One of the biggest needs for the Buffalo Bills is a defensive tackle heading into the 2026 NFL Draft. The team has continued to invest in defensive tackle almost every year since 2018, drafting TJ Sanders, Deone Walker, DeWayne Carter, Ed Oliver, and Harrison Phillips. They have had mixed results with Oliver being the best of the bunch, but at times inconsistent, partially due to injuries. 

One potential target for the Bills on Day 1 or 2 could be Georgia DT Christen Miller. The first team All-SEC enters the draft after securing 64 tackles, 11 tackles for loss, and 4 sacks over his four-year career at Georgia. What’s important to note is that he didn’t start until 2024, meaning most of his production has come over the last two seasons. 

However, Miller has had a variety of injuries, which means the Bills had to do their homework on him before they determined whether he’s a realistic target for them. 

Read below for a full injury history and analysis. 

 

Injury History 

 

2018 – Broken leg at the knee requiring surgery with 3 screws, freshman year, high school. 

2021 – Right MCL sprain, high school state championship, missed All-American Bowl.

2023 – Lower body injury, vs Ball State, missed 0 games.

2023 – Meniscus tear requiring clean up, missed 1 game, and limited during spring workouts. 

2024– Left knee injury vs Auburn, missed 0 games.

2024 – Right shoulder dislocation with labrum tear, vs UMass, missed 2 games, required labrum repair in 2025 offseason.

2025 – No publicly reported injuries. 

 

Christen Miller Injury Analysis

 

Miller has had a variety of injuries over his career that have cost him a total of three missed games in college. Looking at the severity and types of injuries in his history, there are several concerns that may cause further issues once he enters the NFL. 

 

Knee Fracture

 

Looking at specific injuries, we will go in chronological order. It’s known that he suffered a broken leg during his freshman year of high school as a 14-year-old while trying to dunk a basketball. There aren’t any specific details as to where he broke his leg, other than that he required three screws in his knee. 

A fracture in itself isn’t usually too concerning, but what gave me pause was that he was told by his orthopedic doctor that his football career may have been over. It’s not known where the fracture was in the knee at the distal femur or whether he suffered a tibial plateau fracture. The three-month follow-up didn’t look great, but the six-month follow-up showed that he had healed enough to resume playing football.

Additionally, he states that he did not do any formal physical therapy, but he did lift and work out on his own. In my world, with a young athlete like that, it’s crazy that he didn’t have any formal PT. I would want him to have gotten the care he needed, but that is looking back with the benefit of hindsight. The fact that he played another seven years on the knee indicates that it’s a good sign.

 

Knee Sprain/Meniscus Tear

 

His right knee MCL sprain sounded like a garden-variety knee sprain, which is one of the most common injuries in football. The only concern is whether this was the same side he broke his knee. If it’s not, I don’t really have any concerns. If it is, this will be addressed further.

He did have a lower-body injury that didn’t cost him any time, but he did miss the last game of the season due to a meniscus tear that required a cleanup surgery. Having a meniscectomy is sometimes necessary due to having a small tear in an area that will not heal. However, it’s possible the team surgeon felt it was more efficient to rehab. There is concern for arthritic changes, especially if this was the same knee he had injured previously. 

Looking at risk factors for knee osteoarthritis in the NFL Combine, those without a history of knee surgery were at 4 percent for OA. Those with a meniscus repair were at 11 percent for OA upon evaluation and 27 percent with a partial meniscectomy. BMI >30 was also an increased risk for OA and was seen in 20 percent of the defensive linemen and tight ends in the study, but the position was not an indicator of OA. Miller is 6’4”, 321 lbs, which places his BMI at 39, which can increase his risk for OA. This doesn’t imply that he is dealing with arthritis now or will certainly develop it, but this reinforces the longevity concerns.

Looking at the quality of play over the first two NFL seasons when injuries are factored in, defensive players are more likely to play 2 years or more games in the NFL when compared to offensive players. Defensive linemen are most affected by knee and ankle injuries, with the knee injuries leading to fewer games started, fewer mean tackles, quarterback hits, and mean sacks.

Looking at whether he had a lateral meniscectomy, players drafted in the first 4 rounds were 3.7 times more likely to return to play following the procedure than those drafted after the 4th round. This is for players already drafted in the league, but teams will invest more resources in a higher-drafted player than in those drafted in later rounds or free agents. 

Research further supports that if there has been a meniscectomy, the bigger the tear, the bigger the chondral lesion, which is the cartilage of the knee. This directly correlates to poorer objective measures when compared to matched controls. This led to fewer games played and to lower snap counts compared to the control groups. Isolated meniscectomies also led to shorter careers, 5.6 vs 7.0 years, and games played 62 vs 85.

Adding in his left knee injury in 2024 without specific info would have me asking a lot of questions about his knees, especially after discussing the risk for meniscectomy above. 

 

Shoulder Injury

 

His shoulder injury, specifically a right shoulder labrum tear, is notable but less concerning than the previously mentioned knee injuries. 

There does not appear to be any decline in return to performance, but there is anywhere from a 13 to 26 percent chance of re-tearing the labrum following repair. There is also a 58 percent chance of future instability within the shoulder in the future, but considering the frequency that offensive and defensive linemen suffer a torn labrum, this isn’t necessarily a concern. The biggest issue is missed time if he suffers a new injury or future arthritis. Recurrent instability is in the mid-20 percent, but far less (50 percent) than if he hadn’t had surgery. This is also an injury he could play through after some rehab and bracing if it does occur again. 

 

Buffalo Bills Outlook

 

The Bills have met with Miller at both the NFL Combine and had a Top 30 visit. I am certain they wanted a closer look at him, I’m sure, from a medical standpoint, and look at him closer. This is the very least that they should have done. Injuries to both knees and the shoulder as well have me wary about his health once he gets into the NFL. 

In fact, his shoulder is the least concerning “major” injury simply due to the fact that many players suffer this injury and play through it or get it repaired at the end of the season. Spencer Brown, Taron Johnson, Shaq Lawson, Jordan Phillips, among others, have all dealt with this injury, which means the rehab and management are not new. Offensive and defensive lineman commonly have this injury due to keeping their arms out straight while blocking, leading to the force going through the shoulder and placing excess pressure on the labrum, at times tearing it. It’s been repaired, and he most likely has full function. 

If he had a knee fracture, MCL sprain, and meniscus tear on that right knee, I’m really curious how that knee looks by now. If he had these injuries spread out between both knees, that would be more reasonable, but I’d question how things look from an arthritis standpoint. The last thing the Bills need to do is draft a defensive lineman who needs veteran rest days during his rookie contract. That scenario reminds me of Sony Michel or Todd Gurley, both running backs who had their careers cut short due to arthritic knees. 

Miller may be fine and doesn’t show any issues on imaging. Or he may have the after, and it just isn’t bothering him yet. I don’t see how the Bills select Miller in the first round, considering his talent and injury history. I don’t foresee him dropping to the third round, where he would be a great selection, but considering Brandon Beane’s seat may be getting warm, they could trade back and pick him sometime in the second round. This would be out of the ordinary, but if the Bills can get a proven defensive tackle that can come in and play at a high level immediately, even if the medicals are suspect, then that’s a risk I could see him taking. 

The medicals are what everything hinges on. I don’t think he’s a fit medically in Round 1-2, but this could be the year to take a risk early on Day 2 if they can get back into Round 2, especially if he begins to fall.

I’m not certain Christen Miller will be a Buffalo Bill even if he is available when they’re selecting, but I’d like to wish him a healthy and successful career.