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Gather the ingredients.
Make the patties: Mix ground sirloin, panko bread crumbs, egg, milk, ½ packet onion soup mix, Worcestershire sauce, and black pepper together in a large bowl; shape into 5 patties.
Heat a skillet over medium heat. Cook patties in the hot skillet until browned, 3 to 5 minutes per side.
Make the gravy: Melt butter in a separate skillet over medium-high heat. Sauté mushrooms and onion in melted butter until tender, about 5 minutes. Stir flour and remaining ½ packet onion soup mix into mushroom mixture until combined.
Gradually add beef stock and water, stirring continually, until simmering. Reduce heat to medium; cook, stirring frequently, until gravy has thickened, about 4 to 5 minutes. Season with salt and pepper.
Place browned patties into gravy; simmer until very tender, about 30 minutes. An instant-read thermometer inserted into the center should read 160 degrees F (70 degrees C).