High-velocity knee dislocations are among the most challenging type of injury that knee surgeons encounter. These injuries usually result in tears of at least three of the four major ligaments of the knee and frequently have severe capsular, neurovascular, integument, meniscal, and tendinous injuries. Patients with high-velocity knee dislocations often have sustained injuries to other systems (head, chest, and so forth) that may preclude early, aggressive treatment of the torn knee ligaments. Disruption of blood flow through the popliteal artery is common in these injuries, and if disruption is not recognized and treated quickly, will result in amputation. The range and complexity of injury patterns in high-velocity knee dislocations requires the use of a variety of treatment options to reduce mortality, prevent amputation, and to maximize the functional outcome of the injured limb. Patients with knee dislocation are at risk for a wide spectrum of long-term problems ranging from severe stiffness to gross instability.