A 52-year-old woman without risk factors for vascular disease or preceding trauma presented with prolonged pain of the right knee radiating to the calf. Radiographs, duplex ultrasound and MR angiography revealed a popliteal artery occlusion resulting from two exostoses on the dorsal side of the proximal tibia. These exostoses were surgically removed. The postoperative course was uneventful. Six weeks after surgery, the patient reported having no more pain. Bony exostoses occur most frequently on the distal femur and the proximal tibia. In rare cases, they can cause vascular complications including stenosis, occlusion and venous thrombosis. In patients with incapacitating symptoms or vascular complications, surgical treatment is indicated. If an expectative course is opted for, monitoring for vascular complications and malignant degeneration must take place.