It can be said that Jannik Sinner has been plagued by bad luck ever since the Wimbledon final. He has been suffering from knee pain for quite some time now, leading to his withdrawal from all North American tournaments, including the US Open. The Italian also recently announced that he won’t be featuring at the China Open as his knee has still not recovered fully. But it appears that the situation may get even worse for Sinner, as he may even have to undergo surgery to heal his knee.

According to a report from journalist Gabriele Parpiglia, the issue that Sinner is having is more specifically known as iliotibial band syndrome, a condition that affects the band of tissue that runs along the outside of the thigh and knee. Sinner has already visited multiple medical clinics to diagnose the problem. But there haven’t been any positive results so far. There is only a remote chance that he will have to undergo surgery, and that will only happen if all the treatments fail.

“The iliotibial band is a strip of fibrous tissue that is thick, strong, and not very elastic,” the report stated. “It originates in the pelvis, runs down the entire outer side of the thigh, and attaches to the tibia, just below the knee. It acts like a steel cable, helping to stabilise the leg.”

“The problem occurs just above the knee. There, the band passes over a bony prominence of the femur, the lateral epicondyle. Every time the knee bends and straightens, the band slides over it until the tissue between the fascia and the bone becomes inflamed. That’s why we describe it as ‘extra-articular’: the problem is not inside the knee. It is outside, on the outer side.”

The report indicates that Sinner may have to withdraw from the Shanghai Masters as well due to the knee issue. If this does happen, then Sinner’s return will be pushed to late October. He has dropped 1,950 ranking points so far and will lose a further 500 due to his withdrawal from the China Open, as he won the tournament last year.

A withdrawal from the Shanghai Masters won’t hurt Sinner a lot, as he exited the tournament in the second round last year. But there can be consequences if he pulls out of either the Vienna Open or the Paris Masters. This is because the 25-year-old won both of these tournaments last year. A withdrawal from either of these events will also result in Sinner having barely any match practice before the ATP Finals, which will be held in November.

On top of this, Sinner’s ranking is also under threat from Alexander Zverev. The German has lowered the gap to 1,810 points and can even dethrone Sinner if he has a superb Asian swing.

Alexander Zverev has put Jannik Sinner’s ranking under serious threat

Unlike Sinner, Zverev is likely to feature at the China Open. He won’t be under a lot of pressure either, as he exited the tournament in the quarterfinals last year. The same goes with the Shanghai Masters, where Zverev was eliminated in the Round of 32.

Zverev has gotten himself into such a situation following his triumph at the US Open. While he gained 2,000 points in the rankings due to the victory, Sinner dropped a lot as he had reached the final last year.

But while Zverev may be looking like the frontrunner to take over the rankings at the moment, it is far from an easy task. The World No. 2 doesn’t just have to perform brilliantly in the upcoming tournaments, but will also have to rely on Sinner’s participation.

If the Italian does manage to return in the Asian swing and makes a deep run in any tournament, then it will be unlikely that Zverev will reach the No. 1 spot.