This study analyzed over 2,000 patients who underwent anterior cruciate ligament reconstruction (ACLR) over a decade to evaluate the long-term effects of different treatments for medial meniscal tears. We found that patients who had a successful medial meniscal repair at the time of ACL reconstruction experienced less clinically significant knee pain compared to those who underwent meniscectomy. These findings support preserving and repairing the medial meniscus during ACL reconstruction to improve long-term pain outcomes for patients.