Blunt popliteal artery trauma is a challenging injury, particularly when associated with major soft tissue damage. We reviewed our experience with this injury to determine 1) the incidence of vascular injury associated with fractures and/or dislocations about the knee, 2) the incidence of limb loss, and 3) factors associated with amputation. We treated 37 patients with 38 blunt popliteal artery injuries and either fractures about the knee or posterior knee dislocations. Patients who underwent primary amputations were excluded. The incidence of popliteal artery injuries with fractures about the knee was 3 per cent, whereas 16 per cent of patients with posterior knee dislocations had vascular injuries (P < 0.05). Amputations were required in 14 of the 38 injured limbs (36%). None of these patients had a pulse or Doppler signal on admission, and 13 had major soft tissue injury. No patient with a pulse or Doppler signal lost a limb (P < 0.05). Limb loss was primarily related to limited venous outflow and/or severe infection in damaged tissue. Failure of the arterial repair rarely led to amputation, particularly in recent years. Two patients with angiographically proven arterial injuries were treated nonoperatively without complications. The incidence of vascular injuries associated with fractures about the knee is low, but somewhat higher with posterior knee dislocations. The overall 9 per cent rate of positive angiograms suggests that a selective approach may be indicated. The amputation rate remains high, but it has improved with an integrated, multidisciplinary team approach. In patients without a pulse or Doppler signal and with severe soft tissue injuries, primary amputation may be appropriate.