Reconstruction of the interosseous membrane is an emerging procedure designed to help restore anatomic and biomechanical relationships within the forearm after a longitudinal instability injury. The indication for this reconstruction is proven acute or chronic longitudinal instability of the forearm. This technique uses a synthetic braided graft tied over endobuttons at radial and ulnar tunnels. It can also be combined with other procedures such as radial head replacement, wafer procedures, and even ulnar shortening osteotomies for comprehensive management of the condition. Early results indicate that this reconstruction can produce clinical improvement in some patients. Further follow-up is required to determine the long-term durability of the construct, but early results are encouraging in a complex patient population.