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Saints vs. Steelers: Injury Concerns Mount Ahead of Historic Paris Showdown

New Orleans listed 11 players on Thursday's injury report, with Cesar Ruiz sidelined and Alvin Kamara limited. Pittsburgh is also monitoring T.J. Watt, Alex Highsmith and Jalen Ramsey ahead of Sunday's game in Paris.

Oct 18, 2026; East Rutherford, New Jersey, USA; New Orleans Saints running back Alvin Kamara (41) runs the ball against New York Giants safety Jevon Holland (8) during the third quarter at MetLife Stadium. Mandatory Credit: Vincent Carchietta-Imagn Images | IMAGN IMAGES via Reuters Connect

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The New Orleans Saints face several injury concerns as they prepare for Sunday's historic international matchup against the Pittsburgh Steelers at Stade de France in Paris.

Running back Alvin Kamara and starting offensive guard Cesar Ruiz headline New Orleans' injury report, while Pittsburgh is monitoring several key defensive players, including T.J. Watt, Alex Highsmith and Jalen Ramsey.

According to the Saints' official Thursday injury report, 11 New Orleans players were listed Thursday, with three missing practice and three participating on a limited basis.

The Saints (2-4) are looking to build momentum following Sunday's 34-27 victory over the New York Giants, which snapped a three-game losing streak. Meanwhile, Pittsburgh (4-2) enters the matchup seeking its second consecutive victory.

Both teams have several injury situations worth monitoring before Friday's final practice report.

New Orleans Saints Injury Report — Thursday, Oct. 22

Oct 18, 2026; East Rutherford, New Jersey, USA; New Orleans Saints running back Alvin Kamara (41) reacts on the field after the game against the New York Giants at MetLife Stadium. Mandatory Credit: Vincent Carchietta-Imagn Images | IMAGN IMAGES via Reuters Connect
  • RB Alvin Kamara (Back): Limited Wednesday and Thursday.
  • G Cesar Ruiz (Knee): Did not practice Wednesday or Thursday.
  • LB Kaden Elliss (Calf): Limited Wednesday and Thursday.
  • EDGE Anfernee Jennings (Knee): Limited Wednesday and Thursday.
  • K Daniel Carlson (Personal): Did not practice Wednesday or Thursday.
  • RB CJ Donaldson (Shoulder): Limited Wednesday; full participant Thursday.
  • CB Kool-Aid McKinstry (Head): Full participant Wednesday and Thursday.
  • QB Tyler Shough (Left hand): Full participant Wednesday and Thursday.
  • DL Nathan Shepherd (Illness): Full participant Wednesday and Thursday.
  • DL Davon Godchaux (Rest): Did not practice Thursday.
  • QB Spencer Rattler (Knee): Full participant Thursday.

The Saints' biggest offensive concerns involve Kamara and Ruiz, who have been dealing with back and knee injuries, respectively.

Kamara was limited for the second consecutive practice Thursday, leaving his availability worth monitoring heading into Sunday's game.

The veteran running back remains an important part of Kellen Moore's offense, particularly as New Orleans attempts to establish a more consistent rushing attack.

Ruiz's situation is potentially more concerning. The veteran offensive lineman missed practice Wednesday and Thursday because of a knee injury, raising questions about his availability against Pittsburgh's defensive front.

However, Jeremiah Wright played well in his absence during New Orleans’ win over the Giants last week.

Meanwhile, linebacker Kaden Elliss (calf) and edge rusher Anfernee Jennings (knee) were limited for the second consecutive day. During today's player roundtable, Elliss was asked if he would be available to play Sunday, and he said, "Yes."

There was some encouraging news for New Orleans.

Shough, who appeared on the report with a left-hand injury, participated fully in both practices. Cornerback Kool-Aid McKinstry (head) and defensive lineman Nathan Shepherd (illness) also practiced without limitations.

Running back CJ Donaldson (shoulder) improved from limited participation Wednesday to a full practice Thursday.

Kicker Daniel Carlson missed his second consecutive practice because of a personal matter unrelated to injury (he and his wife are having a baby), while defensive lineman Davon Godchaux received a rest day Thursday.

Backup quarterback Spencer Rattler was added to Thursday's report with a knee injury but participated fully.

Pittsburgh Steelers Injury Report — Thursday, Oct. 22

Sep 21, 2025; Foxborough, Massachusetts, USA; Pittsburgh Steelers outside linebacker TJ. Watt (90) celebrates after a sack during the second quarter at Gillette Stadium. Mandatory Credit: Paul Rutherford-Imagn Images | IMAGN IMAGES via Reuters Connect
  • LB T.J. Watt (Rest/Calf): Did not practice Wednesday; limited Thursday.
  • LB Alex Highsmith (Groin): Limited Wednesday and Thursday.
  • CB Jalen Ramsey (Wrist): Did not practice Wednesday; limited Thursday.
  • DT Cameron Heyward (Rest): Did not practice Wednesday or Thursday.
  • RB Rico Dowdle (Knee): Limited Wednesday and Thursday.
  • CB Brandin Echols (Hamstring): Did not practice Wednesday or Thursday; ruled out.
  • WR Ben Skowronek (Calf): Did not practice Wednesday or Thursday; ruled out.
  • S DeShon Elliott (Knee): Full participant Wednesday and Thursday.
  • DL Sebastian Joseph-Day (Triceps): Did not practice Wednesday; placed on injured reserve.

Pittsburgh is also dealing with significant injury concerns, particularly on defense.

The most notable development Thursday was star edge rusher T.J. Watt, who was limited with a calf injury after sitting out Wednesday's practice for rest.

Watt's status matters, given the Saints' offensive line concerns. The former NFL Defensive Player of the Year has 4.5 sacks through six games. 

Fellow pass rusher Alex Highsmith remained limited with a groin injury, while veteran defensive tackle Cameron Heyward missed his second straight practice for rest.

The Steelers also received encouraging news about star cornerback Jalen Ramsey, who returned to practice on Thursday, albeit in a limited capacity. He missed Wednesday's session with a wrist injury.

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