Medial ulnar collateral ligament injury is common in the elbow following repetitive use in overhead athletes and acute trauma such as a fall on to an outstretched hand. This leads to valgus elbow instability confirmed with provocative testing. In patients with functional limitation and radiographic evidence of a midsubstance or diffuse ulnar collateral ligament tear, reconstruction with tendon graft remains the best option. The docking technique, which consists of hubbing the graft in a humeral socket and securing it over a bone bridge, has become the cornerstone of medial ulnar collateral ligament reconstruction, and is a vital tool in the upper-extremity surgeon’s repertoire.