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.
“I gave myself a couple of days to be pissed off and all that, but [I] can’t sit here and sulk about it over and over,” Ragans said. “I got it, and it’s done. I look forward to the steps I get to take throughout the rehab to get back out there and play baseball again with these guys.”
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.”
On Saturday, Ragans and head athletic trainer Kyle Turner provided more details on the type of procedure Ragans had, and it first helps to explain the three different types of Tommy John operations:
- A full reconstruction happens when surgeons replace the existing ligament with a graft from the patient’s arm or knee. This is probably the Tommy John surgery you think of when you hear a player has had it done.
- A revision or repair with internal brace is a newer, modified version of Tommy John that happens when a surgeon replaces the existing ligament and adds a brace or sling to strengthen it.
- Another type of repair happens when a surgeon repairs the existing ligament with sutures and not any external fixation or devices inserted. This is the procedure Ragans had last week.
“The existing ligament was just repaired with sutures,” Turner said. “His flexor tendon was repaired, and then [ElAttrache] cleaned out the back of the elbow on the stuff we knew what was going on, and then closed up and got out of there.”
Ragans has now undergone all three of these Tommy John procedures in his career: A full reconstruction in 2018, a repair with internal brace in ‘19 and the repair with sutures in ‘26. Coming back from three elbow surgeries is rare but not unheard of; Ragans actually has texted with Rays starter Drew Rasmussen already about the rehab process.
“The guys that we know who have had all three have gotten back to the big leagues,” Turner said. “So that’s a fairly good success rate. I don’t think we’ve even scratched the surface of where this is going to go. Dr. [Keith] Meister alone did 80-something revisions last year, so hopefully we don’t see this continue, but the success rate has been very high. Of course, we probably don’t hear a lot about the unsuccessful ones, but the guys that have had it and done it, they’ve all pitched very well when they’ve returned.”
No stranger to long rehab timelines, Ragans is ready to attack this one. It has also helped that Ragans and his wife, Tori, welcomed a baby girl, Scottie, into the world last week – four days before Ragans had his surgery.
The positive part of it is that he can be home to support his family and spend time with his daughter.
“She doesn’t care about baseball,” Ragans said. “She has no idea about baseball. It’s something I’ve never felt before. I look forward to watching her grow, and I get to be with her a little bit more. Unfortunately I don’t get to play baseball right now, but I get to go home to my daughter every day and watch her grow.”
Ragans has been on the injured list since May 8 with left elbow impingement or, more specifically, valgus extension overload. Turner said they didn’t see any compromise to the ligament at that time. Ragans 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.
Ragans was one of the best pitchers in baseball in 2024, finishing fourth in American League Cy Young voting and cementing himself as the Royals’ ace they 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.