Acute acromioclavicular (AC) joint injuries are a commonly encountered clinical condition, most frequently occurring in young males after traumatic impact during sports or high energy accident. The incidence of AC joint injury is estimated at 1.8 per 10,000 people per year with a ratio of 5:1 in males versus females (Chillemi et al., Emerg Med Int 2013:171609, 2013; Andreani et al., Eur J Orthop Surg Traumatol Orthop Traumatol 24(2):237–242, 2014). AC joint instability is typically classified by the Rockwood criteria and can be treated nonsurgically or surgically. According to the Rockwood classification, Type I–II injuries are typically treated conservatively, Type V–VI injuries are typically considered for operative management to restore translational and rotational stability, although recent literature suggests nonoperative management may also be viable, and Type III injuries remain controversial for nonoperative versus operative management (The Canadian Orthopaedic Trauma Society, J Orthop Trauma 29(11):479, 2015). Available repair and reconstruction techniques include both open and arthroscopic approaches; however, a superior technique has not been identified. While current techniques have improved on the traditional repairs such as Weaver Dunn technique with suture, graft, and hybrid-based repairs, outcomes have not been shown to differ among these constructs. Most techniques demonstrate improved clinical outcomes with relatively low failure rates. Risk factors such as higher body mass index and delay to surgery are associated with higher rates of radiographic failure (Clavert et al., Orthop Traumatol Surg Res 101(8 Suppl):S313–S316, 2015). Postoperative recovery usually involves a period of shoulder immobilization for 2–4 weeks after which range of motion can begin with focused physical therapy, prior to strength rehabilitation beginning 8–12 weeks postoperatively. While return to sports (RTS) can vary based on the initial presenting injury, most injuries require 4–6 months prior to RTS. Refractory AC joint arthropathy or arthritis most commonly presents as degenerative, although, less commonly, it is possible for the arthropathy to be secondary to instability resulting from a traumatic incident. AC joint arthropathy can be managed with arthroscopic or open AC joint resection and distal clavicle excision.