Although uncommonly encountered, knee dislocation is frequently associated with major vascular injury. Serious injuries resulting in ischemia demand prompt recognition and efficient management to prevent devastating long-term sequelae. In this review, we detail mechanisms of knee dislocation and associated popliteal vascular injuries. Diagnostic modalities used to evaluate the extent of vascular injury are individually discussed. Appropriate initial management of vascular injuries is crucial and an algorithm for diagnosis and management will be reviewed. We elaborate on the salient points of vascular reconstruction in the context of the dislocated knee: surgical approach, conduct of the procedure, and adjunctive maneuvers are described.