Bolton midfielder Stuart Holden has been ruled out for another six months following surgery on the same knee injury that had sidelined him since March.
The American needed 26 stitches following a challenge by Manchester United defender Jonny Evans in a Premier League match in March.
Holden made his long-awaited return on Sept. 20 in the League Cup against Aston Villa, but Bolton announced on Wednesday that Holden was to undergo a ''routine procedural follow up'' later in the day that would keep him out for six weeks.
However, the procedure revealed cartilage damage and Holden now faces another long period out of action.
The 26-year-old midfielder, who has made 17 appearances for the U.S. national team, wrote on Twitter before the surgery that it was a ''bit of a setback but better for longrun!'' But his mood changed afterward.
''Floored, devastated, gutted, just a few words I can think of,'' Holden tweeted. ''I will continue to fight and I'm ready for another tough journey.....''
The news was also a setback for Bolton, which has missed Holden's influence during a poor start to the Premier League season. Owen Coyle's side is at the bottom of the standings after one win and five losses.
''It is a big, big blow for Stuart because he has worked so hard after he sustained the injury,'' Coyle told the Bolton website. ''But obviously the most important aspect is to ensure Stuart's well being and that's what we are focused on.''
