BACKGROUND: Pediatric anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients is still controversially debated, with several gaps in its literature. More information is needed about the role of concomitant meniscal injuries in postoperative outcomes and return to pre-injury sports level (RTS). METHODS: Fifty skeletally immature patients who underwent ACLR were enrolled prospectively: 21 had meniscal injury additionally, and 29 did not. Patients were assessed with Tegner, Lysholm, Pedi-IKDC, and subjective knee value (SKV) scores presurgery and 6, 12, and 24 months postoperatively. The primary outcome was RTS at 24 months. Secondary outcomes were the 24-month clinical results and the mapping of prognostic factors to RTS in the meniscal injury group. Logistic regression model to estimate OR [95% CI], t test for parametric and Wilcoxon test for nonparametric variables (comparisons of 2 independent groups) were used, as well as t test or Wilcoxon test for paired data, according to the distribution of differences (postoperative-preoperative, paired groups) were used. RESULTS: Out of 50 patients with a mean age of 13.2 years (range 9 to 16), the meniscal injury group had 67% RTS (12/18), and the isolated ACLR group had 75% RTS (18/24) after 24 months, which was not statistically significant, OR=0.67 [0.17 to 2.60], P=0.6. 24-month Lysholm scores were significantly higher in the isolated ACLR group (medians, 95.5 vs. 100.0, P=0.01). There was no significant difference between the groups of Tegner scores, Pedi-IKDC and SKV. No prognostic factors were found for worse RTS after meniscal injury. CONCLUSIONS: There is no difference in RTS 24 months after ACLR with or without meniscal injury in the skeletally immature patient. LEVEL OF EVIDENCE: Level of evidence I-prospective, comparative cohort study.