Ragans undergoes UCL repair on left elbow, faces 10-12 month recovery

KANSAS CITY – Cole Ragans underwent an ulnar collateral ligament repair on his left elbow on Wednesday, with the surgery performed by Dr. Neal ElAttrache in Los Angeles.

The Royals’ lefty now faces 10-12 months of recovery. The club expects his return midseason in 2027.

The extent of Ragans’ elbow surgery was not known until he actually had the operation done, with several different options based on what the surgeon found once he could assess the elbow fully. But the Royals were operating under the assumption that it was going to be something related to Ragans’ UCL, and that they were not going to get Ragans back on the mound in 2026.

“That’s a big loss,” general manager J.J. Picollo said before the surgery. “But we’re working on two months here without having Cole anyway, so it’s not like this is a new thing. But we know how talented he is and how much he can help us win. You just want the surgery to go well, which I know it will, and then Cole, having gone through it before, he knows what this challenge is.

“He’s going to be up for it. He’s in the right frame of mind. He knows what’s ahead of him, and he’ll be able to get back as quick as possible. Hopefully, he’s a great addition to our team sometime in the middle part of [next] year.”

Notably, the Royals were not calling the operation a Tommy John surgery, which is a UCL reconstruction that completely replaces the ligament. That’s a surgery that Ragans has already had twice in his career.

A repair is different, generally considered less invasive, and there are different types. But more details were not made available by manager Matt Quatraro on Thursday.

Ragans and Royals head athletic trainer Kyle Turner are expected to address the media on Saturday, following the Royals’ scheduled team off-day on Friday.

Ragans has been on the injured list since May 8 with left elbow impingement or, more specifically, valgus extension overload. He seemed to be on track for a quick return by the end of May, but he didn’t recover well from his rehab outing on May 23 and then suffered subsequent setbacks before he was shut down for good after June 12. Since then, Ragans had all sorts of testing and appointments before coming to the conclusion that surgery was needed, and he scheduled it for Wednesday.

Ragans was one of the best pitchers in baseball in 2024, finishing fourth in American League Cy Young voting and cementing himself as the ace the Royals were hoping to rely on for several more years. Since then, he’s missed significant time with injuries, including more than three months last year, first with a groin injury and then a left rotator cuff strain.

He returned at the end of the season and had a healthy offseason, and he was the Royals’ Opening Day starter for the third consecutive season in ‘26. But he made just eight starts this year with a 4.84 ERA. In the past two seasons, the 28-year-old has thrown just 97 innings with a 4.73 ERA.