Purpose <p>The objective of the present study is to examine how repairing the capsule affects the radiological and clinical results of treating acute Rockwood type V acromioclavicular joint dislocations using the endobutton method.</p> Methods <p>The study involved patients between the ages of 18 and 65 who had acute Rockwood type V acromioclavicular joint dislocation and were treated using the double endobutton technique, with or without capsule repair, from January 2021 to December 2023. Clinical and radiological assessment was conducted at various time points up to the last follow-up. Functional evaluation was conducted using the Disability of Arm, Shoulder and Hand (DASH) scoring system, Constant-Murley Score (CMS), and Specific Acromioclavicular Score (SACS) at the final follow-up. Radiological evaluation involved the measurement of the coracoclavicular distance and evaluation of complications. Statistical analysis was performed using Mann-Whitney U and Pearson’s Chi-Square and Fisher’s Exact test.</p> Results <p>In this study, a group of 23 patients were monitored over a period of approximately 20.91 ± 8.3 (12–36) months. Functional results were significantly different in favor of Group 2, when the groups were categorized from excellent to poor (<i>p</i> &lt; 0.05). At the final radiograph, the mean coracoclavicular distance showed a statistically significant difference in favor of Group 2 (<i>p</i> = 0.039). Loss of reduction was statistically significantly seen more in Group 1 (<i>p</i> = 0.031). The total rate of complication was similarly in the two groups, showing no substantial variations.</p> Conclusion <p>The combination of the double endobutton method and capsule repair is a secure and dependable procedure that provides sufficient stability. This technique has provided favorable clinical and radiologic results in the treatment of acute Rockwood type V acromioclavicular dislocation.</p> Level of evidence <p>Level III, Retrospective comperative study.</p>