England must complete their Guinness Six Nations title push without Luke Cowan-Dickie but his Exeter team-mate Jonny Hill could return against Ireland on Saturday week.
Cowan-Dickie will undergo surgery to repair the knee ligament and cartilage damage sustained in the 23-19 victory over Wales in round three and may miss the rest of the season.
It is a major setback given that, since emerging as the Lions’ Test hooker last summer, Cowan-Dickie has established himself as England’s first choice in the position and been installed as one of the team’s vice-captains.
The combative 28-year-old was ruled out of the autumn series by an ankle injury and now faces another significant spell on the sidelines with Saracens veteran Jamie George set to take over the number two jersey in his absence.
However, England’s tight five might be reinforced for the title clash with Ireland at Twickenham on March 12th by the possible return of Hill from a high ankle stress fracture that has kept him out since the start of the year.
Hill produced his most impressive international form during the autumn and now is closing in on a full recovery.
"We're disappointed for Luke, for Exeter and for ourselves. He's a very important player to the team and a leader of the group as well," forwards coach Richard Cockerill said.
“It’s a blow to the team but we’ve got good cover. Jamie’s a fantastic player. He’s proved that for the last 10 years or so.
“He did a great job when he came on against Wales and I’m sure he’s looking forward to doing that again.
“Jonny Hill took a full part in training yesterday (Wednesday) and today. It’s positive news on him.
“If Jonny comes through training fully with no reaction, there’s a good chance he’ll be available for selection.”
Flanker Tom Curry is progressing through the return to play protocols for concussion and is expected to be available for the visit of Andy Farrell's resurgent Ireland, but Manu Tuilagi is unlikely to be involved.
Tuilagi is recovering from a minor hamstring strain incurred 48 hours before the Wales match, with his rehabilitation taking place at his club Sale rather than in England camp.
Sharks director of rugby Alex Sanderson is to hold talks with England after the Six Nations to agree the best way to manage a vitally important player whose career has undermined by repeated injuries.
Tuilagi was poised to make his international comeback after tearing the same hamstring in the autumn and Sanderson believes the only possible explanation for breaking down was that “it was probably just a little bit too far, a little bit too soon”.
But England are satisfied that they have got his loading right with the climax to the tournament against France a potential date for his return.
“We have a very good S&C programme here and liaise with the clubs daily. You have to prepare guys to play Test rugby and Manu was doing that,” Cockerill said.
“I don’t think we’d do anything differently. We obviously don’t want to injure players and moving forward we just have to make sure when he comes back to club and Test rugby that he is ready to go.
“Manu has a long history of injuries, especially around the hamstring, and it’s something club and country would like to get to the bottom of and solve so that he’s on the field more often.”
