Sacramone began gymnastics at the age of eight, began competing in the elite ranks in 2002 and joined the U.S. national team in 2003. At the U.S. National Championships from 2004 to 2008, she won twelve medals, including four golds on vault and two golds on floor exercise. At World Championships from 2005 to 2007, she won seven medals, including a floor exercise gold in 2005 and a team gold in 2007. At the 2008 Beijing Olympics, she won a team silver medal.

In 2010, Sacramone made a comeback by winning the National Championship on Vault. Later in 2010 at the World Championships in Rotterdam, Netherlands, she won the World Title on Vault as well. Her gold gave her a total of nine medals overall, joining Shannon Miller and Nastia Liukin as the U.S. athletes with the most medals at the gymnastics world championships until the US team won gold in the team finals at the 2011 World Championships. Though she was injured and could not compete, she still received a medal as an official member of the U.S. team, earning her tenth World medal, making her the most decorated U.S. gymnast in the history of the World Championships.