Six Nations 2019: Dylan Hartley may need surgery on knee injury before Rugby World Cup, admits Eddie Jones

Dylan Hartley may need surgery on his “grumbly” knee before the Rugby World Cup, with England head coach Eddie Jones left to “wait and see” how his co-captain reacts to treatment as he prepares to start the Six Nations without him.

The 32-year-old will miss England’s opening games against defending Grand Slam champions Ireland and France after suffering a knee injury shortly before Christmas, with Jones putting the injury down to the years of wear and tear that Hartley has gone through for club and country.

Yet the prospect of Hartley missing the entire Six Nations cannot yet be ruled out as the hooker must see how his knee reacts to “passive rehabilitation”, though a pessimistic Jones admitted that he might need surgery at some point in the future if the plan fails to work.

“It’s just a matter of how fit he is,” Jones said of his plans to bring Hartley back into the squad once he is ready. “Now, with GPS, you can tell how fit a player is by their training, so we just have to have a look at him. The first thing is he has to get healthy – he’s not healthy yet. Then he’s got to get fit. We’ll just wait and see. But at this stage we’d be hopeful that he’ll be back at least for the Wales game.

“He’s 32 and he’s probably played 300 games for Northampton and he’s played 90-odd for England, plus a few for Worcester, so it’s just wear and tear. That’s all it is. He might eventually need an operation to clean it up, but at this stage they’re doing what they call passive rehab and we’re confident that he should be fit to play in the Six Nations.”

But the England camp will be sweating on how Hartley comes through his treatment. If attempts to get him fit to face Wales on 23 February on the third weekend of the championship prove unsuccessful, a decision will need to be taken on whether to have arthroscopic surgery immediately – which would rule Hartley out for around six weeks – or manage him through the rest of the season before undergoing surgery in the summer ahead of the World Cup.

A six-week lay-off from the end of February would rule Hartley out of the rest of the Six Nations and also the start of April, which would include the East Midlands Premiership derby with Leicester Tigers as well as a potential European Challenge Cup quarter-final, with Saints currently in the mix to qualify for the last eight ahead of this weekend’s group stage finale.

But more concerning for England would be the loss of Hartley’s 97 international caps – 17 more than any other player in the latest squad – and the leadership dearth that is created without him. Ben Youngs and Mike Brown, the next two most-capped players at Jones’ disposal with 80 and 72 caps respectively, are by no means guaranteed places in the starting line-up either, but the Australian believes that the returns of Mako and Billy Vunipola plus Joe Launchbury and the collective 141 England caps between them will ensure that there is no similar issues to the ones experienced without Hartley last year.

“I think we’ve got a growing density of leadership within the team,” Jones added. “We’ve got guys like Mako, Billy and Joe Launchbury to come back into the squad and they’re all good, solid citizens with good values who will help in that area.

“We just took the approach for this camp particularly that we want to beat Ireland and we want to win the Six Nations. Our overall goal is to win the World Cup, but our immediate goal is to beat Ireland. To do that, we need 35 players competing for spots and training at a high level in that camp, so for that reason we decided not to take any rehab players.”