Abstract: [Objective] To compare the clinical efficacy of modified direct anterior shoulder arthroscopy and open double incision combined with self-made adjustable length double Endobutton plate in the treatment of acute acromioclavicular dislocation.[Methods] 38 patients with acute acromioclavicular dislocation admitted to our group from January 2017 to July 2020 were retrospectively analyzed. Among them, 21 patients underwent modified direct anterior shoulder arthroscopy (endoscopic group) and 17 patients underwent open double incision surgery (open group).Perioperative related indicators, functional indicators during follow-up and changes in different imaging Spaces were compared between the two groups.[Results] All 38 patients were followed up for 12-30 months, with an average of (16.37±3.56) months. There were no significant complications in perioperative period between the two groups, and there were no statistically significant differences in operative time and postoperative hospital stay (P>0.05). However, the total length of incision and intraoperative fluoroscopy times in the arthroscopy group were superior to the open group.The difference was statistically significant (P<0.05). VAS score, lifting activity, constant-Murley score and UCLA score were significantly improved in both groups at 1 month, 6 months after surgery and at the last follow-up (P<0.05), but there was no significant difference between the two groups at the same time node (P>0.05).The acromioclavicular joint spacing and coracoclavicular joint spacing in 2 groups were lower than those before surgery 6 months after surgery and at the last follow-up, with statistical significance (P<0.05).[Conclusion] Improved direct anterior shoulder arthroscopy combined with self-made adjustable double Endobutton plate has a satisfactory effect in the treatment of acute acromioclavicular joint dislocation, with the advantages of small incision and less fluoroscopy.