Roethlisberger was seen grimacing in pain after making what appeared to be a routine throw during the second quarter of the Steelers’ game against the Seattle Seahawks on Sunday.
After the play, he left the field and did not return.
Mason Rudolph took over as quarterback for the remainder of the game and is likely to get the initial nod as Pittsburgh's starter with Roethlisberger on the shelf.
The 37-year-old veteran quarterback was hoping to avoid surgery but left it to doctors to make the final decision, sources told ESPN.
Roethlisberger was in the early stages of his 16th season with the Steelers, who are so far 0-2. In Week 1 against the New England Patriots, he was 27-of-47 for 276 passing yards and an interception.
Roethlisberger, known for taking big hits due to a bruising, caution-to-the-wind style of play, started 16 games last season for the first time since 2014. He played 12 games in 2015, 14 games in 2016 and 15 games in 2017.
He led the league with 5,129 passing yards and 675 passing attempts. He had 34 touchdown passes — but also a league-leading 16 interceptions.