Cricket Tour news: It takes much for international sportsmen to confess their mortality. In their minds they march firmly alongside time, in step, not straggling behind. Infirmity is just another challenge to be overcome. Submission is not an option. They remain bullish.

But for the first time since his run of injuries began the England captain Michael Vaughan has admitted that the frequency with which his right knee is letting him down raises serious concerns about his future.

Having been ruled out of today's first Test, he has returned to England for further assessment and treatment on the right knee that required surgery in December.

Vaughan's ambition remains firmly to lead England in the latter stages of this tour - but if that is not possible then certainly against Sri Lanka and Pakistan this summer - into the Ashes next winter and on to the World Cup. But realistically, behind the optimism, there lurks the suspicion that his career may not stand the rigours of the full modern schedule for much longer.

The fact is that in order to maximise Vaughan's contribution to England, he will require careful management by the England coach Duncan Fletcher in consultation with the various medical advisers who surround the captain.

In particular Fletcher must have huge concerns about the future in the one-day game - the most physically demanding over a short period - of a player whose knee clearly cannot be trusted, whose mobility and athleticism have never been from the top drawer and whose limited-overs record as a batsman is a world away from the top-notch Test performer that he is.

If Fletcher decides that England cannot afford to go into a World Cup carrying a player with such a high injury risk, then it is now that he has to make a decision and begin the process, just over a year from the event, of grooming a new captain and revamping the team. To take such a decision at the end of the year, say, is too late. Fletcher, who can be dispassionate, has to be pre-emptive with no concession to sentimentality.

It had been hoped that December's operation had sorted the problem and that he had been allowed adequate rehab, but he began to feel discomfort during the first three-day match in Mumbai. "I knew last week in the end of the Mumbai match that I was struggling because there was a recurrence," Vaughan said.

"We injected the knee on Wednesday night in Baroda hoping to come to Nagpur with the injection having worked - it hasn't. In the nets on Monday it was on the back foot, pushing off for a single, or cutting, that I found trouble. There was also discomfort while fielding, particularly when stretching to the side or bending."

The idea that he made too rapid a comeback after surgery was discounted.

"I was fine during the pre-tour work at Loughborough," he said.

"I had to give it a chance and wouldn't have had it any other way. But it hasn't worked out. The big test was always going to be on grass playing a match. In Mumbai it went well the first two days and then on the last day I just felt it again. Wearing studs on grass is the big key. The twisting and turning, the runs between the wickets, the intensity of the game was always going to be a challenge. I didn't come through that.

"Now it's important that I go and get it right for the team's sake as much as anything. They don't need a captain hobbling around. We need an energised captain like I was last summer. The workload has increased here and the knee hasn't withstood that. It's time to go back and see the specialist and make sure I come back fitter."

There remains a chance that he will follow the example of his former team-mate Darren Gough and visit the Munich clinic of Dr Hans Muller-Wohlfahrt for injections of a viscous extract from crushed cockerels' combs that helped prolong the career of the fast bowler.

"Darren sent me a text actually, mentioning that it worked for him," said Vaughan. "So maybe that's an option. We'll certainly look into it."

Guardian service