All patients with a diagnosis of knee dislocation during a 7 1/2-year period (1984-1991) were reviewed retrospectively. There were 37 knee dislocations (KDs) in 35 patients. The mechanism of injury was predominantly motor vehicle or pedestrian crashes. Popliteal artery injury was present in 6 of 37 (16%). There was no significant vascular injury in 31 of 37 knee dislocations as evidenced by normal arteriograms or absence of vascular complications on follow-up. Of those with no significant vascular injury, 3 of 31 had limb ischemia that improved with reduction of the KD, had normal arteriograms, and had no further vascular treatment. All patients with popliteal artery injury had a pulse deficit (five of six) or a documented history of ischemia (six of six). In the absence of these findings, no patient was found to have an arterial injury. Arterial injuries were treated with interposition (five of six) or bypass graft (one of six) and fasciotomies (six of six). Amputation was required in one of six of the vascular injury group and none of 31 of the remainder of the patients with no vascular injury. We recommend the selective use of arteriography in patients with KDs based on a history or clinical findings of ischemia and do not recommend routine arteriography for all patients with KD.