Complex knee injuries from bouldering: A case series

Bouldering, a dynamic climbing discipline performed without ropes, is associated with high-energy ground falls. While most existing climbing injury literature has focused on the upper extremities, our data indicated an increasing number of complex knee injuries related to bouldering. This review was conducted to characterize the injury patterns sustained from ground falls during bouldering, and to compare the relative burden of these injuries with those sustained in other high-participation sports.

A retrospective case series was performed, including climbers who presented with knee injuries from ground falls during bouldering between March 2022 and October 2024. Patient demographics, injury mechanisms, ligamentous and meniscal pathology, as well as osseous or chondral damage were collected. The injuries were stratified by sex, age group, and injury complexity, including multiligament injury, meniscus tears, and osseous or chondral involvement. The bouldering-related injuries were then compared to institutional data from soccer and basketball, the two most common causes of sports-related knee injuries requiring surgery at the institution's sports center.

Nineteen patients were included, with a mean age of 27 ​± ​5.1 years. Of these, 15 (78.9 ​%) sustained combined anterior cruciate ligament and meniscus injuries. Surgical intervention was performed in 18 (94.7 ​%) patients. Multiligament knee injuries occurred in 4 (21.2 ​%) bouldering cases, accounting for 20 ​% of all multiligament knee injuries treated during the study period. Meniscus root tears were identified in 4 (21.1 ​%) bouldering cases, representing 22 ​% of all surgically treated meniscus root tears. Bone contusions consistent with pivot-shift patterns were observed in 52.6 ​% of patients, with cartilage fissuring and sulcus terminalis impaction in 10.5 ​% each. Compared to soccer and basketball, bouldering demonstrated a relatively higher proportion of complex knee injuries, despite lower participation volumes.

Ground falls during bouldering ground falls have been associated with a high proportion of complex knee injuries, including multiligament knee injuries, meniscus root tears, and injuries to both menisci. These injury patterns are believed to result from high-energy axial and rotational loading, and suggest the need for increased awareness, preventive strategies, and rehabilitation programs tailored to the sport.

Level 4, Case series.