Background: Truly anatomic coracoclavicular ligament reconstruction (TACCR) according to the original insertions is a creative new method for the treatment of severe acromioclavicular separation. This research analyzed the clinical and radiologic results of TACCR in 25 patients with at least 2-year follow-up. Methods: The study enrolled 25 patients with Rockwood type V acromioclavicular joint dislocations who underwent TACCR using 2 Endobutton (Smith & Nephew Inc., Andover, MA, USA) devices from May 2013 to October 2015. Patients were assessed with clinical and radiologic follow-up at 3, 6, 12, 18, and 24 months postoperatively. The clinical assessments consisted of the visual analog scale and the Constant score. The radiographic evaluations were performed by measurements of the coracoclavicular distance. Results: The mean follow-up was 34 +/- 6.8 months (range, 24-48 months). The visual analog scale and Constant scores revealed significant advancements from 5 +/- 0.9 (range, 4-7) and 45 +/- 5.6 (range, 30-54) scores preoperatively to 0 +/- 0.5 (range, 0-2) and 95 +/- 2.9 (range, 91-98) scores at 24 months postoperatively, respectively. The coracoclavicular distance significantly decreased from 23 +/- 5.4 mm (range, 16-34 mm) preoperatively to 8 +/- 0.9 mm (range, 7-10 mm) at the final follow-up. Conclusions: TACCR represents a safe, reliable and creative surgical technique that yields good to excellent clinical and radiologic outcomes in the treatment of severe acromioclavicular separation. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.