What’s next for Royals LHP Cole Ragans after elbow surgery

Kansas City Royals ace Cole Ragans underwent left-elbow surgery Wednesday.

Ragans, 28, is expected to miss the remainder of the 2026 season. It’s his third major elbow procedure as he previously underwent two Tommy John surgeries earlier in his career.

“It was some time today,” Royals manager Matt Quatraro said. “And I have not gotten any word on what has happened in the surgery.”

The Royals sent Ragans to visit with Dr. Neal ElAttrache. The surgery comes after Ragans dealt with left-elbow impingement. On May 6, Ragans left his start against the Cleveland Guardians after three innings.

He was diagnosed with Valgus Extension Overload (VEO) — an elbow condition that’s more commonly known as “pitcher’s elbow.” The injury sidelined him for weeks as he continued to build up his arm strength.

At times, Ragans made significant progress. He recovered enough to go on a rehab assignment with Triple-A Omaha. On May 23, Ragans allowed one run across 4 ⅓ innings with the Storm Chasers.

It was a step in the right direction. However, Ragans didn’t recover well and suffered a setback after the outing. And the Royals decided to shut him down for a short period.

Ragans saw a team doctor and resumed his rehab program. He was back throwing bullpens — as noted by a 23-pitch side session on June 10.

Ragans looked fine during the workout. Yet, he didn’t respond favorably the next day, and it led to the Royals having him see additional doctors.

At that time, it was determined that Ragans needed surgery. The Royals are currently without starters Kris Bubic, Ryan Bergert and Ben Kudrna.

Ragans posted a 4.84 ERA in eight starts. He allowed 10 homers while striking out 45 batters in 35 ⅓ innings.

“He’s not going to be available opening day next year,” Royals general manager J.J. Picollo said. “We know that. You got to try to plan around that, but also with optimism that he’s coming back at some point.”

The Royals have relied on young starters Stephen Kolek and Luinder Avila as replacements. Still, Ragans is a key part of the club’s future. He was the 2025 opening day starter and recently signed a renewed contract this offseason.

“With Cole having gone through it before, he knows what this challenge is,” Picollo said. “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. And hopefully, he’s a great addition to our team sometime in the middle part of the year.”