Purpose This article seeks to improve treatment outcomes in slipped capital femoral epiphysis (SCFE) by outlining advances in diagnosis, understanding of pathomechanics, and -mechanically-based classification. Methods Review of clinical experience with SCFE at our high-volume centre, interaction with other clinical experts, and literature review has allowed a current perspective to be articulated Results SCFE remains an important clinical problem, with late diagnosis still frequent. Improved understanding of the ubiquity of femoroacetabular impingement has guided current classification and treatment protocols Conclusion SCFE is an important clinical problem, with high historical rates of impaired hip function both in childhood and adulthood. Great opportunities exist for improved outcomes following earliest possible clinical diagnosis, modern imaging, and mechanically-based classification of involved hips to allow optimal treatment.