From the Shirtpunch.com's interview with the artist:
"Question: What inspired this design?
Answer: Hundreds of hours of playing Skyrim. I pay very close attention to the world reality and story telling aspect of games. Skyrim had wonderful backgrounds, but it certainly failed a bit with the believability of the NPCs by giving them all the same sentences to say and not switching up their voices a lot. I find that very interesting and funny, but also a bit frustrating. The arrow in the knee meme really managed to express a problem a lot of computer games suffer from in one sentence. This is why I didn't get sick of the meme as fast as others - and it also inspired various drawings I made."
