Sixty patients undergoing primary anterior cruciate ligament reconstruction (ACLR) with Lemaire lateral extra‐articular tenodesis (LET) were randomized to standard care (n=30) or identical surgery with intraoperative virtual reality (VR) headset distraction (n=30). The primary outcome was perioperative state anxiety (STAI-Y1). Secondary outcomes included intraoperative sedation and rescue analgesia, adverse events (hypotension/hypoxaemia/nausea), VAS pain and comfort, and staff-rated satisfaction; knee status (SKV) was assessed at one year. Anxiety and VAS measures were collected preoperatively, intraoperatively, immediately post-op, and before discharge. Overall, the results revealed lower intraoperative and immediate postoperative STAI-Y1 scores with VR, alongside less sedation and rescue analgesia, lower early pain, and higher anaesthesia-team satisfaction; complications were similar. These findings suggest VR distraction is a useful non-pharmacologic adjunct to reduce anxiety and medication use during ACLR under spinal anaesthesia.