Ninety-seven patients with symptomatic acetabular labral tears and limited osteoarthritis (Tönnis grades 0-2) were randomized to receive either hip arthroscopy with postoperative physical therapy (SPT) (n=52) or physical therapy alone (PTA) (n=45). Patients in the PTA group who experienced unsatisfactory improvement were allowed to cross over to surgery after completing at least 14 weeks of PT (CO group, n=32). The primary outcomes were the International Hip Outcome Tool-33 (iHOT-33) and the modified Harris Hip Score (mHHS) at 24 months. Secondary outcomes included additional patient-reported outcome measures (PROMs) and pain scores. Overall, the results demonstrated that SPT led to superior improvements in functional outcomes and pain reduction compared to PTA in both the intention-to-treat and modified as-treated analyses. Additionally, patients who crossed over to surgery experienced similar postoperative outcomes to those who underwent initial surgery. These findings suggest that hip arthroscopy is effective for patients ≥40 years old and that preoperative PT does not compromise surgical outcomes.