The purpose of this review is to report clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with initial access to the peripheral compartment (PC) of the hip. A search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in the PubMed, Embase, and Scopus databases. Studies in which clinical outcomes were reported for patients who underwent hip arthroscopy for FAI with initial access to the PC were included. Data on study characteristics, patient demographics, radiographic outcomes, patient-reported outcomes (PROs), complications, and secondary surgery were extracted. Five studies with 881 patients and 976 hips (55.2% male, age range 32.1 to 48.4 years, follow-up range 3.0 to 74.4 months) were included. In two studies reporting radiographic measurements, the range of preoperative and postoperative alpha angle was 55.5° to 68.7° and 45.5° to 48.3°, respectively. The range of preoperative and postoperative lateral center-edge angles was 33.8° to 39.2° and 30.5° to 32.9°, respectively. Four studies reported one or more PRO measures with all demonstrating significant preoperative to postoperative improvement. The postoperative Non-Arthritic Hip Score (NAHS) and Visual Analog Score (VAS) pain scales ranged from 78.0 to 83.2 and 1.4 to 2.8, respectively. Complication rates ranged from 0.3% to 23.3%, with the rate of paresthesia specifically ranging from 0% to 8.1%. The rate of secondary surgery ranged from 0% to 6.3%. The rate of revision hip arthroscopy and conversion to total hip arthroplasty, specifically, ranged from 0% to 3.1% and 0% to 3.7%, respectively. This systematic review demonstrates that hip arthroscopy for FAI with initial access to the PC shows significant improvements in PROs with low rates of complications and secondary surgery.