Introduction: Acromioclavicular (AC) joint dislocations are common shoulder injuries, often resulting from direct falls onto the shoulder tip. The severity of these injuries, classified by the Rockwood system, ranges from mild to severe. While mild injuries may resolve with conservative treatment, severe dislocations often require surgical intervention, such as TightRope fixation, to restore function and prevent long-term complications. This study aims to assess the efficacy of TightRope fixation in treating severe AC joint dislocations and improving functional outcomes. Materials and Methods: A prospective observational study was conducted at the Tertiary care hospital at Pondicherry among six adult patients with Rockwood types III-VI AC joint disruptions who underwent open surgical fixation. Patients with compound injuries or prior AC joint arthritis were excluded. Pre- and post-operative data were collected using a standardized interview schedule. Functional outcomes were assessed at 1, 3, and 6 months using the Constant and Pain scores. Results: The study included six patients aged 30-62, predominantly male and right-sided. Most dislocations were Rockwood type 3 (50%) or 5 (50%). All patients underwent TightRope fixation with variations in suture material.Functional outcomesdemonstrated significant improvement over time. At six months, patients achieved near-normal function. Initial pain levels were moderate but decreased significantly by three months and were minimal at six months. Conclusion: These results suggest that TightRope fixation is an effective treatment for acromioclavicular joint dislocations with favorable functional and pain outcomes.