The anterior approach to the elbow provides excellent exposure of the anterior capsule, the anterior aspect of the proximal radioulnar joint and the anterior aspect of the collateral ligament complexes. When performing the approach care must be taken to identify and protect the neurovascular structures that lie immediately in front of the elbow. The primary indication for the approach is to perform an anterior capsular release or resection to treat a flexion contracture caused by capsular hypertrophy with a normal or near-normal joint structure. Other indications include repair of the distal biceps tendon, exploration of the neurovascular structures and resection of heterotopic ossification. The approach is not ideal for intra-articular procedures. The approach is contra-indicated if there is extensive scarring anteriorly that would prevent safe identification and protection of the neurovascular structures. The anterior approach continues to have a role in reconstructive elbow surgery, although its role has decreased since the advent of arthroscopic procedures and the widespread use of more utilitarian approaches such as the lateral and posterior approaches.