Thirty-nine patients with 43 complete knee dislocations managed between 1973 and 1990 were reviewed retrospectively to compare the results of surgical reconstruction to nonreconstructive treatment of these injuries. The average patient age was 34 years and the average follow-up was 5 years (range: 1 to 18 years). Patients were evaluated by physical examination and the Lysholm knee scoring scale. Fourteen knees (33%) sustained popliteal vessel injury and five (9%) required amputation. Peroneal and tibial nerve injuries involved 13 knees (30%). Twenty-five of 39 patients (64%) sustained other associated fractures. Three patients sustained associated paraplegia and nine were lost to follow-up, leaving 25 knees available for follow-up examination. Thirteen knees were managed by surgical reconstruction of their ligamentous injuries and 12 were managed by nonreconstructive means. The surgically treated group had an average Lysholm knee score of 80 compared with the nonreconstructive group with an average score of 66. Average range of motion of was 106 degrees for the surgical group and 95 degrees for the nonreconstructive group. Despite the severity of the initial injury and the potential presence of vascular/nerve injuries, surgical reconstruction provides superior results to immobilization alone in the management of these injuries.