While playing college hockey at Boston University, Sacco was selected 71st overall in the 1987 NHL draft by the Toronto Maple Leafs. He played three seasons with Boston University, he joined the Maple Leafs for his professional debut in 1990. Sacco joined the U.S. team in the 1992 Winter Olympics, finishing fourth. He went on to play nearly five seasons in the NHL with the Anaheim Mighty Ducks, just over a season with the New York Islanders, three seasons with the Washington Capitals and 34 games with the Philadelphia Flyers, where he ended his career in 2003.

After retiring as a player, Sacco became the head coach of the Lake Erie Monsters, a Colorado Avalanche affiliate in the American Hockey League, in 2007. Although the Monsters did not qualify for the playoffs in either season with Sacco as head coach, Sacco was promoted to head coach of the Colorado Avalanche on June 4, 2009.

Former professional hockey player Joe Sacco played in the National Hockey League for 13 seasons.

On June 4, 2009, Sacco was named the head coach of the Colorado Avalanche. He replaced former head coach Tony Granato, who was fired after the team recorded the worst season in team history.