David Moyes has described Jan Kirchhoff’s latest injury as a “massive” blow to Sunderland.
The midfielder, who was celebrating his birthday, was stretchered off the pitch 56 minutes into Saturday’s 1-1 draw with West Bromwich Albion at the Stadium of Light.
Kirchhoff, who missed the start of the season with a hamstring injury, appeared to injure himself as he landed after jumping for a header.
He was in some pain and had to be carried from the pitch, with the German clutching his left leg.
Kirchhoff will now be assessed, but it is the latest injury blow to Sunderland, with midfielders Lee Cattermole (back), Steven Pienaar (hamstring), Adnan Januzaj (ankle) and Seb Larsson (knee) already out.
Moyes said: “Not to have him, Steven Pienaar and Adnan Januzaj is massive, because they help us play better and we are short in that area. They are big, big misses to this club.
“If we lose Kirch and we lose Catts, we lose a little bit of the steel and a little bit of the boys who have been here before while we’re looking to build a new team.”
Kirchhoff missed the opening four games of the season with a hamstring injury picked up in the pre-season game against Montpellier and now faces another spell out.
Kirchhoff going off led to Moyes making a tactical switch, with sub Patrick van Aanholt introduced as a wing-back, with Sunderland playing 3-5-2 for the rest of the game.
It worked, with the Black Cats rescuing a point in the 83rd minute thanks to van Aanholt’s strike past Albion keeper Ben Foster.
And Moyes says it was important to avoid another defeat going into the international break.
“It was really important not to be sat in that position,” said the Sunderland boss, with just two points on the board from seven Premier League games.
“I’m really disappointed not to get all three points, but it wasn’t for the want of trying, and it wasn’t for the want of the players doing the best they can, and maybe the players are doing the best they can.
“If they’re doing their best, then that’s all you can ask for.
“They kept going and tried to find a way through and deservedly got one back.”