few peer reviewed case reports have been reported with various techniques of reconstruction [ 1 , 39 ] . allum did not report vascular lesions as a complication after aclr in a review article on this subject . a 44-year - old male has a previous medical history of open medial and lateral ligament repair of the right knee 15  years previously ( motor accident ) . functional instability of the right knee due to acl deficiency was the reason for referral to our service . the graft was fixed with a bone mulch screw on the femoral side and a washerloc device in the tibia ( arthrotek , inc . thromboprophylaxis for deep venous thrombosis was given by means of low molecular weight heparin ( 2500  ie daily ) during hospital stay . on the 17th day of post surgery , he experienced pain and swelling in the popliteal fossa of the right knee . two days later , the fossa pain returned with alterations of skin color , sensory loss and an increasing cold right foot . angiography revealed a subtotal occlusion of the popliteal artery at the level of the superior genicular artery ( fig .  1 ) . no further emboli were noted , however , the peripheral flow qualified as too slow and suspect of small distal occlusions . anticoagulant therapy with intravenous heparin as well as epidural analgesia was administered until complete recovery of peripheral circulation . sensory loss of the foot slowly recovered after 4  months . vascular analysis in rest and strenuous activity was performed at 4  months . he had no more complaints , symmetrical ankle - brachial index in both legs and intact pulses at the foot and ankle . the patient has full range of motion of the right knee with a lachman and anterior drawer test of 02  mm ( international knee documentation committee ) and absent pivot shift test . 1angiography of the right knee showing subtotal occlusion of the popliteal artery at the level of the superior genicular artery ( reproduced with permission from ) angiography of the right knee showing subtotal occlusion of the popliteal artery at the level of the superior genicular artery ( reproduced with permission from ) a case of fatal pulmonary embolism after aclr with venous origin has been published recently . arterial lesions of the popliteal artery after aclr have been presented in few peer reviewed case reports even with an all - inside technique of arthroscopic acl reconstruction and fixation as well as any type of graft . a composite graft consisting of a polypropylene ligament augmentation and the middle third of the quadriceps - patellar tendon was fixed to the lateral femur with a staple . spalding et al .   reported a case of unilateral claudication 8  years after acl reconstruction with use of a gore - tex ligament . a cyst had formed around the femoral insertion of the ruptured synthetic ligament and was excised without vascular repair . evans et al .   reported a pseudoaneurysm of the medial inferior genicular artery following acl reconstruction using a central third patellar tendon graft fixed with interference screws . at 5  weeks , ligation of the artery and removal of the thrombus led to full recovery . the cause of the lesion was elevation of the periosteum on the medial side of the tibia for tibial tunnel preparation . aldridge et al .   described an avulsion of the middle genicular artery after a bone - patellar tendon - bone autograft fixed with interference screws . probable cause for the avulsion of the middle genicular artery was the debridement of the femoral acl remnant tissue . we have previously published two cases of popliteal artery lesions caused by a drill for bicortical tibia fixation after quadruple hamstring aclr [ 6 , 7 ] . in the first case , the drill had caused an intimal lesion at the level of the infragenicular popliteal artery which led to the pseudoaneurysm . vascular repair was performed 12  days after acl reconstruction but sensory loss of the saphenous and medial plantar nerves was still present at 4  months follow - up . the second case was a simultaneous traumatic pseudoaneurysm and thrombosis of the popliteal artery after aclr . at surgical exploration , there was no apparent relation of the femoral fixation device to the pseudoaneurysm of the supragenicular popliteal artery . the pseudoaneurysm was ligated and a venous jump graft was performed to bypass the thrombosis located more distally in the popliteal artery . in this review of the literature on arterial complications after aclr , all cases are associated with direct damage to the popliteal artery at time of aclr [ 1 , 3 , 69 ] . there was no apparent direct damage to the popliteal artery in the 44-year - old male patient presented in this case report . the popliteal artery occlusion was not in line with either the femoral nor tibial fixation device . vascular analysis did not reveal any pre - existent vascular causes for arterial embolus formation proximal to the popliteal artery . precursors could have been pre - existent intimal vascular damage or adhesions of the artery at the level of the superior genicular artery in combination with the use of the tourniquet and aclr . . clinical symptoms of pain in the popliteal fossa and sensory deficits in lower leg and foot should prompt the physician to analyze possible injuries of the popliteal artery . the differential diagnosis should include compartment syndrome and deep venous thrombosis . doppler examination as well as intact pedal arterial pulses are unreliable in diagnosing arterial lesions after acl reconstruction .
arterial complications after anterior cruciate ligament reconstruction ( aclr ) are rare . 
 we present a case report of a 44-year - old male patient with a subtotal occlusion of the popliteal artery , with sensory loss in the foot , 17  days after aclr . 
 embolectomy and anticoagulant therapy led to full recovery of the peripheral arterial circulation . 
 the sensory loss of the foot also fully recovered . to our knowledge , this is the first case report of an embolus of the popliteal artery after aclr without relation to graft fixation . a literature review on vascular complications after aclr is presented .