Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes

Am J Sports Med. 2020 Mar;48(3):730-738. doi: 10.1177/0363546519899931. Epub 2020 Jan 31.


Background: There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes.

Purpose: To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes.

Study design: Case series; Level of evidence, 4.

Methods: During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores.

Results: Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5).

Conclusion: Increased attention should be placed on the climber's knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.

Keywords: anterior cruciate ligament (ACL) injury; heel hook; injury mechanism; meniscal tear; sports injury; valgus.