Abdelrahman AA, et al. - Fifty-two patients with acute acromioclavicular joint dislocation type III and IV were involved in this comparative study by the experts in order to contrast clinical outcomes and cost-efficiency between arthroscopic and open repair using TightRope in acromioclavicular joint dislocation III and IV. Constant-Murley Score progressed from 40.68 for the Arthroscopic Repair Group (ARG) and 40.70 for the Open Repair Group (ORG) preoperatively to 84.18 and 84.45 following 2 years from the operation. The visual analog scale score declined from 60.59 for the ARG and 64.50 for the ORG 1 day following surgery to 18.04 and 17.87, respectively, following 6 months. On a postoperative day 1, the coracoclavicular (CC) distance declined from 29.27 mm in the ARG and 28.16 mm in the ORG preoperatively to 9.86 mm in the ARG and 10.54 mm in the ORG. Rewidening of the CC distance occurred subsequent to 6 months and 1 year postoperatively though continued to be stable at final follow-up. A notable variation in surgical time and cost of consumables was noted. Therefore, open and arthroscopic repair of acute acromioclavicular joint dislocation gave good clinical outcomes, however, the arthroscopic technique is more expensive and has a longer surgical time.