Background There is limited insight into trauma mechanisms of knee injuries in bouldering and sport climbing for both non-competitive and competitive athletes. Purpose Based on a recent rapid increase of knee injuries caused by bouldering and sport climbing, we aimed to examine traumatic mechanisms of injury, demographics, distribution and severity of knee injuries in affected athletes. Study Design Case series; Level of evidence, 4. Methods Within a four-year period, we performed a retrospective multi-center analysis of acute knee injuries in both competitive and non-competitive climbers. Traumatic mechanisms were inquired and severity levels, therapies and outcomes recorded using Visual Analog Scale (VAS), Tegner, Lysholm and a climbing-specific outcome score. Results A total number of 71 patients (35% competitive athletes and 65% non-competitive athletes) with 77 independent acute knee injuries were identified. Four different trauma mechanisms were thereby recorded: High step (20.8%), Drop knee (16.9%), Heel hook (40.3%) and (ground) Fall (22.1%). The leading structural damage was medial meniscal tear (29.3%), found significantly more often in non-competitive athletes. A specific climbing injury is iliotibial band strain during the heel hook position, causing 46.8 % of all injuries; most injuries resulted from indoor bouldering. Surgical procedures were predominantly necessary within the non-competitive group. One year after the injury, the average Tegner score was 5.6 ± 0.6 (3-6), Lysholm score was 97 ± 4.8 (74-100) and climbing specific outcome score was 4.8 ± 0.6 (2-5). Conclusion: Increased attention on the climber’s knee is required, especially due to the worldwide rise of indoor bouldering. Sport specific awareness- and training programs for both noncompetitive and competitive climbers to reduce acute knee injuries should be developed and sports medical supervision is mandatory.
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