The Ecosystem Approach to Fisheries (EAF) has been proposed as a holistic approach for managing fisheries. Although EAF is a widely accepted concept, many challenges remain in its practical implementation, particularly in small-scale fisheries (SSFs) in developing countries. Long-term evaluations of EAF performance in SSFs are scarce and even fewer when considering co-management (Co-M) as the institutionalized governance mode implemented under an EAF scheme (EAF/Co-M). This paper addresses the implementation, development process and performance of an EAF/Co-M in the yellow clam SSF of Uruguay through multiple fishery indicators for the period 2007-2015. EAF/Co-M showed a highly positive response in abundance and biomass of the harvestable stock through time, stabilization in individual sizes above the minimum landing size limit, and a fairly constant exploitation rate at low levels that did not exceed 25%, accompanied by relatively constant CPUE values through time. Temporal variations in unit price and revenues per unit of effort showed higher values after EAF/Co-M implementation. These indicators, taken together, suggest that the enhanced production capacity of the fishery during the EAF/Co-M implementation did not have a negative impact on the stock. The number of fishers involved in the activity has not changed markedly through time, but two remarkable positive changes occurred in the composition of the group: (i) an increasing number of licenses allocated twice in a row through time, which suggests the consolidation of a stable group of fishers; and (ii) a significant increase in the number of women directly involved in the fishing activity. This study provides solid empirical evidences to the idea that EAF, coupled with Co-M as a formal governance mode, could be helpful to address management tasks and to improve social-ecological conditions of SSFs.