We have reviewed fourteen Australian Rules Football players who were seen consecutively by a single surgeon with grade III acromioclavicular joint injuries between January 1993-June 1997. After discussion at initial consultation eight players elected for non-operative management and six for operative management. Two players in the non-operative group subsequently underwent surgical reconstruction after failure of non-operative treatment. The mean return time to non-contact training was 2.4 weeks (range 1-4, S.D. 1.52) in the non-operative group and 6.3 weeks (range 3.5-10, S.D. 2.99) in the operative group. However return to sports specific training (contact training) was at a mean of 20.8 weeks (range 10-32. S.D. 8.56) in the non-operative group and 13.6 weeks (range 6-24. S.D. 7.06) in the operative group. Return to competitive football matches for the non-operative group was at a mean of 26.2 weeks (range 10-34,S.D. 8.84) and 18.8 weeks (9.5-28. S.D. 8.05) for those treated operatively. These results were not statistically significant. At final follow up the subjective scores for the current overall condition of the shoulder when compared to the uninjured side, were 72.5 (range 20-100, S:D.24.9) for the non operative group and 87.3 (range 75-100, S:D.10.61) for the operative group and this difference was also not statistically significant. Conclusions in this study are limited by small numbers and lack of statistically significant results. The results show a trend towards faster return to ARF and a more satisfactory outcome for patients undergoing surgery compared to their non operative cohorts.