Objective To investigate the effectiveness of one-stage direct suture technique under arthroscopy for the treatment of anterior cruciate ligament (ACL) injury combined with anterior meniscus root injury. Methods The clinical data of 9 patients with ACL injury or tibial intercondylar eminence fracture combined with anterior meniscus root injury who were admitted and met the selection criteria between September 2017 and September 2024 were retrospectively analyzed. There were 3 males and 6 females, aged 21-52 years, with an average age of 37.1 years. The time from injury to surgery ranged from 5 days to 5 years, with a median time of 40 days. Among them, 5 cases had ACL injury, including 4 cases of type 1 and 1 case of type 2 according to Sherman classification; 4 cases had tibial intercondylar eminence fracture, including 3 cases of type 3 and 1 case of type 2 according to Meyers-McKeever classification. There were 7 cases of anterior root injury of lateral meniscus and 2 cases of anterior root injury of medial meniscus. The preoperative International Knee Documentation Committee (IKDC) score was 45.0±12.3, and Lysholm score was 49.2±12.4. Preoperatively, 7 cases were positive in anterior drawer test, Lachman test, and McMurray test, while 2 cases could not complete the test due to pain limitation. Preoperatively and at last follow-up, IKDC score and Lysholm score were used to evaluate knee joint function, anterior drawer test and Lachman test were used to evaluate knee joint stability, and McMurray test was used to evaluate meniscus condition. Results The operation time was 30-100 minutes, with an average of 64.2 minutes; the total hospital stay was 2-12 days, with an average of 4.5 days; the postoperative hospital stay was 1-4 days, with an average of 1.8 days. All incisions healed by first intention without surgery-related complications. All 9 patients were followed up 2-30 months, with an average of 18.8 months. No internal fixation-related complications occurred during the follow-up. At last follow-up, MRI review showed good ligament tension, and CT showed good fracture healing. The results of anterior drawer test and Lachman test were all negative. McMurray sign was negative in all cases. The IKDC score was 88.3±5.1, and Lysholm score was 88.3±5.6, both showing significant improvement compared to preoperative scores (t=14.001, P<0.001; t=10.192, P<0.001). Conclusion One-stage direct suture technique under arthroscopy for repairing ACL injury or tibial intercondylar eminence fracture combined with anterior meniscus root injury can achieve good effectiveness without fixation device-related complications.