<p>Pseudoaneurysm (PSA) formation after knee arthroscopy is a rare but potentially limb- and life-threatening complication. In the worst-case scenario, it may lead to acute rupture, haemorrhagic shock, or limb loss. More frequent presentations include a pulsatile mass in the popliteal fossa and signs of critical or acute limb ischemia, although symptoms can vary. In this manuscript, we provide a literature review and report a rare case of popliteal artery pseudoaneurysm formation after knee arthroscopy and its subsequent treatment using an open surgical repair technique. We performed direct surgical repair of the pseudoaneurysm through a lazy S-shaped incision, using the small saphenous vein as patch material. We avoided the use of prosthetic materials or bypass grafting. Post-procedure follow-up revealed resolution of symptoms. Open surgical repair remains the gold standard, although endovascular therapy or hybrid approaches may be feasible in selected clinical scenarios. It is essential to raise awareness within the orthopaedic scientific community to prevent the oversight of such complications and to consider pre-procedure protocols that could help identify vascular complications early.</p>