between september 2007 and august 2010 , we performed arthroscopic surgery in 207 patients . of them , the indications for surgery were hip pain with associated mechanical symptoms and intractable pain after conservative treatment for at least 12 weeks . on physical examination , all had a painful range of motion with positive impingement test ( flexion , adduction , and internal rotation ) . preoperative imaging included plain radiographs ( pelvis anteroposterior and frog leg ) and computed tomography ( ct ) arthrogram to detect bony impingement and labral tear . we excluded those who had undergone previous hip surgery and those with avascular necrosis , rheumatologic disorder and patients with arthritis on radiography ( tonnis grade > 2 ) . there were 10 men and 11 women with a mean age of 35 years ( range , 22 to 57 years ) . preoperative diagnoses included isolated labral tear in 11 hips , cam - type impingement in six hips , and pincer - type impingement in four hips . preoperative radiographs revealed tonnis grade 0 to 1 changes in 20 hips and grade 2 changes in one hip ( table 1 ) . we performed hip arthroscopy using a standard fracture table with patient in the supine position . traction was applied with slight extension and adduction of the hip joint with enough force to open the joint approximately 1 cm . two or three portals ( anterolateral , anterior , and/or posterolateral ) were placed for arthroscopic labral repair . a suture anchor was placed on the capsular side ad secured , followed by a suture passer was used to deliver a limb suture through a small portion of the substance of the labrum . an arthroscopic sliding knot was tied and passed down the cannular to secure the repair . the operation was completed by joint lavage and injection with local anesthetic . postoperatively , all patients followed a standardized rehabilitation program . immediately after surgery , passive and active range of movement was permitted . patients were kept toe - touch weight bearing for 2 weeks with range of motion encouraged but avoiding extremes of external rotation . in general , patients typically required 2 to 3 weeks of crutch assistance . patients who underwent microfracture were kept toe - touch weight bearing for 6 to 8 weeks . clinical and radiographic follow - up evaluations were performed at the 6 weeks , 3 months , 6 months , 12 months , and every 6 months thereafter . clinical evaluations were performed using harris hip score ( hhs),10 ) visual analog scale ( vas ) , western ontario and mcmaster universities ( womac ) osteoarthritis index , university of california , los angeles ( ucla ) activity , and a satisfaction survey . radiographic analyses included anteroposterior view of pelvis , frog - leg lateral view , and translateral view of hip . all radiographs were assessed using the tonnis classification,11 ) which was used to grade radiographic degenerative changes , and the outerbridge classification system,12 ) which grades the degree of chondromalacia . the difference between preoperative and postoperative outcome measures were analyzed using wilcoxon signed rank test for continuous outcome measures and fisher exact test for categorical outcome measures . eighteen patients reported that they were satisfied with the reduction or elimination of preoperative pain . although the clinical scores improved compared to preoperative scores , three patients were not satisfied with the results of the surgery . in these patients , the vas score was reduced by 2 points , womac score was reduced by 10 points , hhs score was increased by 3 points , and the ucla score was not changed . the overall rating for the 21 patients ( 21 hips ) , using the hhs was 73 points ( range , 64 to 84 points ) preoperatively and 83 points ( range , 66 to 95 points ) postoperatively ( p < 0.001 ) . four hips ( 19% ) had an excellent score , 11 hips ( 52% ) a good score , five hips ( 24% ) a fair score , and one hip ( 5% ) had a poor score ( p < 0.001 ) . the womac score was 16 points ( range , 2 to 50 points ) at the final follow - up evaluation . ucla activity at the latest follow - up improved in 16 patients and remained the same in two patients . the mean vas score decreased from 8 to 2 at the latest follow - up ( table 2 ) . at the time of surgery , arthroscopy showed synovitis in 14 hips . four of these patients had an outerbridge grade iii articular cartilage lesion of the acetabulum at the time of surgical exploration . the tonnis grade of osteoarthritis did not change in all patients at the latest follow - up . significant complications , such as infection , heterotopic ossification , thromboembolic episodes or permanent nerve injury , did not occur at the latest follow - up . eighteen patients reported that they were satisfied with the reduction or elimination of preoperative pain . although the clinical scores improved compared to preoperative scores , three patients were not satisfied with the results of the surgery . in these patients , the vas score was reduced by 2 points , womac score was reduced by 10 points , hhs score was increased by 3 points , and the ucla score was not changed . the overall rating for the 21 patients ( 21 hips ) , using the hhs was 73 points ( range , 64 to 84 points ) preoperatively and 83 points ( range , 66 to 95 points ) postoperatively ( p < 0.001 ) . four hips ( 19% ) had an excellent score , 11 hips ( 52% ) a good score , five hips ( 24% ) a fair score , and one hip ( 5% ) had a poor score ( p < 0.001 ) . the womac score was 16 points ( range , 2 to 50 points ) at the final follow - up evaluation . ucla activity at the latest follow - up improved in 16 patients and remained the same in two patients . the mean vas score decreased from 8 to 2 at the latest follow - up ( table 2 ) . four of these patients had an outerbridge grade iii articular cartilage lesion of the acetabulum at the time of surgical exploration . the tonnis grade of osteoarthritis did not change in all patients at the latest follow - up . significant complications , such as infection , heterotopic ossification , thromboembolic episodes or permanent nerve injury , did not occur at the latest follow - up . although most studies reported encouraging short to midterm results of arthroscopic treatment of labral tear , all of these studies were conducted in western countries ( table 3 ) . to our knowledge , this is the first study regarding acetabular labral repair in an asian country . eighteen of 21 patients were satisfied with relief of pain and/or improvement of their functional outcome with no progression of arthritic change of radiographic evaluation at the minimal 2 year follow - up . bedi et al.7 ) performed a systemic review to assess outcomes after surgical treatment of labral tears and femoroacetabular impingement ( fai ) . they reported 65% to 85% of patients who underwent open surgical procedures were satisfied with the outcome at a mean of 40 months after surgery as compared to 67% to 100% of patients who underwent arthroscopic surgery who were satisfied . however , most of the published research has addressed debridement of torn acetabular labrum . with increasing knowledge about the function and importance of the labrum , surgical techniques including suture anchor repair must be encouraged to maintain the function of the hip joint and decrease the development of early arthritic change . larson et al.6 ) compared the outcomes of arthroscopic labral debridement ( 44 patients ) versus refixation ( 50 patients ) in 94 patients at a mean follow - up of 3.5 years . they concluded that labral refixation resulted in better outcomes and a greater percentage of good to excellent results compared with the results of labral debridement . schilders et al.8 ) compared arthroscopic labral repair ( 69 hips ) and resection ( 32 hips ) in 96 patients ( 101 hips ) at a mean follow - up of 2.4 years . although we could not compare debridement with repair in our series , our findings are consistent with previous studies . in this study , the hhs improved from 73 points ( range , 64 to 84 points ) preoperatively to 83 points ( range , 66 to 95 points ) postoperatively , and the ucla activity improved in 16 patients and remained similar in two patients at the latest follow - up . eighty - six percent ( 18/21 ) of patients were satisfied with their arthroscopic labral repair . beaule et al.5 ) reviewed acetabular labral tear and mentioned that acetabular labral tears rarely occur in the absence of a structural osseous abnormality , such as fai . fai is a proposed etiology of early osteoarthritis in young patients.13,14,15 ) however , the incidence of hip osteoarthritis in the general population has marked ethnic and racial differences.16 ) the rate of moderate to severe idiopathic and secondary hip osteoarthritis in caucasians is 3%-6% compared with  1% in east indians , blacks , hong kong chinese , and native americans.17,18,19 ) epidemiologic data suggest that the incidence of fai and acetabular labral tear in asian countries might be lower than in western countries.16,17,18,19 ) however , if the patients have acetabular labral tear with osseous abnormality , daily activities are more seriously inconvenienced in asian patients , as the asian life style and culture requires more flexion and abduction motion of the hip joints . seventy one percent ( 15/21 patients ) in this study reported excellent and good results at the minimum 2-year follow - up . ilizaliturri et al.20 ) performed arthroscopic surgery on 19 hips who were diagnosed with fai with labral tear and reported 84% good to excellent results at the minimum follow - up of 24 months . larson and giveans21 ) compared the outcomes of arthroscopic labral debridement ( 36 hips ) with those of labral refixation ( 39 hips ) . they reported 89.7% good and excellent results in refixation groups at the minimum follow - up of 12 months . firstly , there was no control group and the total numbers of patients were small . nevertheless , this study proves the value for athroscopic procedures on acetabular labral tear with or without osseous abnormality . secondly , acetabular labral tear is frequently associated with other osseous structural abnormalities , such as cam and/or pincer - type deformities . however , we evaluated and did confirm the 86% satisfaction rate at minimum 2-year follow - up . in conclusions , arthroscopic labral repair resulted in 86% satisfaction and 71% good to excellent results at a 2-year follow - up . therefore , the hip arthroscopic procedure might be an excellent alternative to open surgery and promises greater probability of good to excellent results .