West Ham manager Sam Allardyce fears midfielder Jack Collison could be facing a crunch decision on his continuing knee problem.
The 23-year-old Wales international was instrumental in helping the Irons win promotion back to the Barclays Premier League last season. However, he has yet to feature since as he battles a niggling knee problem which has afflicted him for the last two years.
"It is a concern to us because we would hope we are looking to him recovering enough to start training and playing," Allardyce said. "If that does not happen very soon, our medical staff will have to seek somebody else's advice on what we can do. The cut-off point is very soon. An operation would make it better, but it would never recover 100%."
He added: "I don't know how long that would put him out for and I hope it doesn't get to that. But we have seen some slow improvement in the last few weeks and a better improvement this week than at any other stage of the time he has been out."
Allardyce added: "It is from the old injury he had. He has a problem that is going to stay with him for the rest of his career and he manages it brilliantly. But there are times when he gets a lot of fluid in there and he is not available for training. It is us managing that side of it.
"That knee for Jack unfortunately is never going to be 100% so he has to do a management job. It is not as drastic as Paul McGrath or Ledley King, but it is similar."
Collison managed 37 appearances for club and country last season, which Allardyce admits has impacted on his preparations for life back in the Premier League.
"We thought it would be okay and he thought it would be okay and at that particular time he had no real problems with his knee," Allardyce said.
"Perhaps it was the excitement and the adrenalin of the games we were playing and his strong mental state that it did not appear to be a problem.
"Jack is gutted, obviously. He is almost like the forgotten man. The rest of the team go away and play in the Premier League and he, having been such a major part of us getting there, cannot be involved. There can't be anything more soul-destroying than that."