Fourteen studies, including 2,357 patients with anterior cruciate ligament (ACL) injuries, were included in this systematic review and meta-analysis comparing ACL reconstruction (ACLR) alone versus ACLR combined with anterolateral ligament reconstruction (ALLR). Pooled outcomes of interest included return to sports rate, return to competition rate, Tegner score, and anterior cruciate ligament-return to sports injury (ACL-RSI) scores. The analysis demonstrated that ACLR combined with ALLR was associated with significantly higher rates of return to sports and return to competition compared to ACLR alone. However, there were no significant differences in Tegner scores or ACL-RSI scores between the groups. These findings suggest that while ACLR combined with ALLR may enhance return-to-sport outcomes, it does not necessarily improve self-reported activity levels or psychological readiness.