© 2019 Elsevier Inc. The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus force at the elbow, especially during the arm-cocking and arm-acceleration phases of the overheard throwing cycle. Injuries of the UCL can range from partial thickness tears, end avulsions, to chronic attritional ruptures with poor tissue quality. The incidence of UCL injuries is on the increase, especially among adolescent overhead athletes. If the athlete fails conservative measures, surgery is recommended for those desiring to return to overhead sports. Over the past 40 years, UCL reconstruction has been the gold standard for all varieties of UCL injuries.