When Alexander Zverev tore the ligaments in his right ankle in the 2022 French Open semifinal vs. Rafael Nadal, the 26-year-old left the court in tears and in a wheelchair. A year on, that terrible injury is beginning to look like the turning point in the German's career.

Zverev's frustration after losing 2-6, 6-7 to Daniil Medvedev in the Italian Open in Rome on Tuesday was clear to see and hear.

"I have no desire to say anything because I'm out earlier than I wanted to be," he told Sky afterwards, adding that he remains "1,000 kilometers away" from the top players in the men's game.

"If you want to say you're in it, then you have to win at least once. And I'm not doing that."

Out of that frustration, doubt is now beginning to grow. "I'm not able to go deep at a tournament at the moment," Zverev said. "This is probably my worst tennis since 2015, 2016. There is a reason for that ... I've not forgotten how to play tennis, but that is the reality of the situation at the moment and you can't talk it up."

Back then, Zverev's journey was just beginning. Since August 2016, he has continuously been Germany's number one men's player. But seven years on, on the brink of his return to the French Open, Zverev is a shadow of his former self.

Comeback struggles

The early exit in Rome is just the latest setback for Zverev in a year of disappointments. Ironically, it was here in 2017 that Zverev began his rise towards the top group in world tennis when he beat Novak Djokovic to win the tournament, the first Masters trophy of his career.

Four more titles followed and, after a tricky 2019, his first Grand Slam Final (US Open) in 2020 and Olympic Gold in the pandemic-delayed Tokyo Olympics the following year.

All of that feels a lifetime away now. After surgery, opening up about life as an elite athlete with diabetes , as well as angry outbursts and more than seven months of recovery, Zverev has struggled in his comeback year.

He lost in the second round of the Australian Open to start the season, as he did in the tournaments in Rotterdam and Doha that followed. It was only in Dubai that he made the semifinals, losing to Andrey Rublev.

A fourth-round defeat at Indian Wells to Medvedev was a glimmer of hope, but then in Miami defeat in the second round followed. Then, on a wet afternoon in Munich that also happened to be Zverev's 26th birthday, the German lost in the first match of his first clay court tournament of 2023, world number 78 Christopher O'Connell proving too much to handle.

"If it's cold then that's not good for my game," Zverev had said before the match. He was proven right.

Losing touch

Beyond the conditions and the opponents that are making life difficult for the 26-year-old, is the question of mentality.

"In training, I'm playing to the level I had before my injury," Zverev had said after his second-round win against David Goffin in Rome this season. Unlike in the past, however, he is "sometimes incredibly nervous" before matches.

German tennis legend Boris Becker believes Zverev is "being overtaken by younger players" such as Carlos Alcaraz. Speaking on a Eurosport podcast, Becker thinks Zverev hasn't yet adapted his game to tennis in 2023.

"Tennis changes every 18 months," Becker said. "That means you always have to improve accordingly. You get the impression that Sascha [Zverev's nickname] hasn't improved and opponents know exactly how they have to play against him. That is a problem!"

So much so, that Zverev has now lost his spot as Germany's number one to Jan-Lennard Struff, who dramatically reached the final of the Madrid Open earlier this month. Despite defeat to Alcaraz, it was the greatest success of the 33-year-old's career, despite only gaining wildcard entry as a "lucky loser."

It was a week in which the momentum was with Struff and he took full advantage.

Score to settle in Paris

What Zverev wouldn't give for those kind of breaks at the moment. The French Open begins on May 28 and represents a chance for him to settle a score and perhaps restore some of the confidence that once characterized his game.

"[My struggles] could have resolved themselves in Madrid, where I've won twice before and played in the final three times," he said. "I just have to win and then it will resolve itself."

Victory at the 2023 French Open would be a remarkable turnaround for Zverev given how his season has gone so far, but the bigger question is what will happen should the victory drought extend to the end of this season?