The American victory over Ghana could hardly be considered Pyrrhic, but with Jozy Altidore carried off the field on a stretcher after a first-half hamstring injury, there are major questions. Altidore was not the only injury, with Matt Besler also leaving the game at halftime due to a hamstring injury. How will Jurgen Klinsmann and his USA squad overcome these injuries?
Altidore hadn't even hit the turf when half of America was already groaning. Altidore sprinted forward on the left flank and pulled up hard, grabbing at the belly of his left hamstring. He went down and immediately called for the medical staff. He never tried to get up, knowing he could not continue. The strain will undergo further testing, but it looked significant given Altidore's reaction.
With only a few days to get healthy, a Grade II strain would push Altidore past not only the next game against Portugal, but it would also put him in jeopardy of missing a significant portion of the rest of the tournament. At this stage, Altidore will be re-evaluated at the U.S. base Tuesday, according to ESPN FC, which will likely include MRIs and other images before any further decision is made.
A moderate or Grade II strain would normally have a timeline for return of between two and four weeks. That would leave Altidore out for a significant period of time, if not the rest of the tournament. Trying to play through the strain would leave Altidore at a severe physical deficit and at a greatly increased risk of further injury if he tried to play through it.
If there's any chance Altidore can play against Portugal, or even if the medical staff puts his possible return at either the following game or tries to prep him for a possible round of 16 game, they will immediately go to work with therapies. Much of the healing will amount to rest, but the American medical staff will have every therapy and modality available to them in Brazil. They will no doubt take a "kitchen sink" approach.
Without Altidore and with Clint Dempsey's nose nearly kicked back to Rio, the U.S. is thin up front. Klinsmann has options, but he's sure to hear the whispers of "should have rostered Landon Donovan" about a million times between now and Sunday's kickoff.
Aside from Altidore's significant injury, the U.S. needed to make a key halftime substitution due to another hamstring injury. Matt Besler pulled up and showed a problem late in the first half but was able to stay on the pitch through the end of the half. The medical staff took a look at it and may have tried to treat it, but in the end, Besler could not continue.
From all outside indications, Besler's injury was not as serious as Altidore's, but it was nonetheless problematic enough to bring him out of the game. There's not as clear of a timeline as there is with Altidore, but the game against Portugal and beyond are in question if he's not able to respond. It will be difficult for Klinsmann and his staff to trust Besler to make it through a full 90 minutes without a setback.
John Brooks, who came on for Besler to start the second half, was the hero of the Ghana win with his late goal, but he may be called on for more against Portugal. Matched up against a desperate Portugal team and the kind of speed in Cristiano Ronaldo that can expose the American defense, Brooks will be tested early and often if he's in the starting XI.
The Portuguese team is not without injuries. Fabio Coentrao left the Germany game with a groin strain, telling the media afterwards (via Goal.com), "I honestly think the World Cup is over for me." Coentrao is out for the group stage at least with the severe groin strain, and likely much longer.
With an injury to Hugo Almeida as well, plus the absence of defender Pepe after his red card, the Portuguese have a must-win game with a short roster. It may dull the loss of Altidore and Besler to some extent, but both teams have their hopes of moving out of the "Group of Death" resting on one game.
The U.S. and Portugal will have more updates on the injuries in the coming days, but expect both teams to be forced into adjustments. If Jozy Altidore is out, Klinsmann's plan of forward pressure and physical play will be compromised as much as Altidore's hamstring.