In a large skillet, heat the butter and oil over medium heat. Add shallots and a pinch of salt cook ~2 minutes until softened. Stir in garlic and cook 30 seconds until fragrant.
Carefully add the meatballs to the pan, cover, and simmer over medium-low heat for 10-12 minutes, stirring occasionally, until the orzo is tender and the sauce is super creamy.