Purpose <p>To evaluate patient reported outcomes following combined ACJ stabilization using a clavicle hook plate and coracoclavicular augmentation with double-button fixation.</p> Methods <p>This retrospective case series analyzed prospectively included all patients who underwent surgical treatment for isolated grade III or V acromioclavicular joint (ACJ) dislocation between 2021 and 2024. Inclusion criteria comprised age between 18 and 60 years and a minimum follow-up of 2 years. Associated traumatic injuries or fractures, and chronic cases defined in excess of more than three weeks from injury to surgery, were excluded. Clinical outcomes were assessed using the QuickDASH and Simple Shoulder Test (SST) scores.</p> Results <p>Twenty-three patients (mean age 48.3 ± 10.2 years; mean follow-up 27.7 ± 2.8 months; <i>n</i> = 17 Type V, <i>n</i> = 6 Type III) were included. The mean preoperative QuickDASH score of 56.6 improved to 1.2 at 24 months, with 87% achieving MCID and SCB by 6 months and 100% reaching all clinical thresholds by 12 months. The mean SST score improved from 33.0 to 100. All patients reached MCID, SCB, and PASS by 12 months. Hook plates were removed at a mean of 5.6 months; four required early removal at 3 months due to pain and limited function. Two patients had mild superficial wound infections.</p> Conclusions <p>Combined suture button and hook plate fixation in acute acromioclavicular joint dislocations results in excellent patient-reported outcomes, with return to normal shoulder function by 12 months. At six months, all patients met thresholds for MCID and SCB on the Simple Shoulder Test, while 87% achieved both benchmarks on the QuickDASH, indicating a high rate of clinically meaningful recovery.</p> Level of evidence <p>Level IV; Case series.</p>