The Australian charge at Roland Garros ended when Kokkinakis fell painfully short of forcing 11th seed Karen Khachanov to a deciding set in their third-round match on Friday night.
It was clear the chest muscle, which the South Australian badly injured in 2019, had flared midway through the 6-4 6-2 3-6 7-6 (7-5) loss to Khachanov.
Kokkinakis competed with vigour and held a set point to force a deciding set when serving at 5-4 in the fourth but ultimately failed to back up 100 per cent physically from his near-five-hour victory two days earlier over 2015 Roland Garros champion Stan Wawrinka.
The 27-year-old said the muscle struggles to handle the intense workload that comes at grand slams and that surgery at some stage may be required to enable him to live up to his potential in majors.
"It's just the same rupture I've had since 2019," Kokkinakis said.
"I did it so bad that it's tough for me to progress a little bit when I try to back up some deep matches," he said.
"I know I'm going to be sore in my legs. I know I'm going to have little aches, stuff like that. But it's just the one injury that … stops me a little bit.
"I'm going to get a little bit of other advice, maybe some surgical stuff, and see what the result is, because I'm always limited a little bit when I try and back up matches.
"It is probably not the first or second match, but it's sort of third and fourth onwards kind of affects me a lot."
Despite matching his best result at a major, Kokkinakis was dejected after falling on the wrong end of another thriller.
He surrendered a 4-2 lead in the first set and was well beaten in the second, but rallied strongly from midway through the third stanza against Khachanov, a semi-finalist at the past two grand slams.
The Adelaide native held a point to force a deciding set when serving at 5-4, but made a forehand mistake when too aggressive. He then double-faulted to give the Russian a chance to level the fourth set.
Kokkinakis led the tiebreaker 4-1 but conceded momentum with a couple of errors and, despite saving one match point in remarkable fashion, he slipped to the ground on the second when shaping to hit a forehand.
"I think you've got to think about it, to try and realise what went wrong and how to deal with that the next time around," he said.
"It's the same way I've lost big points. Me being kind of ultra-aggressive and trying to not let my opponent dictate, because I don't want them to dictate on the big points.
"I want to have it in my own racquet. But then there's the balance of trying to over-press. So that's the tricky part.
"But I'll definitely speak to them and decompress a little bit. (I'm) not going to let it linger too much."
Kokkinakis will move to a ranking in the mid-80s at the completion of the French Open, but the surge has come too late to earn direct entry into Wimbledon.
He will write to tournament organisers in the hope they recognise his rise through the rankings and his position on the ATP Tour Race in 2023, which sits in the mid-30s, and offer a wildcard.
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