Background/Objectives: Anterior cruciate ligament (ACL) injuries are common in sports; they can be seen with an arthroscope in more than half of instances of acute traumatic hemarthrosis and are frequently associated with meniscal tears. By reducing soft tissue injury and enabling faster recovery while attaining comparable long-term outcomes, the switch from open surgery to arthroscopic ACL repair (ACLR) has transformed treatment. However, maintaining efficient intra-articular visualization is essential for both patient safety and surgical precision. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted across major medical databases, including PubMed, Web of Science, and ScienceDirect. The search strategy incorporated key terms such as epinephrine, irrigation fluid, and ACL reconstruction to identify relevant studies. The study focused on English-language clinical studies within the last 10 years that clearly assessed the safety and efficacy of epinephrine-added irrigation in ACL repair. The study design, patient demographics, specific outcomes (visualization, operation time, hemodynamics), and statistical findings were all carefully retrieved. The results were combined to determine the intervention’s safety profile and clinical value. Results: The pooled analysis demonstrated that the intervention group significantly decreased operating time (SMD = −0.51, 95% CI: −0.90 to −0.12, p = 0.01; I² = 24%). However, postoperative knee function showed no statistically significant difference between groups (OR = 1.80, 95% CI: 0.61 to 5.30, p = 0.29; I² = 0%). Postoperative pain levels also did not differ significantly between groups (SMD = −0.27, 95% CI: −0.63 to 0.09, p = 0.14; I² = 0%). Heterogeneity was low across all analyses (I² = 0–24%). Conclusions: Low-dose epinephrine in irrigation fluid significantly reduces operative time during arthroscopic ACL reconstruction, suggesting improved surgical efficiency. However, it does not significantly improve postoperative knee function or reduce pain compared to control irrigation. The intervention appears to be a reasonable alternative to tourniquets without major systemic cardiovascular effects. Nevertheless, preclinical data indicate potential chondrotoxicity. Therefore, while epinephrine can be considered to improve operating efficiency and reduce tourniquet-related problems, surgeons should weigh its use cautiously, especially in younger patients or those with susceptible cartilage.