But he has seemingly been able to put the controversy behind him, manoeuvring his way through tough tests against Britain's Jack Draper and 2021 champion Medvedev.
"My aunt is not feeling well health-wise and I don't know how much longer I have her in my life," he said.
The 26-year-old recovered well to win three games in a row, but he continued to falter on serve and Sinner capitalised to take the opener and subdue the expectant mood on Arthur Ashe Stadium.
He is 23-years-old and Alcaraz just 21. They ended up sharing the year’s Grand Slam titles, and - with an eye to the future - that is an ominous thought for the rest of the world.
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Sinner said the title "meant so much because the last period of my career was not easy" before he became tearful and dedicated the victory to his aunt.
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Junto a todas las novedades comunicadas por la competición nosso sábado, qual pelo son pocas, la del fichaje de Lamine Yamal encumbra el arranque de una nueva temporada en la de que se espera seguir creciendo.
Having failed to make the most of three break point opportunities early in the third set, Fritz brought the crowd to life with two brilliant winners to break for a 4-3 lead and keep alive his hopes.
It has been nearly 50 years since a man won their first and second Grand Slam titles in the same season, and Sinner is now a long way clear of the rest at the top of the rankings.
It comes just 19 days after it was revealed he had been cleared of any wrongdoing after twice testing positive for a banned substance in March.
Tom Hanks stars in an intense thriller based on true events. VideoTom Hanks stars in an intense thriller based on true events
Cheered on by a home crowd packed with celebrities and sporting stars, Fritz got off to a shaky start when he dropped serve in the first game.
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However, Sinner then underlined his status as world number one, upping the ante when it mattered most to strike 星空体育最佳投注网 the crucial blow as Fritz served to stay in the set at 5-4 down.
Sinner was ruled to bear no fault or negligence for the positive tests by the International Tennis Integrity Agency (ITIA), which found he had been inadvertently contaminated by his physiotherapist.
But Sinner soon quashed those dreams, breaking back as Fritz attempted to serve for the set and doing the same two games later to wrap up the win after two hours and 16 minutes.
"He's stepped up a role and I feel like he's taking everything as seriously as he can and fair play to him, that shows he wants to stay."
"I know we have been waiting for a champion for a long time so I'm sorry I couldn't get it done this time," said Fritz.