Posterolateral rotatory instability (PLRI) is a pathologic condition affecting those with disrupted lateral collateral ligament (LCL) complexes. It consists of subluxation of the radiohumeral joint leading to pain, snapping, and giving way of the elbow joint. Everyone from the general population to advanced athletes can suffer from this injury. A history of an elbow dislocation is a common incidence that leads to PLRI. Athletic populations at risk for this injury include any of the contact sports and those at risk during falls; examples include wrestlers, gymnasts, skaters, and basketball and football players. The first described physical exam maneuver was the lateral pivot shift test that could be used to detect this problem. Diagnosis is best confirmed with magnetic resonance imaging arthrography of the afflicted joint to confirm disruption of the LCLs. Nonoperative treatment can be used in a select patient population; however, if the ligaments fail to heal, then surgical intervention may be indicated to manage this injury. Multiple methods have been described including open surgery with plication or grafting and arthroscopic repair, plication, and grafting. Reports on the results of surgery indicate a high success rate in return to play after surgical intervention and appropriate rehabilitation.