was performed of reported determinants influencing the ATR risk. Studies were eligible if there was: (i) description of determinants predicting ATR; (ii) an outcome defined as ATR; (iii) any study design with at least ten adults included with ATR; (iv) use of statistical tests regarding differences between patients with an ATR and healthy controls; (v) a full text article available; (vi) an article written in English, German or Dutch. Quality assessment was done using a standardized criteria set. Best-evidence synthesis was performed. Results We included 31 studies, of which two (6.5 %) were considered high-quality studies. Moderate evidence was found for increased ATR risk and decreased fibril size of Achilles tendon. Conclusion Based on the results of this systematic review there is moderate evidence that decreased tendon fibril size increases the ATR risk. There is limited evidence for many other factors, some of which are modifiable, such as increased body weight, oral corticosteroid use and quinolone use and living in an urban area, and therefore may be of interest in future studies. Furthermore, these results showed that more high-quality studies are needed for evaluating the determinants influencing the ATR risk.