 Abnormal wearing of the hip joint or femoroacetabular impingement and dysplasia represent the two most common causes of secondary osteoarthritis of the hip joint. These pathologies are known to produce distinctive chondral flaps visible during hip arthroscopy. But the destructive mechanics behind each diagnosis differ significantly. That makes treatment planning especially difficult for patients who show signs of both impingement and dysplasia. To provide some clarity, researchers examined 95 patients demonstrating acetabular chondral flaps during arthroscopy with the goal of correlating those findings with radiographic data. The patterns that emerged could help surgeons deliver the best possible care for patients with mixed hip pathologies. Patients exhibited one of two types of chondral flaps upon examination, inside-out or outside-in. Inside-out flaps feature an intact chondrolabral junction with the detached sleeve of chondrolabral tissue from the central hip socket. This morphology tends to be most commonly associated with femoral dislocation and hip dysplasia. Outside-in flaps, on the other hand, are centrally anchored and show a break in the chondrolabral junction. As such, they are typically linked to the bone-over growth that defines impingement. For those same patients, the research team gathered radiographs of the hip and divided them into two groups based on the lateral center edge angle, or LCE angle. That's the angle between an imaginary vertical line through the femoral head and the lateral edge of the weight-bearing hip socket. Group 1 included hips with LCE angles greater than 20 degrees, while those in Group 2 demonstrated angles equal to or less than 20 degrees. Comparing the hip arthroscopy and radiographic data revealed a statistically significant relationship. 90% of the hips in Group 1 exhibited an outside-in lesion, and 88% of hips in Group 2 exhibited an inside-out lesion. That suggests that the type of chondrol flap a patient shows can predict the dominant pathway leading to cartilage damage, either impingement or dysplasia. Of course, assessing hip instability by the LCE angle alone could be a tremendous oversimplification. A true assessment goes much further, including parameters such as femoral torsion, congruency of articulation, and clinical range of motion, just to name a few. So while the LCE angle might offer a quick and easy indicator of possible hip pathology, broadening the scope to include more of these contributors is certainly the best course of action for treating patients with signs of both impingement and dysplasia.