England today revealed that Andrew Flintoff faces the prospect of another operation on his right knee once the current Ashes series is completed.
Lancashire all-rounder Flintoff has been battling with a troublesome knee injury throughout the summer and was ruled out of the fourth npower Test at Headingley.
England remain hopeful he can recover in time for the final Test at The Oval on August 20, which would also be the last Test of his career, but have not ruled out the prospect of a further operation after that.
"Andrew has shown great determination and selflessness making a conscious decision to push through discomfort in order to help the England team reclaim the Ashes," a statement from the England and Wales Cricket Board read.
"This is in the knowledge that a further operation is a possibility."
Flintoff had injections in his right knee, which was operated on earlier this year after he injured it during his Indian Premier League stint with Chennai Super Kings, to get him through the second Test at Lord's and last week's drawn third Test at Edgbaston.
But with just three days between the final day at Edgbaston and the start of today's fourth Test at Headingley, Flintoff was unable to persuade England's management he was fit enough to withstand the rigours of another match so soon.
England insist they have not treated Flintoff's injury with a succession of cortisone injections to mask the problems and have underlined their commitment to considering his long-term health.
"In order to give Andrew a chance of playing in the second and third Tests, he received a series of artificial synovial fluid injections into the knee joint and cortisone injections into some of the bursa on the outside of the knee joint to help settle the inflammation," the statement added.
"Andrew is still very keen to play in the fifth Test at the Oval and a decision on this will be made in due course.
"He will not be exposed to undue risk or masking injections and any decision regarding his participation in the fifth Test will be made in conjunction with the ECB, his surgeon and the Lancashire medical team."
If Flintoff does undergo another operation it would almost certainly rule him out of the seven-match one-day series against Australia which begins at The Oval on September 4, and the two Twenty20 Internationals at Old Trafford beforehand.
He would also be a major doubt for the Champions Trophy tournament in South Africa, which begins on September 24, although he could return for England's tour of South Africa, which starts with two Twenty20 internationals and five one-day internationals in November.