Elbow instability is not a single entity, but rather a spectrum of injuries, both acute and chronic. While acute instability is usually quite easily diagnosed and treated, in virtually all instances the chronic condition is much more problematic. Nonoperative treatment and early motion are recommended for acute injuries. An associated fracture decreases the likelihood of a good result. A thorough knowledge of the normal and pathologic anatomy, as well as a clear understanding of the osseous and soft-tissue reconstructive options, is essential, particularly for the proper management of recurrent and chronic elbow instability. Even for patients with the latter, however, reasonable treatment options are available.