Ulnar collateral ligament injury of the elbow is a problem most associated with baseball pitchers but can be a challenging pathology for any overhead throwing athlete. The prevalence of these injuries has been steadily increasing over the past several decades, as has the need for surgical management. Surgical reconstruction has long been considered the gold standard for complete ulnar collateral ligament injuries in throwers, but repair has surfaced as a viable option for younger patients or those with isolated proximal or distal injuries with good tissue quality. Ulnar collateral ligament repair continues to evolve with modified techniques, including graft augmentation.