Hip instability among the athletic population is an evolving concept that has gained recognition for being a significant source of pain and functional impairment in recent years. For the most part, athletes experience hip microinstability, which refers to extra physiologic femoral head motion without obvious hip dislocation. This phenomenon is usually accompanied by hip pain that may influence athletic performance and poses a challenging diagnosis due to possible multifactorial etiologies. Therefore, a thorough understanding of the patient’s history is the first step in making the differential diagnosis, followed by general and focused physical examination and imaging. Imaging modalities may vary from plan plain radiographs, computerized tomography (CT) scans with or without three-dimensional reconstructions (3D CT), and Magnetic Resonance Imaging (MRI). The first line of treatment is generally a tailored physical therapy regimen, which typically includes patient education, activity modification, and anti-inflammatory medications as needed. Some surgeons may also use intra-articular diagnostic and therapeutic injections containing corticosteroids, hyaluronic acid, or platelet-rich plasma (PRP) to confirm and treat hip pathology. In cases not amenable to conservative treatment, surgery must address the underlying causes of instability. The surgeon must be prepared to correct soft tissue pathologies such as labral tears, articular cartilage damage, capsular laxity, and additional bony abnormalities. Depending on the extent of the bony dysplasia, surgery can vary from hip arthroscopy to acetabular reorientation (i.e., periacetabular osteotomy (PAO)), and even hip replacement. Most recently, arthroscopy has been increasingly used to treat borderline dysplasia (BDH).