A systematic review and meta-analysis of 19 studies found that younger athletes (under 25 years) who return to high-level sports after anterior cruciate ligament (ACL) reconstruction (ACLR) have a 23% secondary ACL injury rate, compared to 15% for all athletes. The ipsilateral ACL reinjury rate was 7%, and the contralateral ACL injury rate was 8%. Younger athletes who return to sport had a 20% secondary ACL injury rate, while those under 25 years had a 21% rate. These findings suggest that age and return to high-level activity are significant risk factors for secondary ACL injury. The study highlights that young athletes who return to high-risk sports have a 30-40 times higher risk of ACL injury compared to uninjured adolescents. The review emphasizes the importance of activity modification, improved rehabilitation, and neuromuscular training to reduce the risk of secondary ACL injuries in this population. The study also notes that contralateral ACL injuries are more common than ipsilateral graft failures, and that female athletes are at higher risk for contralateral injuries. The results indicate that early return to sport increases the likelihood of reinjury, and that rehabilitation programs should focus on functional goals and biomechanics to minimize this risk. The review acknowledges limitations, including potential underreporting of injuries and variability in study designs. Overall, the findings underscore the need for tailored rehabilitation and return-to-play strategies to reduce the risk of secondary ACL injuries in young athletes.A systematic review and meta-analysis of 19 studies found that younger athletes (under 25 years) who return to high-level sports after anterior cruciate ligament (ACL) reconstruction (ACLR) have a 23% secondary ACL injury rate, compared to 15% for all athletes. The ipsilateral ACL reinjury rate was 7%, and the contralateral ACL injury rate was 8%. Younger athletes who return to sport had a 20% secondary ACL injury rate, while those under 25 years had a 21% rate. These findings suggest that age and return to high-level activity are significant risk factors for secondary ACL injury. The study highlights that young athletes who return to high-risk sports have a 30-40 times higher risk of ACL injury compared to uninjured adolescents. The review emphasizes the importance of activity modification, improved rehabilitation, and neuromuscular training to reduce the risk of secondary ACL injuries in this population. The study also notes that contralateral ACL injuries are more common than ipsilateral graft failures, and that female athletes are at higher risk for contralateral injuries. The results indicate that early return to sport increases the likelihood of reinjury, and that rehabilitation programs should focus on functional goals and biomechanics to minimize this risk. The review acknowledges limitations, including potential underreporting of injuries and variability in study designs. Overall, the findings underscore the need for tailored rehabilitation and return-to-play strategies to reduce the risk of secondary ACL injuries in young athletes.