After a close first half that saw the Bills up 14-10, they pulled away in the second half, defeating the New Orleans Saints 31-19 to move to 4-0. The Bills were in control for pretty much the entire game but the defense let the Saints hang around much longer than they should have, missing multiple tackles.
The defense is a continued work in progress but the offense continues to hum, scoring 30+ points again for the fourth consecutive game. Despite the offensive success, the Bills did deal with several injuries of varying severity.
Read below for a full injury breakdown following Sunday’s win.
In-Game Injuries
LB Terrel Bernard (Left Ankle/Heel)
Bernard briefly exited with 8:50 left in the second quarter when he got his left heel stepped on by Jordan Phillips. There may have been some pain where he got stepped on which required a brief assessment by training staff, but this forced the heel of his shoe off. Due to the assessment, he had to miss one play before he returned to play.
This was more of a hurt, not injured play but noteworthy.
DE Greg Rousseau (Left Leg)
Rousseau was slow to get up with 1:35 left in the third quarter with what looked to be a left leg issue. Looking at the video, he whipped around while he tried to hold onto his player, looking to hit his left leg.
He did not leave but lacked some explosion the next several plays. He never received an in-game designation but it was worth highlighting in the event that he shows up on the injury report.
He has been slowed by a right knee bone bruise after a Derrick Henry collision during the first play of the third quarter in Week 1.
DE AJ Epenesa (Undisclosed)
Epenesa was shaken up briefly with 1:34 left in the third quarter when he completed a tackle. He was slow to get up and walked gingerly off the field, motioning to his right leg. He did look like he took a hard shot to his left shoulder but the broadcast view doesn’t show whether his right leg was hit.
He was briefly assessed on the sidelines before he returned to finish the game including making a key fourth quarter sack. We need a better angle or body part designation to determine the exact injury.
OL Alec Anderson (Left Shoulder)
Anderson appeared in post game pictures with a left shoulder brace with no prior injury known. Looking back at film, his last play before donning the brace was with 7:07 left in the fourth quarter.
He takes on two defenders and wraps his left arm around the one but it isn’t clear what exactly he injured. He did not miss any remaining special teams snaps and appeared in good spirits entering the locker room.
It’s unknown whether this will be anything but always worth noting.
P Cameron Johnston (Left Knee)
By far the most significant injury of the day, Johnston took another shot this week on a roughing the punter penalty. He was hit on the inside portion of the knee which is his plant leg. He went down in pain and initially struggled to get off the field.
Fortunately he was able to walk off and return with a brace on his left knee to hold for a field goal attempt towards the end of the game.
Following the game, he was seen walking off the field with a noticeable limp and later went for x-rays.
There are multiple possibilities for his potential injury including a contusion, bone bruise, hyperextension, MCL sprain, LCL sprain, or even meniscus. Considering how he was hit and rotated, I don’t suspect an ACL or even PCL, but this one will be one to watch closely. I suspect that the Bills will work out punters in case Johnston has to miss time.
Johnston states that his knee feels solid which would imply the ligaments are intact but scans will confirm or deny what he says.
If this turns out to be something, this would be his second serious injury in two seasons after he tore his ACL in his right knee last year with the Pittsburgh Steelers in Week 1.
Update 9/29/25
According to the team, Johnston is dealing with a foot/ankle injury. This is different from the left knee injury he was cleared to return from yesterday. He still very likely has a knee injury but it may just be a bone bruise rather than any actual structural damage.
As for the foot/ankle possibilities, he hypothetically could have injured both legs. He could be dealing with a low ankle sprain, midfoot sprain, or even Jones fracture within the left foot when the foot violently rotates inward.
As for his right side, he could be dealing with a bone bruise, a high-ankle sprain, or even a medial ankle sprain when the right foot lands and he rotates away.
There is no timeline for return considering the different possibilities. It won’t be anytime soon and with a potential IR stint, the Bills brought in punters to try out on Monday.
We may see Johnston around with a boot or limp or something that tells us what the specific injury is. This is highly unfortunate especially after tearing his right ACL last year in Week 1.
Final Thoughts
The Bills are 4-0 and find ways to win. It’s disappointing to see them allow a team like the Saints to stick around, but it is the NFL and every team still has talent.
Next week, the Bills host the New England Patriots in Week 5 on Sunday Night Football. This team appears to be on cruise control towards the bye but have a tougher matchup in Week 6 against the Atlanta Falcons. However, as the saying goes, don’t count your chickens until they hatch. As someone who owns chickens, it is entirely true.
It was a sloppy game due to penalties and the defense, but they did get the win. Make sure to check back for the latest injury updates following Monday and throughout the week.
Top Photo Credit: Democrat & Chronicle
