Previously overlooked and considered a solely vestigial structure, we now understand that the ligamentum teres (LT) is a significant hip stabiliser with both proprioceptive and nociceptive functions, and a recognised source of hip pain and instability. Tears of the LT can be classified into three categories. Type I complete tears are usually traumatic in origin, and type II partial tears and type III degenerative tears occur more often under chronic conditions, including subluxation/overuse injury and osteoarthritis, respectively. Surgical indications for LT tears have evolved significantly and depend on tear classification. Debridement, using radiofrequency probes and curved shavers, remains effective for the majority of partial tears with mechanical symptoms. However, surgical LT reconstruction using autografts, allografts, or synthetic grafts is indicated in cases of persistent hip instability, particularly in revision arthroscopy. In addition, while diagnosis is challenging, O’Donnel’s LT test and advanced imaging, particularly magnetic resonance arthrography (MRA), improve preoperative identification. Creating bone tunnels in the acetabular fossa and femoral head, graft passage and fixation using EndoButtons, suture anchors and interference screws are key technical steps of the procedure. Careful patient selection, graft preparation, tunnel placement and managing hip position during fixation to achieve optimal graft tension while minimising the risk of neurovascular injury are critical. Arthroscopic management of LT tears have demonstrated promising outcomes. While debridement is associated with exceptional short-term outcomes, some patients experience recurrent LT tears. Similarly, LT reconstruction provides significant improvements across several patient-reported outcome measures, pain and stability, accelerating return to sport, but is associated with a reoperation rate of 33%. With further advances in surgical innovation, there is a recognised need to refine surgical indications for both procedures. In particular, LT reconstruction requires careful evaluation of the graft options, donor sites and associated risks and benefits.