CHICAGO – After determining last week that Cole Ragans needs elbow surgery, the left-hander has a date set and will undergo the procedure this coming Wednesday, July 1, but we won’t know the full extent and severity of the surgery until the doctors begin to operate.
Dr. Neal ElAttrache will perform the surgery on Ragans next week.
“They’ve read the MRI, but I think they’re not going to be clear on the extent of [the surgery] until they get in there and understand what they see,” manager Matt Quatraro said.
Ragans has been on the injured list with a left elbow impingement and, more specifically, valgus extension overload since May 8. He’s had various setbacks, with the pain concentrated in the back of his elbow, and was transferred to the 60-day IL on June 17.
It’s not uncommon for a player to undergo a procedure without knowing the full extent of the damage done, especially pitchers who have elbow surgeries. One example from this year is Blue Jays starter José Berríos, who underwent a surgery in mid-May that ended up being Tommy John surgery. Berríos and Ragans aren't in the exact same situation, but that’s an example of the unknowns of a surgery’s extent before operating.
Ragans has already had two Tommy John surgeries on his elbow as a Minor Leaguer with the Rangers before the Royals acquired him in a 2023 mid-season trade. That manipulation of the elbow can make imaging harder to read, which might have led to the MRIs that Ragans has had over the past few weeks being inconclusive.
The next question when a pitcher is facing a surgery is, inevitably, the timeline for his return. And that will vary extensively based on the type of procedure Ragans could end up having, although it’s safe to say he won’t be making a quick return just based on having to undergo an operation. The approach is always to go in with the least invasive technique but with the ability to pivot based on what the surgeon finds. Ragans could be facing a few months of rehab or, at worst, over a year if ligament damage is detected.
Regardless, this is not the way Ragans nor the Royals envisioned 2026 to go for their top left-handed starter, who missed a good chunk of ’25 with injuries as well. The 28-year-old rose to prominence in ’24 with a 3.14 ERA across 186 1/3 innings and a fourth-place finish in American League Cy Young voting. Since then, he’s been limited to 97 innings the past two seasons.
Now that he’s undergoing another elbow surgery, the Royals are just hoping that the worst news doesn’t come midway through that procedure.