Abrasion damage of concrete induced by sediment-laden flow has been a significant durability problem for hydraulic structures. Due to the complexity of dynamic fields and concrete properties as well as the interaction effects between them, many aspects are still subjected to debate despite the tremendous efforts that have been made. In light of this and in order to further advance our understanding, this work aims to present a state-of-the-art review on critical aspects of the abrasion behavior of concrete. Important theoretical basics and mechanisms behind abrasion-induced concrete damage are presented first and different performance indicators that have been used for abrasion damage characterization are discussed. Following that, relevant abrasion test methods are comparatively reviewed and the effects of important hydraulic parameters and concrete properties on concrete abrasion behavior are analyzed in depth. Moreover, representative prediction models proposed for the estimation of concrete abrasion damage are discussed. In addition, an overview of recent development strategies for improving concrete abrasion resistance is presented. Based on the critical analysis of the research status, some important research gaps and challenges are highlighted