Cook the Pasta: Boil the elbow macaroni in salted water, but cook it 2–3 minutes less than the package directions. Drain and set aside.
Brown the Beef: In a large skillet or Dutch oven, cook the ground beef and chopped onions over medium heat until the meat is browned and the onions are tender. Drain excess fat.
Add Garlic and Sauce: Stir in the minced garlic, tomato sauce, diced tomatoes, Worcestershire sauce, Italian seasoning, salt, and pepper. Simmer for 10 minutes to blend the flavors.
Combine Everything: Stir in the cooked pasta until evenly coated with the sauce.
Add Cheese and Bake: Transfer the mixture to a baking dish, sprinkle cheddar cheese on top, and bake at 350°F (175°C) for 20–25 minutes, or until bubbly and golden.
