My theory about my knee
To save some time I first need to explain a little bit about the anatomy of the knee. My theory is mainly about the ACL and the hamstrings. It is important to realize that these two structure have a close and very important relationship. The ACL serves the purpose of keeping your tibia in place. More specifically it limits anterior (forward) movement of the tibia in relation to the femur.
You have three muscles in your hammies, the biceps femoris(red), the semimembranosus(orange), and the semitendinosus(purple). They all originate on the ischial tuberosity (fanny bone). However, all three insert (distal attachment) at a different spot. The biceps femoris attaches on the head of the fibula, the semimebranosus attaches to the back side of the medial epicondyle (back inside of your knee), the semitendinosus wraps around the front of your knee and attaches on the anterior (front) medial (inside) aspect of your tibia. These origins and insertions are critical to knowing and understanding the different movements caused by the muscles. All three muscle cause flexion of the knee. However, our knee can also rotate internally and externally. Bend your knee to 90 degrees and turn your toes inward (internal rotation) and then outward (external rotation). The biceps femoris is primarily responsible for external rotation. The semimembranosus and semitendinosus are responsible for internal rotation. I know there is a good chance that some might have any idea what I am talking about, Dad, but it is important to understand the mechanics of the knee to understand my theory.
One more important role of the hammies. Because the biceps femoris and semitendinosus wrap around the knee, they play an important role in preventing anterior gliding of the tibia on the femur. Also, the ACL is must susceptible to tear when the knee is in a rotated position. For instance if I am cutting to the basket and plant my leg in a position that is forcing external rotation, then my semitendinosus will contract to hold my knee in place and keep the bones from moving to much in the wrong direction.
Next important thing for you to understand in order understand my theory. When I tore my ACL for the first time Dr. M decided to use a hamstring graph. This requires a cool instrument that runs along the tendon of the semitendonosus and shaves off a chunk large enough to serve as your ACL. The doctors then drill some holes and screw this graph into place. The semitendonosus tendon is left to hypertrophy and grow back to normal size. I did not know this until recently. I had also thought that they had just taken the entire tendon and had somehow tied my semitendonosus into my semimembranosus.
I specifically remember a moment during my first recovery when I thought for a short time I had retorn my ACL. It was my freshman year and all of my friends and roomates were playing snow football. I had decided to sit and watch (I was still in my brace). As I was getting up to leaving I felt a pull and what I thought was a snap in the back of my leg. I think I probably hyperextended it slightly. I thought I had retorn my ACL, I went and laid in my bed terrofied at what I had just done. I woke in the morning my knee felt okay, I had a check up in a week and my ACL was still there when the doctor checked. So I just forgot about it. You all know the rest of the story, I have continued to hurt and retear my ACL and other knee structures over and over again.
My theory is this: that day when I thought I had torn my ACL I acually tore the tendon of my semitendinosus. This makes sense, mainly because it is easy to feel that my right knee has a tendon where the semitendonosus should be when my left knee does not. The semitendonosus causes internal rotation and will help control excessive external rotation. the third time I tore my ACL occured when I was driving the lane and jumped of my left leg to the right. this action must of caused excessive external rotation and the semitendonousus is meant to restrict that. However, I did not have a semitendonosus and therefore my knee twisted to much and my ACL popped. I remember feeling that external twisting of my knee as I felt the ligament tear. I haven't run this theory by Dr. Noonan yet but I plan on doing so and seeing what he thinks. If I am incorrect I am curious to know why I am missing that tendon.
What does this mean? absolutely nothing. Except that now I think that I know what is wrong and that gives me some peace of mind. Thank you for reading this.
