Maybe somebody can defeat or validate my logic here:
1. I have had crap ankle flexibility since before I started weight training. I have never had dorsiflexion that would allow my knees to pass over my toes in a squat because of ankle bone spurs.
2. I have at points been quite strong in the dead lift and wide-stance back squat. These were two lifts that did not require much ankle flexibility.
3. A wide-stance back squat and powerful dead lift, trained often, result in a well-developed posterior chain. Glutes and hamstrings. These exercises, trained at the exclusion of movements that directly target the quads, could create a hamstring-quadricep muscle imbalance.
4. This study
shows that in the ACL insufficient knee the hamstring-quad ratio is typically higher due to a weakened quadriceps.
Theory: a much stronger pair of hamstrings than quads (when the ratio is typically reversed) could be the result of a life of motion dominated by posterior chain musculature. This ratio of forces on the knee could be contributing to my risk for ligament injuries, and my acute knee pain that is usually felt when my heels leave the ground and where quadriceps would usually dominate knee extension.
Developing ankle mobility (via surgery and PT) and focusing on training the quadriceps through any pain-free methods possible until they are AT LEAST AS strong as the hamstrings could be key in ridding me of knee pain and knee injuries.