Carolina at Chapel Hill T he Anterior Cruciate Ligament (ACL) Research Retreat VIII was held March 14-16, 2019, in Greensboro, North Carolina. The retreat brought together clinicians and researchers to present and discuss research advances in ACL injury risk, outcomes, and prevention. Prior retreats (2001-2012) 1-6 largely focused on advances in primary injury risk-factor identification and prevention (ie, preventing the initial trauma). Despite our improved understanding of ACL injury risk and the success of primary prevention efforts, ACL injuries continue to occur and lead to short-term and long-term consequences that have substantial effects on joint health and quality of life for years to come. To address these additional challenges, the ACL Research Retreat expanded in scope to include secondary ACL injury risk and prevention in 2015 7 and the short-term and long-term sequelae of early-onset osteoarthritis that results from the initial trauma (herein, posttraumatic osteoarthritis or PTOA) in 2019. The ACL Research Retreat VIII therefore considered ACL injury risk and prevention along a continuum that includes primary, secondary, and tertiary risk identification and prevention strategies as described by Palmieri-Smith et al (Table 1). 8 To illustrate this continuum, consider a soccer team comprising 13-year-old girls. We know the ACL injury risk increases dramatically from ages 13 to 16, 9-11 such that girls have a 2 to 4 times greater risk than similarly trained males. 12,13 Thus, our first goal for this age group, especially 970 Volume 54 Number