OBJECTIVES: The management of acromioclavicular (AC) injuries has long been debated. We analyzed our results in treating such cases using hook plates and ligament suture. DESIGN:: Retrospective nonrandomized study. SETTING: Level I Trauma Center (University Hospital). PATIENTS: Twenty-five patients (mean age 41 years) with complete Tossy III AC joint disruptions. Using the Rockwood classification, 15 dislocations were classified as type V injuries, 9 as type III injuries, and 1 as a type IV injury. INTERVENTION: All patients were operatively treated using AC hook plates with ligament suturing after a median delay of 7 days. MAIN OUTCOME MEASURES: Clinical and radiographic evaluation using Constant-Murley functional score and Taft et al criteria. RESULTS:: A retrospective clinical and radiographic evaluation of 23 patients was performed after an average follow-up period of 30 months. The mean Constant score was 97 (range, 90-100) points, and the mean Taft score was 10.6 points. All but 1 patient were satisfied with their treatment outcome. Eight cases showed some loss of reduction after plate removal. A poor correlation existed, however, between clinical and radiographic results. CONCLUSIONS: The hook plate is a reliable fixation tool for complete AC joint dislocations, ensuring immediate stability and allowing early mobilization with good functional and cosmetic results. Routine plate removal should however be reevaluated.