Reconstruction of the Anterior Cruciate Ligament (ACL) is one of the most commonly performed procedures in orthopaedic surgery. Long-term outcomes following ACL reconstruction are not well documented. Additionally, it is poorly understood how associated injuries, such as meniscal pathology or chondral defects, affect patient outcomes following ACL reconstruction. The purpose of this study was to document ten year outcomes after ACL reconstruction as well as to determine if concurrent surgery for meniscal injuries or chondral defects affected outcome. A prospective data registry was queried for patients undergoing ACL reconstruction with minimum 10 year followup. 278 patients were identified an average follow-up of 14 years (range 10 to 22 years). The average age was 33. Outcome scores collected included Lysholm score, WOMAC score, Tegner Activity level, SF12 PCS and MCS, and patient satisfaction with outcome. Patient satisfaction with outcome was on a scale of 0 to 10, with 0 being totally unsatisfied, 10 being totally satisfied. Based on surgical data that was prospectively collected, 159 of the patients had meniscus pathology requiring treatment and 83 had chondral defects requiring treatment. This study was IRB approved and all data was prospectively collected and stored in a data registry. The average Lysholm score was 82 (range 25 to 100) and the average WOMAC score was 8.4 (range 0 to 55). The average SF12 PCS was 53 (range 24.5 to 66.3) and MCS was 54 (range 23 to 65). The median Tegner activity score was 6 (average=5.1) and the median patient satisfaction with outcome was 10 (average 8.7). Years of follow-up did not correlate with any outcome score. Satisfaction with outcome was significantly correlated with Lysholm (rho=0.58;p=0.001),WOMAC (rho=-0.52;p=0.001), SF12 PCS (rho=0.4;p=0.001), and Tegner activity level (rho=0.3;p=0.001). For patients requiring treatment of chondral defects, Lysholm (77 vs. 84;p=0.007), Tegner (4.5 vs. 5.0;p=0.001) and SF12 PCS (54.1 vs. 50;p=0.001) were significantly lower. The Lysholm difference was only 5 points, which is lower that the minimal detectable change (MDC) for the Lysholm score and would not be considered detectable difference. The difference in Tegner was also lower than the MDC. There was no difference in patient satisfaction with outcome between the groups. Disability as measured by WOMAC was higher in patients with CD (12.2 vs. 6.7;p=0.004). For patients requiring treatment of meniscus pathology, Tegner was the only variable that was significantly lower (4.9 vs. 5.4;p=0.008); however, the difference was again lower than the MDC. There was no difference in Lysholm, SF12, WOMAC and patient satisfaction between the groups. At long-term follow-up, patients have excellent outcome scores and high satisfaction with outcome following ACL reconstruction. Differences in outcome scores were seen based on associated pathologies; however, these differences do not meet the threshold for detectable difference. Patient satisfaction was not changed by the additional procedures. Patient satisfaction at an average of 14 years postoperative was more dependent on function and activity level than on treatment of the meniscus or chondral defects.