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A retrospective study of the surgical treatment methods for complete acromioclavicular (AC) dislocations was initiated to investigate the efficacy of each. During the years 1972–1985, a total of 95 surgical procedures were performed for complete AC dislocations. The medical records of 90 cases were available for review. The operative methods compared coracoclavicular (CC) with AC fixation methods. Excision of the distal clavicle was performed for chronic dislocations. AC fixation methods included Kirschner wires alone, Kirschner-wire fixation with coracoacromial ligament transfer, and Kirschner-wire fixation with tension wiring. Results were graded using evaluation of pain, range of motion, and residual deformity. AC fixation methods proved to be more successful than CC fixation methods. Excellent results were obtained in more than 89% of both AC and CC methods. AC methods had more minor complications including infections and implant breakage, but no failure or recurrences of the dislocation. CC methods resulted in 9% failure or recurrences. Of the AC fixation methods, the Kirschner wire with tension wiring gave the best results but required a more extensive operation for removal of implants. Excision of the distal end of the clavicle is an adequate form of treatment for the chronic complete painful AC dislocation.