Ronaldo's knee dominates build-up to key USA vs Portugal Group G clash

Clint Dempsey and Cristiano Ronaldo will be key men in a game likely to define Group G. Photograph: Stan Honda/AFP/Getty Images

USA and Portugal head to Manaus with a raft of sick notes and suspensions altering the prospects for Sunday's vital Group G match, and at least a couple of question marks hanging over key players – neither of whom has an obvious replacement.
Let’s start with Cristiano Ronaldo. Because as Ronaldo himself might tell us, everything starts and ends with Ronaldo. And as he has reportedly told the Portuguese medical team: "I'm the one that says whether I'm playing or not.”
It was clear that the left-knee injury Ronaldo nursed through the warm-up games was still hampering him on his arrival in Brazil and in Portugal's opening game, a dispiriting 4-0 defeat by Germany.
From the ice-packed evidence of this week’s curtailed training sessions, he is still far from fully fit. One report in Spain even had a doctor telling the Real Madrid star that the MRI on his latest setback suggested he should sit out the next two months, let alone Sunday’s game, for fear of a career-ending tendon tear. The same doctor has been cited in a Portuguese paper as denying he said anything of the sort.
If Ronaldo is at all fit, it’s hard to see Portugal not starting him in what is now a must-win game (a draw could leave their fate hanging by a goal-difference thread). Yet whatever Jürgen Klinsmann’s understandable wariness about Portugal as a wounded animal, the USA coach might prefer to take his chances against a less-than-100% Ronaldo in the testing, Amazonian conditions in Manaus, no matter how good he is.

If Ronaldo does play, it's worth remembering that his lack of impact on game day one was not just down to injury – Germany stifled his supply to perfection. From a US perspective it is worth noting that such an approach is far from the preserve of the elite, since Israel and Northern Ireland were also able to pressure Portuguese supply lines at times during qualifying.
Of course, Portugal will definitely be missing other players, the injured Fabio Coentrao and Hugo Almeida, who limped out of the Germany game, and they will also be without the suspended Pepe. While those players will be missed, Ricardo Costa and André Almeida should be able deputies in defense, and Helder Postiga will probably cover up front.
In fact it’s arguable that never mind these three, or whatever happens with Ronaldo, the absence of the USA striker Jozy Altidore will create the most significant alteration to the pattern of this game, so key is he to the Americans' preferred style of play.
The diamond midfield that Klinsmann has tried to introduce of late requires Altidore to do a lot of muscling and running up front, with Clint Dempsey free to run off him when the USA attack. When Altidore pulled up with a hamstring injury against Ghana, to be replaced by Aron Johannsson, that fact – plus the broken nose that hampered Dempsey’s breathing and movement, plus an uncharacteristically muted performance from Michael Bradley – meant that the USA found themselves under sustained pressure and without a natural outlet up front.
Altidore is definitely out for Sunday, though the other player withdrawn against Ghana due to a hamstring complaint, the central defender Matt Besler, will be available, meaning goal hero John Brooks will likely be on the bench again.
He may play a part, though. Manaus has already lived up to its reputation as a cruel venue and the USA, who made much of their familiarity with extreme conditions in the lead-up to the tournament, seemed to struggle in relatively benign conditions in Natal.
To lose one player to a hamstring injury in the first half of your opening game might seem a cruel misfortune. To lose another at half-time and see others apparently struggling with fatigue you might expect to see in extra-time in the knockout stages suggests there may be something to the persistent criticism of Klinsmann for over-training his player