High-level athletes are at an increased risk of ACL injury, particularly when participating in competitive pivoting sports at a young age. Several sport-specific, anatomic, biologic, biomechanical, and neuromuscular risk factors for ACL injury have been identified. Prevention of ACL injuries in this population has been widely researched with promising results from neuromuscular training programs; however, adequate patient adherence remains as a notable barrier to widespread implementation and success. Programs should be designed to emphasize the correction of kinematic patterns associated with a higher risk of ACL injury, including dynamic valgus and quadriceps muscle dominance. Preventative bracing has demonstrated largely conflicting results and is not currently recommended in routine practice. Discussions surrounding the influence of environmental factors on ACL injury risk, including playing on artificial surfaces, are becoming increasingly popular. However, more studies are needed to determine the efficacy of changing the competitive athletic environment given the strong influence of other anatomic and biomechanical risk factors.