NEW YORK—Fans crammed shoulder to shoulder leaned over the rails above the Grandstand, as Victoria Azarenka struggled to create separation from Misaki Doi on the court below.

Signs of stress surrounded the former No. 1, who struggled to read her opponent's twisting lefty forehand, slapped a point-blank smash into net, barked at herself in frustration after unruly errors, and saw the blue kinesio tape around her knee slowly peeling away like a temporary tattoo.

Knee and foot injuries have limited Azarenka to 18 matches and hampered her mobility this season, but ailments haven't diminished her defiance. Swinging with more authority and moving with more confidence as the match progressed, Azarenka fought back for a 6-7 (3), 6-4, 6-1 victory to reach the U.S. Open second round for the ninth consecutive year.

Playing for her first U.S. Open main-draw win and first career victory over a Top 20 opponent, the 90th-ranked Japanese was not awed by her harder-hitting opponent. The first set was devoid of a service break as tension ratcheted into the tiebreaker. Down an early mini-break, Doi frequently made the aggressive baseliner move, mixing her topspin forehand with some shorter backhand slices. She reeled off six straight points in snatching the 59-minute first set with 15 winners compared to 13 for the two-time U.S. Open finalist.

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At 5'3" and 121 pounds, Doi is hardly an imposing physical presence—a couple of the ball kids towered over her when handing her a towel—but she's not a defensive counter-puncher. The woman who grew up looking up to former No. 1 Justine Henin can take the ball early and curl her cross-court forehand with angle and depth. She's also skilled on the swing volley and showed her touch working the drop shot and lob.

Initially befuddled by Doi's slice serve on the ad side, Azarenka began to read and react to it more effectively in the second set. After 17 straight service holds, four consecutive breaks followed. Serving for the second set at 5-3, Azarenka spun her ninth double fault into the tape to face break point again. Doi, who tormented Azarenka by lashing her lefty forehand down the line, struck that shot again and drew a running forehand error to break back for 4-5. Doi had a game point to level, but her inside-out forehand strayed.

Blasting a backhand winner crosscourt, Azarenka snatched a hard-fought second set with a furious double fist-pump that prompted coach Sam Sumyk, eyes concealed behind a pair of dark sunglasses, to leap out of his seat and raise a clenched fist to his charge in response.

After a brief bathroom break, Doi faced a triple break point dilemma in her opening service game. She swept a forehand swing-volley beyond the baseline as Azarenka broke for a 2-0 advantage in the decider. But closure did not come without complications for Vika. She fought off a pair of break points in a draining fifth game; on the second, Doi attacked behind a slice backhand and Azarenka mishit a backhand lob that dropped in, eventually surviving a tense, 10-minute game to hold for 4-1.

The match was a mixed bag for Azarenka, who struggled to string aggressive points together at the outset, looked a bit sluggish off the mark in the opening set, and littered 47 unforced errors, including 11 double faults. Ultimately, Azarenka should draw strength from the fact she fought hard, stayed positive, and made the right adjustments when it mattered most. She stepped to the left to cut the angle off on Doi's slider serve on the ad side, began accelerating through her shots, and moved with more confidence as the match progressed.

The 17th-ranked Belarusian will face Christina McHale, the pride of Teaneck, N.J., in round two. They have split two prior meetings, with Azarenka administering a 6-0, 6-0 shutout in their lone hard-court clash in Doha last year.