ACL Reconstruction: Allograft vs Autograft?

I saw the surgeon yesterday.

Surgery is the path forward, especially given my goals of staying active and continuing to compete at a high level in cyclocross. My unique goals and age put me in a unique box that, frankly, my surgeon has not seen before in terms of deciding between autograft or allograft. If I were a 25 year old national level soccer player, there'd be no question about it, and we'd choose the Gold Standard; patellar autograft, a procedure in which a segment of my own patellar tendon is harvested for the reconstruction.

 However, given my love of cycling and goal to one day win a national title, he is hesitant to do anything to upset the knee any more than necessary. In particular, he feels the repetitive motion of pedaling could irritate the resultant scar tissue of the patellar tendon, if we were to take that route. The hamstring tendon is another option, but given its involvement in knee flexion, the surgeon feels it carries the same issues relative to irritation over the millions of cycles (pun not intended) in pedaling.

The allograft, or utilisation of cadaver tissue for the reconstruction, apparently fares about the same statistically as the autograft in older patients. While I agree with the surgeon on not wanting to cause insult to any more of the knee that has already been done, I wonder how much of the data for older patients is skewed by the fact that most patients over 40 suffer this kind of injury and then naturally slow down and/or cease to participate in physical activity. If this is true for a majority of those undergoing ACL reconstruction, then the material used really doesn't matter since it's not really being stressed. I know one such patient who, while never as avid a skier as I, has sworn off skiing in the wake of her surgery. I wonder for how many in the data set used to tout the efficacy of using cadaver tissue this is true. Even without my lofty cycling goals, I hope to remain active in many sports, such as skiing and kiteboarding, that while not necessarily heavy on the cutting and pivoting, remain very high energy.

On the other hand, cycling is a relatively straightforward pursuit as far as the knee is concerned. There is not a lot of cutting, pivoting and sudden change of direction. These are the things that really beg for -- and tend to stress -- a functioning ACL. That said, cyclocross is a unique beast, with frequent dismounts from and remounts on the bike, jumping over barriers, running through sand and/or muddy, slippery terrain. Changes in direction may be small and infrequent, but when they occur they can be sudden, unexpected and forceful. I'd meant for this to be an unbiased, un-opinionated explanation of how my surgeon and I saw the various options, but I may have just made my decision.

What are your thoughts?
What was your experience when having ACL reconstruction?
Would love to hear from everyone, but especially from cyclists.

wondering

in a previous post, i alluded to the fact that i wasn't quite sure where my recent success had come from. and, to some degree, that's entirely true. i mean, i know i've worked super hard and have been trying to do everything right -- and within reason, no, i haven't purchased Normatech recovery boots or rented a hypoxic sleeping tent. my diet is not perfect, but pretty darn good. i'll try to post on that another time. but training-wise i'm not entirely sure what might be different and what might be creating these positive results.

here are some thoughts from a conversation I had with a high school friend who has been racing at an elite level for way longer than me, is way more knowledgable than me about training, is also self-coached, and -- oh, by the way -- has a Stars and Stripes jersey from a couple of years ago. a super guy, he never balks when i ask him for training advice. what follows is some explanation about my plan going into the Sly Fox/Victory weekend and some questions around some unexpected changes and how they may or may not have played a role:

training question: my plan this past weekend was to only race Sunday. so i designed my week as follows:

• M: off/recovery (turned out to be off)
• T: HARD (descending intervals, followed by a 2x20)
• W: moderate (sweetspot intervals, 4x8)
• R: HARD ( tabata style intervals, 2x20 mins, :30 on, :20off)
• F: off
• S: openers
• Su: RACE!

that was the plan. then my wife switched her schedule around so i could race  both -- yes, i am a lucky man! -- though, with the late change i registered for the wrong race and lost my first row call-up. so, i raced Saturday with no openers the day before, basically with NO workout the day before -- and won! nothing else in the schedule above changed. also, because i was helping another racer in the parking lot with a dead battery, i didn't get to do my usual warm-up . got in a much shorter warm-up. on a very cold day. and, i won. similarly, on Sunday, i didn't take my truck because my wife needed it. as a result, i didn't have all the gear i usually take, and for reasons that I can explain another time, this led to me again getting a much shorter than usual warm-up on a really cold day. 

so, that's a lot to decipher, but you're a smart reader and if you've stuck with me this far, my questions are these:

  -- could it be that i either don't need "openers" or even possibly do better without "openers" before a race? a previous coach once told me that my openers were a bit too much stress, although what he prescribed ended up being almost exactly the same TSS both in real life and when modeled in trainingpeaks and trainerroad.

  -- could it be that my previous warm-up routine was also too much and I was leaving too much on the trainer before the race? my "go to" trainer warm-up is 35 minutes long and is about 33 TSS points. seems reasonable, but when combined with three laps of course recon, maybe it's too much.

-- could it be that my fitness is finally coming in and i am way overthinking all of this? i'm starting to wonder if this is the case. what's really interesting to me, is that on paper -- or on the LCD screen -- , my fitness (CTL) this season has been about the same or higher than it was on a day-to-day comparison against last season. that said, i came into this season with no MTB racing compared to a ton of MTB races in the summer of 2016. i also had essentially no training in June. i had some results early this fall that were not on par with my expectations, and i wonder if even though the software thought i had similar fitness earlier in the season, it wasn't quite right.

i know that everyone is different and what works for me might not work for you and vice-versa, but i just thought i'd share my experience and see if anyone has any feedback or insights that they'd like to give to me and our community.

another thing, that i didn't really touch on here, but do touch on a little in my previous post is the mental stress. maybe by not focusing so much on the result and the process and the desire to win, maybe by focusing more on the fun and the relationships and the people, i've found a proper balance.

next season

next season starts now

dreams of stars and stripes fuel me

grateful confidence

blessed

lately, i've been blessed with some great results. here's the thing -- i don't know why. or, at least i'm not sure why. not a lot has changed. i'm self-coached -- again. i've had a few coaches in recent years. they've all been great, but with each one something has led to me to cancel the service. one time a move, one time a break from competitive cycling to spend more time with family, and, ok, one just wasn't that great and i quit him before my free trial ended. so, i'm thinking i may start to use this blog as a venue to share my experiences, thoughts and questions on training. with complete transparency. sometimes, i worry about revealing my training secrets with potential competitors, but within our community, we're really all friends, so what the heck? knowledge is only one piece of the puzzle, right? the bigger piece is putting in the work.

after reading the "treatise" as i shall henceforth refer to the blog post of another master's athlete who recently stopped competing, i've actually had to step back and evaluate why i love this sport so much. was i, too, competing for the wrong reasons? was i missing opportunities to bond with my tribe? was i too focused on my process and my preparation at each race that i was missing those chances for connection? as result of this soul searching, i've made a conscious effort to be more present each week and at each event. in some cases, this has had the effect of shortening my warm-up or making me forget some "essential" part of my rigid pre-race regimen. but, interestingly, it has not negatively impacted my race performance -- in fact, it may have even improved it (and i want to dig into this relative to the conversation above) -- and it has made me feel better and more connected to this group.

 this weekend brought two new courses for the PACX series.

Troegenator Cross:

playing in the rain, mud and cold

saturday was the Tröegs Independent Brewing-sponsored Troegenator Cross at Allenberry resort in Boiling Springs, PA. The was a mix of grass, macadam, gravel and wooded trail surfaces. the day started dry but overcast. when i arrived at 8:00 am, the temperature was 37 degF. i meandered over to where kelly and dlowe were parked and chatted for a bit and sipped my coffee, procrastinating against kitting up in the cold. when i finally got on course, i was treated to a pretty interesting course that traversed grass, macadam, gravel, a harvested corn field and wooded trails. in pre-ride it was dry, resulting in a fairly fast and flowey course -- well, except for the steep gravel road climb. in pre-ride, i bumped in  judah and we both tried to see if we could ride it. on the third attempt, i finally made it. my heart rate was almost maxed, but i revelled in the fact that i'd done it. at some point around 9:00 am, it started to rain. looking through weather history, at 10:49 am -- eleven minutes before the start of my race -- weather underground has recorded "heavy rain". the rain took an interesting course and made it super fun. for me. the corn field seemed to mostly a clay-based soil, and so, while it stayed relatively firm, it developed a layer of slick greasy mud on top. you could power through here while sliding around. fun. the gravel climb become completely unrideable. the wooded trail became a sloppy mess. more fun.

at some point, though, the race ceased to fun. the cold and wet turned my fingers numb. i could not feel where the shifters were, could not brake well, and had my hands bounced off the bars a couple of times. after the race, i found the unlocked boiler room in the heated bathroom and tried to regain some warmth. despite finding this much need heat source, i continued to shiver uncontrollably for at least 30 minutes. i was still shivering at my car and in my dry clothes when i noticed a vehicle having trouble escaping from the grassy, sloped field that served as the parking lot on this day. i ran over to help push the car out of the mud and up the hill. then, there was another. and another. after the fourth vehicle was freed, i noticed i was no longer shivering. not only had the effort helped me warm up by using my body again, it warmed my heart. dare i say, that might have felt better than winning my race.

with my only dry clothes now soaked, i went down to the huge beer tent to do podiums and to hang out a bit. i grabbed a pretty tasty veggie burger and spent some time talking with folks. thanked dave borden for his role in putting on a great race. thanked bob joos for his infectious enthusiasm.

it was a good day. despite the cold and the rain, i wouldn't have changed a thing.

WCCX #2:

PA State CX Champion M45-49

sunday was the second race of the year put on by the trio of bob reuther, scott gamble and shawn carey. the race was designated as the Pennsylvania State Cyclocross Championships and held at The Phelps School, a venue that had been used for area CX races in years past. The course was fast and flowy, as are most Reuther designed courses, but not without a significant amount of elevation change. on the back half of the course, there was a section of dirt that was the result of some recent excavation. the previous day's rain had turned the freshly laid dirt into a soft, spongy surface. not quite mud. but your tires would sink into it. first, we'd encounter this section in a downhill direction. then, after traversing several twists and turns, the course headed back uphill, and it was at the top of the climb where riders needed to cross this spongy dirt again for about 20 yards. in pre-ride, i noticed others having a hard time pedaling through this. i like to churn big gears. i thought this could be the place to make a move. the other notable feature on this day was the wind. windspeeds were in the 20's with gusts into the 30's.

with some of these close to home races, i tend to let my guard down in terms of preparation. i end up arriving later than i want, i forget stuff, i lose focus. this race, 10.9 miles from home, was no different. i forgot my drinks at home and had to turn around to get them when i was already about halfway there. i showed up to staging far too close for comfort. as the official gave the 1-minute warning, i was still frantically wrestling with my clothes. i didn't reset the Garmin, so once the race did get started, the device was barking at me to start intervals that are setup for my pre-race warm-up. i forgot to press the record button on the GoPro mounted to my handlebars. i forgot to eat my Gu.

reuther makes an early move.

our race began fast. by the time we reached the first downhill section, which was super fast, fun, flowy, i was second wheel behind barry wahner. while i was tempted to pass him, i kept telling myself to be patient, stay calm. before we reached the double barriers, reuther went to pass us both. i slotted in behind his wheel and stayed there, trying to be as patient as possible. on the up
hill leading to the spongy stuff, i made my move. i got to that section first and built a gap there that continued to grow through the race. although i felt like my lead was growing, i was nervous every time that i'd hit a gusty headwind that maybe i was getting hit with more headwind than my competitors and dumb luck would end up conspiring to steal my victory. about 1-1/2 to 2 laps into the race, my legs started to bark at me and i wondered if i'd gone out to hard. i pushed through and eventually they began to feel like the usual suffering. i really wanted to win this race badly. i had won a state championship back in 2014. oddly, i came in second in that race. since the winner of the race was over fifty, he won the 50-54 age group and i won the 45-49. i was psyched to have won the championship, but it never really quite sat right with me. by winning this race outright, it erases all doubt. i like this path much better.

after the race, i was able to help with the juniors race and cheer on many other races. i got to hang with lots of great folks. i got a great recommendation for a gift to thank my wife for her support in this awesome craziness that is cyclocross racing. after the last race of the day, we began tearing down the course. it's awesome to see how the community comes together to pitch in. the whole time we worked, one of my mom's favorite phrases ran through my head, "many hands make light work."

another great day with this community.

many thanks to Howard Brown at Trek Bicycle Shop in Newark, DE and Bill Bradley at Trek Bicycle Shop in West Chester, PA for the continued support of the team!

too many words

i love to write.

i hate to write.

too many words, experiences, feelings flow through my mind.
conspiring to erase an order or sense of logic that i try to coerce them into.
(and yes, i just ended a sentence with a preposition and that will bother me, but i don't want to craft it differently for fear of losing the rest of this thought.)

i am blessed beyond measure. i have had some amazing experiences and results lately.
in working to connect more, i feared losing an edge.
paradoxically,

 -- or perhaps not! --

i have made more of the connection i seek
and
my
edge
has
gotten
sharper.

Opportunities missed

I wrote the post below on October 16th in response to another blogger's post about his departure from competitive cycling, and have been back and forth about publishing it. I published it that day, but quickly pulled it down. I'm still bothered by it. It churns through my head at every race that I've been to since reading this other person's words. And sometimes, that's good. It has helped me to re-evaluate why I'm there. Why I'm stealing time away from my family to ride bikes around in circles. Why I'm suffering through heat and humidity, cold and rain, frostbite and uncontrollable shivering. I'm still figuring it out, but I think it comes down to the people. This cycling community -- and more specifically, this cyclocross community -- is my tribe. We share something that can't be explained. We might not always agree, or even always get along, but we understand each other and we share a love of the effort, the journey, and, yes, perhaps a bit too much, the bikes. And with that, here's the old post:

Someone I've raced bicycles against the past couple years just posted his treatise on why he's "retiring" from competitive cycling. After assuring his readers that he doesn't judge them for not making the same decision as he, he writes about how competitive cycling is self-serving and self-aggrandizing and that he longs for a more "sustainable" lifestyle. Actually, he choses to use the phrases "self-promotion", "embellishment of the ego" and "selfish". This, after I've just read D.Lowe's thoughtful and touching piece and the resulting facebook comments about the cyclocross community and how it's really more like a family than anything else:

my goals in cross, some are not about the racing,
I got to the course early, and had a bit of nice extra time.
Pedaling around the parking lots, I got a chance to stop and chat
and listen, shake hands,
talk racing,
with,
whomever I came across.

And while these people cherish the effort and the time spent together "on and off the bike", this retiring athlete has the gall to project his motivations on the community. You can never know exactly how another feels, but from his address, and I quote, "racing and trying to win races is nothing more than self-promotion and embellishment of the ego", it seems that for 38 years he may have been doing it for the wrong reasons. Others race for lots of other reasons that have very little to do with ego and winning. Many people line up every weekend with no thought of winning, but with every intention of putting forth their best self "on and off the bike". Some people race to have a measuring stick for their own personal improvement.  Some people race to have the motivation to stay fit. I, myself, fall into this category. I know when I am not racing, it is easier to let my diet slip, easier to have a few more beers or glasses of wine than I should, easier to shrug off a day of exercise if the weather sucks or if I just simply don't feel like it. Some people race to meet others who also love bikes and/or bicyclists and/or mud and/or beer and/or heckling and/or hand-ups and/or community and/or whatever. There are a whole host of reasons that people race, and I would argue that most of them are NOT "embellishment of the ego".

The whole thing rubs me the wrong way.

Please, tell me in the comments below, why do you race bicycles?

Charm City

I raced Charm City CX this weekend. Last year was my first time racing this staple of Mid-Atlantic cyclocross racing. I did the double last year and again this year. They changed the age ranges this year for the masters categories. Not sure why. Seems to be a trend up and down the East Coast.

Lots of people are gaga over Charm City CX. I think it's fine. This year, the flyover was a impressive; three-legged affair where one of the legs was made up of (apparently -- I never bothered to count) 22 very steep steps, while the other two legs were ramps to ride back down. Saturday we went straight upon reaching the top of the steps. Sunday we made a right turn and went down the other ramp.

Saturday was crazy hot for October -- and a totally sufferfest. In the 40+ race, Roger threw down a furious pace and led start to finish. On Sunday, the temps were cooler, but the humidity was oppressive. Roger let others lead first lap, but soon grew tired of this and took off. Both days I finished 12th and almost exactly 3 minutes behind him. At least, I'm consistent(ly slow).

A couple of interesting things happened this weekend:

1. On Saturday, during one of the sand sections, I was trying to pass someone. I hear this women, who I am not sure is part of his posse or not, start yelling, "Elbows out! Put him into the tape!" And sure enough, this a-hole starts coming my way and trying to push me into the tape. Now, I love me so good heckling, but how about we not encourage dirty racing? Can we all agree on that?
2. Also Saturday, during one of the descents on this fun steep up and down section, one of the hecklers calls out, "Nice arms, Popeye!" I've never thought my forearms were very big, i.e. like Popeye, but as my biceps get smaller and smaller as I spend more and more time on the bike. I could see how it might look like they are. Anyway, it was funny and just kinda stuck with me, even while I was struggling with race, I was kinda laughing on the inside.
3. Sunday (today), I was in the top 5 or 6 on the prologue climb. As we neared the mansion and forced pinch point that the organizers put into the course, I went pass a guy. He starts yelling, "Don't do it! Don't do it!" Then, he elbows me and steers into me, forcing me into the tape. I almost took out one of the stupid wooden stakes that they seem so hell bent on using at Charm. I didn't go down, I didn't hit the stake, but I did lose places. I'm not saying that was the whole explanation for my not-so-strong finish, but it sure didn't help. But more than anything, it angers me that people are so willing to crash people out of a race to maintain a spot. 

I didn't have ideal preparation for these races. Hell, a week before I didn't even know I was going. Then I did sign up, and a few days later, I learned that the father of a good friend had passed away, my friend would be flying in to town, and that the memorial service was Friday night. He's also a racer and told me that I probably spent too much time on my feet that night and that the late night didn't help either. 

Also, from the not ideal prep department, I was awakened at 3:30 am this morning (Sunday) to a chirping smoke detector that refused to stop chirping even with two different brand new batteries installed. 

It was a good weekend. I raced the best I could given my weak spring and summer training schedules. I saw some good friends and learned some more about racing -- and people. I'll take it.