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Backgrounds To compare the reduction effect of single loop and double loop in the treatment of acute acromioclavicular dislocation, postoperative complications and the effect of shoulder function recovery, so as to determine the best fixation method for acromioclavicular. Methods Patients with acute acromioclavicular dislocation treated with TightRope fixation in our hospital from January 2014 to May 2019 were reviewed. According to the different fixation methods, it can be divided into single loop group and double loop group. The difference and difference ratio of coracoclavicular spacing between the affected side and the healthy side at the 1st day, 3rd week, 6th week, 3rd month, 6th month, 1st year, 2nd year and the last follow-up were compared between the two groups, as well as the postoperative visual analog scale pain score (VAS), American Shoulder and Elbow Surgeon score(ASES) and constant-Murley score. Results On the 1st postoperative day, there was no significant difference in the reduction effect between the single loop group and the double loop group (P = 0.90,P = 0.93). 3 weeks after surgery, although the overall difference and difference rate of CCD between the two groups were different (P = 0.00,P = 0.00), there was no significant difference between type ⅲ and type ⅳ in terms of injury type (Type ⅲ P = 0.13,P = 0.16; Type ⅳ p = 0.22, p = 0.20;). Since 6 weeks after surgery, there were significant statistical differences in CCD difference rate between single loop group and double loop group. Conclusions Both single loop and double loop Tightrope can achieve satisfactory results in the treatment of fresh Rockwood ⅲ - ⅴ acromioclavicular dislocation. The single-loop group has the risk of postoperative reduction and loss.