Abstract Background: Anterior cruciate ligament (ACL) injuries, often associated with meniscal tears, are common in young athletes. Timely surgical intervention is crucial to restore function, reduce pain, and prevent long-term sequelae such as osteoarthritis and persistent knee instability. Objectives: To compare early and midterm clinical outcomes, patient satisfaction, functional recovery, and complication rates following isolated ACL reconstruction versus combined ACL and meniscal repair over a follow-up period of up to two years. Methodology: This retrospective study analysed 135 patients undergoing ACL reconstruction (ACLR) at Ninewells Hospital, University of Dundee. Patients were categorised into isolated ACL tear and ACL with meniscal tear groups. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS) for pain, and Tayside patient satisfaction questionnaire at 26, 52, and 104 weeks. Statistical analysis included t-tests and binomial tests. Complication rates were documented. Inclusion and exclusion criteria ensured a homogenous study population without multi-ligament or fracture-related knee injuries. Results: Isolated ACL tears accounted for 40 patients; 95 had combined ACL and meniscal injuries. Most cases occurred in patients under 25 years. Both groups showed significant pain reduction (VAS) and functional improvement (KOOS) at all follow-up points (p<0.001). The ACL-only group demonstrated superior early outcomes in pain, function, and sports participation, whereas by 52–104 weeks, the ACL+ meniscus group achieved better scores in quality of life and sports function. Satisfaction was consistently high in both groups but slightly higher in ACL-only patients at early follow-ups. Complication rates were 13% for ACL-only and 20% for combined repairs, with graft failure most common. Most complications occurred within 26 weeks and were managed conservatively or with minor surgical interventions. Conclusion: Both isolated ACL reconstruction and combined ACL with meniscal repair significantly improve pain, function, and satisfaction. Early recovery is faster in isolated ACL injuries, but combined repairs demonstrate superior long-term quality of life and sports function outcomes.