SAN JOSE, Calif. – More than three months into the MLS season, the San Jose Earthquakes have yet to be able to suit up one of their most recognizable players.

And it’s possible Steven Lenhart’s absence is only just beginning.

Lenhart, the fan favorite who scored 10 goals for the 2012 Supporters Shield-winning Quakes, has spent the last two months working with a specialist to try to solve long-standing soft-tissue problems in his right knee – and avoid potential season-ending surgery. It hasn't gone as well as anyone would hope.

“I feel sorry for him because he’s trying everything he can to get himself healthy to play,” San Jose general manager John Doyle told MLSsoccer.com this week. “And the progress is – he takes a step forward, and then he takes two steps backwards. So he’s having a tough time trying to get his knee right.”

The 6'1", 190-pound Lenhart has taken a pounding over the years – his mark of 4.18 fouls won per 90 minutes last season was the highest rate in MLS for players with at least 500 minutes played – and it has taken a toll on his knee, which has required three arthroscopic procedures since 2011.

Doyle said that if the specialist’s treatment doesn’t allow Lenhart to return to form as a target man in the Quakes’ attack, the recommendation of team doctors is another surgery – and this one wouldn’t be a quick fix.

“The next option is a microfracture-type surgery, which is a big, long surgery that brings mixed results,” Doyle said. “We’re trying to do everything possible to see if he can get his knee to not swell up [after playing].”

Patients trying to rebuild cartilage – which is not naturally regenerated by the body – to avoid the intense pain of bone rubbing on bone will often undergo microfracture surgery, in which holes are drilled in a bone to generate scar tissue as a replacement. The new tissue is not as strong as original cartilage, however, which is why some patients try other options, including autologous chrondrocyte implantation (in which cartilage cells are grown in a lab and placed in the joint as a cushion) or platelet-rich plasma therapy (which aims to heal the remaining cartilage and reduce swelling).

Athletes undergoing microfracture surgery typically need the better part of a year to recover, meaning that Lenhart – who signed a new deal with the Quakes this winter – would likely be out for the entire 2015 campaign. There’s also no guarantee that a player will return to full effectiveness. For every success story – such as Real Salt Lake's young star Jordan Allen – there’s a cautionary tale (see former No. 1 NBA draft pick Greg Oden).

In Lenhart’s case, Doyle said, there is no timetable for a potential surgery, and the 28-year-old Lenhart continues to work diligently in hopes of getting back without another procedure.

“It’s really kind of a wait-and-see [situation],” Doyle told reporters. “We’ve been working with our doctors, with him, with our trainers. He sees a specialist in LA that works on his knee daily. He’s doing some training to try to get himself healthy, but it hasn’t progressed well. It’s been a tough process for him.”

San Jose have already lost another key forward, Swiss international Innocent, for several months due to a meniscus repair. But although MLS clubs get a replacement roster slot when a player is ruled out with a season-ending injury, they do not get salary-cap relief. Doyle said, therefore, there isn’t much room to add a ready-made replacement in the upcoming transfer window.

“We have [target] forwards. We have Adam [Jahn] and Mark [Sherrod],” Doyle said. “There’s not a lot of space. . . . The guys that are here have to score goals and play well. It’s a great opportunity for them.”