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Complex knee injuries from bouldering: A case series.

Jhulia Kawachi Cruz¹, Khim Yew Chew¹, Mok Ying Ren¹

¹Division of Sports Shoulder & Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, 119228, Singapore.

Journal of ISAKOS : Joint Disorders & Orthopaedic Sports Medicine

|August 24, 2025

Summary

Bouldering ground falls lead to complex knee injuries, including anterior cruciate ligament (ACL) and meniscus tears. These injuries are more severe than those in soccer or basketball, necessitating sport-specific prevention and rehabilitation.

Keywords:

Bouldering Ground falls Knee injuries Meniscus root tear Multiligament knee injury sports-related injury

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Area of Science:

Sports Medicine
Orthopedic Surgery
Biomechanics

Background:

Bouldering involves high-energy ground falls without ropes.
Knee injuries are an increasing concern in bouldering.
Existing literature primarily focuses on upper extremity injuries in climbing.

Purpose of the Study:

To characterize knee injury patterns from bouldering ground falls.
To compare bouldering knee injuries with those in soccer and basketball.
To assess the burden of complex knee injuries in bouldering.

Main Methods:

Retrospective case series of 19 bouldering patients (March 2022-October 2024).
Collected data on demographics, injury mechanisms, and knee pathology (ligamentous, meniscal, osseous, chondral).
Compared bouldering injuries to institutional data from soccer and basketball.

Main Results:

15/19 patients had combined anterior cruciate ligament (ACL) and meniscus injuries.
4/19 cases involved multiligament knee injuries (MLKI), representing 20% of all MLKI.
Bouldering showed a higher proportion of complex knee injuries than soccer or basketball.

Conclusions:

Bouldering ground falls cause a high rate of complex knee injuries, including multiligament injuries and meniscus root tears.
High-energy axial and rotational loading likely contribute to these injuries.
Increased awareness, prevention, and sport-specific rehabilitation are needed for bouldering athletes.