The two Tottenham players James Maddison must follow before injury return for Roberto De Zerbi

The Tottenham Hotspur midfielder was shown in training on Wednesday but caution has been urged over the England international

The images of James Maddison training with his fellow Tottenham players gave hope to supporters but they also arrived with a note of caution.

The 29-year-old has faced a long road back after rupturing his anterior cruciate ligament in his right knee during Spurs' pre-season last year, towards the end of Son Heung-min's farewell game in South Korea against Newcastle United on August 3. Maddison has documented his rehabilitation from those early days after the surgery on his YouTube channel so the fans have been able to go on the journey with him.

His most recent video, filmed weeks before it was released a fortnight ago, showed him taking his first steps back into working with the ball on the Hotspur Way pitches with other players also in rehabilitation. All these weeks on, Wednesday's video footage from Roberto De Zerbi's training session showed Maddison involved in some of it with his first team team-mates and then on Thursday he was again captured heading out with the team as they worked towards Saturday's Premier League game against Brighton.

Relegation-threatened Tottenham and De Zerbi desperately need creativity in the team and Maddison has been a huge part of the club's better performances in recent years before missing all of this season so far. So it is natural that the fans would want him to play some part in the final six matches of the season as Spurs attempt to avoid relegation.

However, caution has been urged around Maddison without any expectation that he is about to step back into Premier League football right now and that is simply part of his reintegration at this stage of rehabilitation.

It has been just under eight-and-a-half months since he suffered that injury in Seoul, having only recently before that game come back from a medial collateral ligament injury into pre-season training.

Players coming back from anterior cruciate ligament injuries take their time after first returning to full training, increasing the load on their bodies with the twisting and turning and eventually contact nature of sessions.

Maddison need only look at two of his team-mates to see the path taken. The most recent, Radu Dragusin, returned to training in September last year, eight months after injuring his ACL in his right knee during Spurs' Europe League win against Elfsborg the previous January.

The Romanian would not play any match football until he got 45 minutes in a behind-closed-doors friendly against Leyton Orient at Hotspur Way two months later. He did not make a Premier League squad until the following month, in December against Liverpool and finally made his competitive return to action in the final five minutes of Spurs' 1-0 win at Crystal Palace on December 28 - the last time Tottenham won a Premier League game.

That meant Dragusin did not return to competitive action for almost 11 months after his ACL injury.

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There is also Rodrigo Bentancur who had a swifter timeline and is back in training himself right now after recovering from a serious hamstring injury suffered in January. The Uruguayan also has experience of an ACL injury, picked up on February 11, 2023 in a match against Leicester City.

The midfielder was back in full training with his team-mates in around the same time as Maddison, just shy of eight-and-a-half months after suffering the injury.

Then Spurs manager Ange Postecoglou said on October 20: "We'll be careful with him. He's now fully training so he's into the whole session. We've drip-fed him into training in the last sort of month and he's coped pretty well with that. Now he's in to full training.

"We've got to be mindful that he's missed a fair bit of football. I think the more he trains with the first team over the next few weeks, we'll pick out moment but he's looking good at training. We're looking forward to getting him back."

There was a shock though as Bentancur came off the bench for the final minute of normal time, again in a win at Crystal Palace, on October 27. He would play half hour cameos in the next two games in November before a surprise start against Aston Villa at the end of that month in which he tore ankle ligaments after a challenge by Matty Cash to put him out for another month.

Maddison will be looking at Bentancur's ACL return and hoping to emulate his timeline rather than Dragusin's, although the recovery length is different for everyone and dependant on a range of factors. Much depends on how full his involvement currently is in training with De Zerbi's side.

One boost for Maddison came in his first YouTube video after his surgery when Bentancur explained back then that his recovery was longer than Maddison's would be because he also damaged the meniscus in his knee, which the England international did not.

De Zerbi's predecessor Igor Tudor told football.london that he was hopeful Maddison would play some part this season and the club's vice-captain will be desperate to help the team in these tense final weeks. However, he will also have to be mindful of not placing any risk whatsoever on his body at a crucial time in his career.

In that first video after the surgery Maddison said: "I've already looked [at the average time out], if it's eight months, six months isn't a question. The stage I'm at now, this needs to be right now. I'm 28, I'm going to be 29 when I return, I'm in my prime, really. These are my peak years ahead of me. I need to come back and I need to stay fit. So actually I'm not going to be pushing to say 'oh why are you taking so long', sort of thing.

"But if it gets to eight months and we're flying or whatever, if I'm in the right frame, that will allow me to play this season won't it, towards the end?"

All eyes are on what the answer to that question ends up being and whether Maddison can play any role in the weeks ahead.