In April 2008, more than 80 attendees from across the United States and Canada participated in the fourth research retreat focused on the gender bias in anterior cruciate ligament (ACL) injury. The retreat was cofounded by Irene Davis, PhD, PT, and Mary Lloyd Ireland, MD, who hosted the 3 previous research retreats in Lexington, Kentucky, in April of 2001, 2003, and 2006. In the first year (2001), a consensus document of what we know, don't know, and still need to know related to this problem was developed.1 Each subsequent retreat has revisited and updated the previous consensus statement as new evidence has emerged.2,3 Over the past 6 years, the number of attendees has grown, and the retreats have attracted some of the foremost nationally and internationally known clinicians and scientists with a common interest in ACL injury. We were pleased to continue this important work by hosting Research Retreat IV in Greensboro, North Carolina.The meeting featured an opening presentation from ACL Retreat cofounder Mary Lloyd Ireland, MD; invited keynote presentations by Scott McLean, PhD, and Bruce Beynnon, PhD — expert scientists well known for their research into factors associated with the gender bias in ACL injury; and 31 fifteen-minute podium presentations of recently completed research relating to the gender bias in ACL injuries. The opening presentation set the stage for the meeting by providing a historical perspective of what research has taught us about the ACL injury gender bias over the past 20 years, and the keynote presentations focused on the current knowledge and theories associated with neuromuscular, biomechanical, anatomical, and hormonal risk factors. The podium presentations were organized into thematic sessions centered on sagittal-plane landing mechanics, sex comparisons in landing and cutting, fatigue and perturbation studies in landing and cutting, anatomical and hormonal factors, and risk factor screening and prevention. Significant time was provided for group discussion after each keynote and each group of podium presentations. At the conclusion of the meeting, participants revisited and updated the consensus statement from the 2006 retreat.2 Following are the consensus statement, keynote presentation summaries, and abstracts organized by topic and presentation order.