Abstract Introduction: The acromioclavicular (AC) joint, a crucial point of shoulder articulation, facilitates overhead and across-the-body arm movements. Athletes, especially those in high-contact or fall-prone sports, frequently experience AC joint injuries. These injuries, based on the Rockwood classification, range from type I to type VI, with treatments varying accordingly. One innovative treatment method reconstructs both ligaments using a semitendinosus autograft, aiming for an anatomical and functional restoration of the joint. This study evaluates the outcomes and complications of this method. Methodology: Study design: A prospective study from January 2021 to July 2022. Data source: Patients with Rockwood type III to VI AC joint ligament disruptions treated at Osmania General Hospital. Sample size: 14 patients. Surgical Technique for Acromioclavicular Ligament Reconstruction: Detailed steps encompassing patient positioning, graft harvesting and preparation, surgical approach, graft fixation, and postoperative care. Results: A total of 14 patients with AC disruptions (12 men and 2 women) treated with semitendinosus reconstruction were followed up for 24 months. Out of 14, 13 were Rockwood type III and 1 was type V ACJ dislocations. The mean patient age was 41 years (25–59 years). Functional outcome was assessed according to the constant-Murley score, according to which 7 patients had excellent, 6 had good, and 1 had an adequate outcome. We had only 1 case of surgical site infection leading to delayed rehabilitation leading to loss of abduction. Discussion: AC joint disruptions represent a significant percentage of shoulder injuries, especially among young, active individuals. Conservative treatments are typical for lower-grade injuries, but high-grade injuries often necessitate more invasive approaches. Our study included 14 patients, focusing on a semitendinosus autograft reconstruction. The historical Weaver–Dunn procedure, though once popular, has been phased out due to recurrence and strength issues. Our method, avoiding the controversial coracoid tunnel drilling, has shown promising results with no recorded fractures. Conclusion: The semitendinosus autograft method, with its biological orientation for coracoclavicular ligament reconstruction, presents fewer complications, especially in terms of coracoid fractures and reduction losses.