The Buffalo Bills no longer can rely on Matt Milano.
That鈥檚 a harsh reality, but it is one the team鈥檚 coaching staff has to accept after the linebacker suffered yet another injury during Sunday鈥檚 loss to the New England Patriots at Highmark Stadium.
On Monday, head coach Sean McDermott classified Milano as 鈥渨eek to week鈥 with a pectoral injury. Milano originally suffered the injury in Week 2 against the New York Jets, which kept him out of the second half of that game and the next two. He returned to play the first half against the Patriots before again being sidelined.
Bills linebacker Matt Milano is considered "week to week" with a pectoral injury.
Milano now has missed the equivalent of three of the Bills鈥 five games this season, the continuation of a troubling trend that dates back to Week 5 of the 2023 season. It was during that season that Milano suffered a devastating leg injury in a game against the Jacksonville Jaguars in London, knocking him out for the remainder of the year. A torn bicep muscle suffered in training camp in summer 2024 sidelined Milano for the first 11 games of the regular season. He returned to play in three before missing another one because of a groin injury.
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Put simply, it has been one thing after another 鈥 after another 鈥 after another.
鈥淭hat's what it's been from the standpoint of his injuries the last two or three years,鈥 head coach Sean McDermott conceded. 鈥淚 don't want that for him. Nobody wants that for him. Nobody works harder than Matt Milano to stay healthy. So, right now, it's going to be a next man up for this week, and we'll take it one day and apparently, now, one week at a time, and just see where it goes.鈥
Those couldn鈥檛 have been easy words for McDermott to speak. Milano was part of the 2017 draft class, meaning he has been with McDermott from the beginning of the coach鈥檚 run in Buffalo. When the new Highmark Stadium opens in 2026, Milano figures to one day be honored as one of the great players in franchise history, in whatever form that takes.
A first-team All-Pro in 2022, Milano ranks fourth in franchise history since 1999 with 60 tackles for loss. He鈥檚 10th in that same time frame with 39 passes defended, while his 42 quarterback hits ranks 12th. For a long, long time, whenever the defense needed an impact play 鈥 whether it was a timely takeaway or a must tackle 鈥 Milano was the guy to make it.
McDermott ruled out the possibility of Milano going on injured reserve, 鈥渁t this point,鈥 meaning the team believes he will be able to return in less than the required four-game absence a stint on IR necessitates.
But if and when he does come back, then what? How can the coaching staff build a game plan around having Milano on the field, knowing full well he hasn't been able to stay there?
They can鈥檛, and they shouldn鈥檛.
Dorian Williams proved capable in Milano鈥檚 absence last season, although he is dealing with a knee injury at the moment that kept him out of Week 5. The team signed veteran Shaq Thompson in the offseason, and he has been impactful in the first five games 鈥 both on the field and in the locker room as a leader. The coaching staff has to have an honest conversation about whether either of them can be a more trusted, reliable option than Milano at this point in their respective careers.
Bills linebacker Matt Milano, left, and linebacker Shaq Thompson tackle Patriots running back Rhamondre Stevenson, forcing a fumble on Sunday at Highmark Stadium.
The Bills have played 39 games, including the playoffs, since that trip to London. Milano has missed all but 10 of them, meaning he has been available less than 25% of the time 鈥 a percentage that is even lower when you consider the games he has started, but has been unable to finish.
鈥淚 know it鈥檚 really tough on him,鈥 defensive coordinator Bobby Babich said. 鈥淥n a personal level, the guy does everything right, when you talk about taking care of your body, all those type of things.鈥
There is no reason to doubt that is true. The Bills have raved about how Milano has approached his rehab. He has done everything he can to stay on the field 鈥 but it hasn鈥檛 been enough.
That has to take a psychological toll.
鈥淣o matter what the circumstance is, don鈥檛 let negativity creep in your head, right? Because, to me, there鈥檚 a little bit of, 'That doesn鈥檛 help the healing process, at all,鈥 " Babich said. 鈥淪o, we鈥檙e going to continue to take it day by day and keep Matt positive. I know he'll do everything he can to be out there. 鈥 All these guys want to play. They play this game because they love it and it brings them joy, and to not be out there is not fun.鈥
Babich said he has never seen any of that negativity creep into Milano鈥檚 process.
The same can鈥檛 be said for the fan base. Reaction to the linebacker鈥檚 latest injury on social media has been mostly filled with frustration, which is the nicest way of putting it.
More bluntly, they鈥檝e had enough of the injuries.
It鈥檚 time to start wondering if the team has, too. The Bills reworked Milano鈥檚 contract in the offseason, shaving a year off it and making him an unrestricted free agent after this season. At 31, and with his recent injury history, it was very much a prove-it deal. As in, prove that he can stay healthy and be a difference-maker for the defense.
Five weeks into the season, Milano has proven otherwise.
