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About 60% of alpine meadow has been degraded, with around 8% considered extremely degraded on the Qinghai-Tibetan Plateau. The natural restoration of extremely degraded land will take more than 200 years and is the biggest challenge for ecological restoration worldwide. To improve the effectiveness of restoration, reseeding native plant seeds has become the main active restoration approach for extremely degraded meadow. However, it is still unclear whether this active restoration approach of native plant reseeding can promote the self-recovery ability and natural regeneration of extremely degraded alpine meadow. To address this knowledge gap, we have conducted long-term active restoration research of extremely degraded meadow on the Qinghai-Tibetan Plateau. Our findings indicate that the meadow vegetation was in an unstable state after active restoration within 10 years. After 10 years of active restoration without meadow management, the plant community degraded again. Soil nutrients also declined significantly after 10 years of active restoration without meadow management, with notable geographical variations. Long-term active restoration did not significantly improve the soil carbon storage. During the long-term recovery process, the vegetation carbon pool was regulated by nitrogen, while the soil carbon pool was primarily regulated by living plant roots. However, long-term active restoration had positive effects on soil seed bank density and species number. Reseeding native perennial grass seeds can improve the soil seed bank and the vegetation-soil system's resilience of alpine meadow. Therefore, for the active restoration targeting the extremely degraded alpine meadow, it is necessary to implement good post-restoration management practice to enhance the meadow's self-recovery ability. Additionally, introducing moderate livestock grazing could promote the ecological restoration's effect and ensure sustainable recovery of alpine meadow.