The Manchester City star limped off in the first half against Burnley in the Premier League season opener last week.
He was also absent for their UEFA Super Cup win on penalties against Sevilla on Wednesday.
And as reported by Belgian outlet HLN, De Bruyne will return to his home country to go under the knife in an attempt to fix the recurring issue, putting him out for between three and four months.
They state that examinations following the injury showed he does need surgery and that it will take place soon in the European country’s largest city Antwerp.
As reported by Mail Sport’s Jack Gaughan on Tuesday, De Bruyne is now facing the prospect of missing the rest of this year.
It is a significant blow for manager Pep Guardiola, who furnished City with a first Super Cup victory when they met Sevilla before returning to defending three trophies after last season’s famous Treble.
‘It’s serious,’ Guardiola said of his talisman, who was advised surgery is required after consultations with three doctors. ‘We have to decide on surgery or no surgery in the next days but he will be a few months out. Surgery will be three or four months.
‘It is a blow and big loss for us. Kevin has specific qualities. You can lose it for one or two games but for a long time this is tough for us.’
Reinforcements will now be needed for that, City pressing ahead with their pursuit of West Ham United’s Lucas Paqueta, valued at around £80million.
The interest in Paqueta pre-dated De Bruyne’s latest problem, with City having already gone in for the Brazilian at £60m. Rennes winger Jeremy Doku is also hoping to seal a move.
‘We have to look forward and we have alternatives there at other options,’ Guardiola said. ‘Opportunities now for the other ones – life gives you that – and I am pretty sure they will take it.’
There is a clamour for Phil Foden to be thrown more responsibility in central areas, with Rodri revealing that the England international is ‘the best player we have between the lines, turning and facing the goal’.