➤ Medial elbow pain in the throwing athlete can result from a variety of sources, including medial epicondylitis, valgus extension overload, ulnar collateral ligament (UCL) insufficiency, ulnar neuritis, and others.➤ Initial treatment following a UCL tear involves a period of rest (no throwing or strenuous use of the elbow) followed by rehabilitation and a graduated throwing program.➤ UCL reconstruction (UCLR) has become the preferred surgical treatment method for patients with a symptomatic, deficient UCL who wish to return to sports.➤ Several modifications to the original technique described by Jobe et al. have been proposed, including a muscle-splitting approach, a docking technique, and the use of various grafts, including hamstring autograft and several types of allografts.➤ The timing of return to sport following UCLR varies from patient to patient, with some patients being able to return within 12 months and others taking >18 months. Although the literature varies, typically >80% of patients are able to return to the same level of sport following UCLR.