[Objective] To compare the clinical effects of three surgical methods for acute Rockwood type Ⅲ acromioclavicular dislocation: reconstruction of coracoclavicular ligament with double bundle and three endobuton, single bundle and double endobuton, and traditional nail hook plate fixation under total arthroscopy.. [Methods] The clinical data of 49 patients with Rockwood III acromioclavicular dislocation treated in our hospital from October 2016 to December 2020 were analyzed retrospectively. According to the results of preoperative communication between doctors and patients, 15 patients in the double beam group, 17 patients in the single beam group and 17 patients in the hook plate group were compared in the perioperative period, follow-up and imaging results of the three groups. [Results] There was no significant difference in general data among the three groups. The incision length, intraoperative blood loss and postoperative hospital stay in the double bundle group and single bundle group were less than those in the hook plate group, with significant differences (P<0.05). After treatment, the Constant Murley score, abduction ROM, anteflexion ROM and external rotation ROM of the three groups increased gradually at each time point (P<0.05). At the last follow-up, the constant Murley score, abduction ROM, anteflexion ROM and external rotation ROM of the double beam group were significantly better than those of the single beam group and the hook plate group (P<0.05). After treatment, the VAS scores of the three groups decreased gradually at each time point. There was a statistically significant difference in VAS scores of each group 4 days and 14 days after treatment (P<0.05). There was no statistically significant difference in VAS scores of each group 3 months and 18 months after treatment (P>0.05). The imaging evaluation showed that the CCD and ACD of the three groups at the last follow-up were significantly reduced compared with those before surgery (P<0.05). There was no statistically significant difference in ACD between groups 2 weeks after operation and at the last follow-up (P>0.05), but there was statistically significant difference between the CCD double beam group and other groups at each time point (P<0.05). [Conclusion] The clinical effect of double beam group in the treatment of acute Rockwood Ⅲ acromioclavicular dislocation is better than that of single beam group and hook plate group.