Objective To investigate the clinical efficacy of arthroscopic debridement and cruciate ligament reconstruction in the treatment of gouty anterior cruciate ligament (ACL) pathological injury. Methods The data of 22 patients with arthroscopic reconstruction in the treatment of gouty ACL pathological injury, who visited Beijing Chao-Yang Hospital of Capital Medical University from Jan. 2015 to Jan. 2020, were retrospectively analyzed. All patients met the diagnostic criteria of gout and had clinical symptoms such as redness and swelling of the knee joint, pain and limited activity. Magnetic resonance imaging (MRI) indicated that the continuity of anterior cruciate ligament was lost or blurred. The efficacy was evaluated by Lysholm score and Kujala score before operation and at different follow-up points after operation, and the complications were recorded. Paired t-test was used to compare the preoperative and postoperative scores. Results All the 22 patients were males, aged from 19 to 56 years, with an average age of (32.4±5.1) years, and with 10 lesions on the left and 12 on the right. All the patients received functional exercise according to the rehabilitation plan. The follow-up duration was 3-48 months. The Lysholm scores and Kujala scores of patients at different follow-up points after operation were significantly higher than those before operation, and there were significant differences in the scores at 1 month, 3 months, 6 months and 12 months after operation compared with those before operation (all P<0.05). Conclusion For patients with gouty ACL pathological injury, early anterior cruciate ligament reconstruction can achieve satisfactory clinical results and improve patients’ physical exercise ability.