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Currently, several graft options have been described for reconstruction of the medial ulnar collateral ligament of the elbow. Palmaris longus, gracilis, plantaris, toe extensor, and even Achilles tendon autografts have been well documented. To our knowledge, no study has investigated the clinical outcomes following the use of allograft tendon for primary medial ulnar collateral ligament reconstruction. It is our hypothesis that medial ulnar collateral ligament reconstruction with hamstring allograft provides results similar to those reported with autograft without the potential complication or risk of donor-site morbidity.We retrospectively reviewed the records for 123 overhead throwing athletes with medial ulnar collateral ligament injuries who had had unsuccessful nonoperative treatment. All patients were managed with reconstruction with use of a hamstring allograft and were followed for a minimum of twenty-four months. One hundred and sixteen of the 123 patients were contacted and were included in our study. Outcome measures included Conway-Jobe rating scale, the mean time to return to play, the maximum level of competition, and overall satisfaction with the reconstruction.At the time of the most recent follow-up, 110 of the 116 patients had returned to play. Thirty-three (30%) of these 110 athletes had returned to a level of play above that prior to injury, sixty-four (58%) had returned to play at the same level, and thirteen (12%) had returned to level of play lower than that that prior to the injury. The mean time to return to play was 9.9 months. One hundred and fourteen of the 116 patients who were contacted considered the reconstruction to be successful. The Conway-Jobe score was classified as excellent for 80% of the patients, good for 13%, fair for 7%, and poor for none.The use of allograft tissue for the reconstruction of the medial ulnar collateral ligament in throwing athletes provides outcomes similar to that of autograft tissue after twenty-four months of follow-up.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.