Keynan Middleton To Undergo Season-Ending Flexor Tendon Surgery

Cardinals right-hander Keynan Middleton will undergo surgery to repair his flexor tendon and will miss the entire 2024 season. Derrick Goold of the St. Louis Post-Dispatch was among those to relay the news on X.

Middleton, 30, signed with the Cardinals this offseason on a one-year deal with a $6MM guarantee. He’s making a $5MM salary this year and there’s a $1MM buyout on a $6MM club option for 2025.

The Cards were hoping to install Middleton as a key piece of their relief unit after his strong 2023 season. Between the White Sox and Yankees, Middleton tossed 50 2/3 innings last year with a 3.38 earned run average. His 10.8% walk rate was a bit on the high side but he also struck out 30.2% of batters faced and got grounders on 56.6% of balls in play.

Middleton was undoubtedly hoping to build on that campaign and put another strong year together, but it will instead be a lost year for him. He was shut down in the middle of March due to a forearm strain and began the season on the injured list. He received a platelet-rich plasma injection while trying to recover and progressed far enough that he began a rehab assignment. But he then experienced renewed discomfort and was shut down. Now that it has been determined surgery is necessary, he’ll be sidelined for the remainder of the year.

Injuries have been an unfortunately common occurrence for Middleton in his career. He underwent Tommy John surgery back in May of 2018, wiping out the remainder of that season and much of the subsequent campaign as well. In later years, he made trips to the injured list due to a right biceps strain, right elbow inflammation, a right ankle strain and a sprained left great toe. Even last year, when he was healthy enough to make 51 appearances, he missed a couple of weeks due to right shoulder inflammation.

He’s already on the 15-day IL and will be transferred to the 60-day version whenever the Cards need his roster spot for some other transaction. He’ll spend the rest of the year rehabbing and the Cards will then have to decide whether or not they want to bring him back for 2025, a net $5MM decision. Flexor tendon surgery generally has a lesser recovery timetable than other major elbow surgeries and it’s possible Middleton will be healthy by next spring, but the Cards might just take the buyout and keep the $5MM available for other moves, as they could always circle back to Middleton later in the offseason if he’s recovering well.

The Cards have Ryan Helsley as their closer and will give setup work to guys like JoJo Romero and Andrew Kittredge for now. If the club stays in the playoff race for the next few weeks, they will likely pursue some bullpen help prior to the deadline.