Los Angeles got the win it flew east for on Sunday. The Rams left Northwest Stadium with a 20-13 victory over the Washington Commanders, a third straight win, and a 5-4 record. They also left with a problem that could shape the rest of their season.

The Puka Nacua injury came on the Rams’ final offensive snap, a nothing play in a game they’d already won. One jet sweep, one low tackle, and Los Angeles lost the receiver its whole passing game runs through. McVay said Monday that Nacua will likely land on injured reserve, and when reporters pressed him, he put the timeline at “at least a month.”

It was a strange way for a big night to end. Nacua had just put up 14 catches for 150 yards and a touchdown, his best yardage total of the season. Then, with 1:44 left and the Rams trying to bleed the clock, he took a handoff, gained five yards, and stayed down.

How the Puka Nacua injury happened

Third-and-11 at the Rams’ own 49, up by seven, late in the fourth quarter. McVay called a jet sweep for Nacua, who took the handoff and cut upfield behind a pulling tackle. He picked up five yards to the Washington 46 before Commanders safety Jeremy Reaves wrapped him up low, around his right knee. Linebacker Sonny Styles arrived a beat later, according to the play-by-play.

Nacua stayed on the turf for a moment, then limped off, and was later seen with a brace on his right knee. Nothing about it looked serious in real time, and the Rams punted the ball away to close out the win.

News of the injury didn’t surface until after the game, when ESPN’s Adam Schefter and NFL Network’s Mike Garafolo reported that Nacua had hurt his knee on that final snap and would have an MRI on Monday. Both added that the team did not believe he’d torn his ACL, though the scan would tell the full story.

McVay hasn’t hidden his second thoughts about the call. “I’d be lying to you if I said I haven’t questioned the decision-making on that last play over and over in my head of what could have been another option that you felt like could have gotten a conversion,” he told reporters Monday, according to NBC Sports. The Rams didn’t need the first down. They needed the clock to run.

What the MRI showed

Monday’s scan brought the news Los Angeles feared: Nacua sprained both the MCL and the PCL in his right knee, McVay said, and he’s also dealing with turf toe. The Rams’ own site confirmed the same three injuries in its Monday update, and Reuters reported that Nacua is likely headed to injured reserve.

That’s a heavy diagnosis for one play. The MCL and PCL are two of the four main ligaments that hold the knee together, and turf toe, a sprain of the big toe joint, can linger for weeks on its own. Nobody with the Rams has put a precise return date on any of it. McVay would only say Nacua is “going to be out for a good amount of time” and that injured reserve is the strong likelihood.

A move to injured reserve carries a fixed cost: at least four games out. With a bye tucked into Week 11, the earliest he could suit up again is Week 15, when the Rams host Dallas on December 20. The four games he’d miss: at Arizona, at home against Green Bay and Kansas City, and on the road in San Francisco on December 13.

No report since Monday’s MRI has mentioned an ACL tear, and the team’s early belief that the ACL survived has held up so far. That’s the injury that would have ended Nacua’s season outright. This one doesn’t, but a month is the floor, not the ceiling.

What the Puka Nacua injury means for the Rams

Los Angeles was already thin at receiver before Sunday: Davante Adams has been out since Week 6, when he ruptured his left hamstring in an 18-16 loss to Arizona. That injury needed surgery and came with a six-to-10-week timetable. Adams had a cleanout procedure in late October, and McVay has said the Rams hope he returns on the shorter end of that window, which could put him back as early as Week 12 against Green Bay.

Adams and Nacua share the team lead with four touchdown catches each. Sunday showed how lopsided things already are. Stafford threw for 228 yards, and Nacua accounted for 150 of them. Every other Ram combined for 12 catches and 78 yards.

The depth chart behind them is a group of young players and role players: Tutu Atwell, Konata Mumpfield, Jordan Whittington, and C.J. Daniels have split what’s left. They’ll get their chance now, because there isn’t another proven option on the roster. McVay said Monday the Rams will “explore all avenues” for help, according to ESPN’s Sarah Barshop, and the trade deadline hits at 4 p.m. ET on Tuesday, November 10. That’s a tight window, and the Rams may have to pay a premium for a rental.

Guard Steve Avila also left Sunday’s game with a hamstring strain, the Rams said Monday.

A defense doing its part

If there’s a bright spot, it’s the other side of the ball. Myles Garrett, back for his first game since Week 1, had three sacks and forced a fumble in Washington, per Reuters. The Rams’ defense has kept them in games while the offense finds itself, and it’ll need to do more of that with Nacua out.

A win that came at a cost

The Rams trailed 10-6 at halftime, and their offense looked stuck. Stafford finished 26 of 43 for 228 yards with a touchdown and an interception, and for long stretches, he had one place to go with the ball.

Nacua was that place. He caught 14 of the 19 passes Stafford threw his way, ran twice for 20 yards, and scored the go-ahead touchdown on a seven-yard pass with 12:51 left, leaping over Commanders cornerback Trey Amos in the back corner of the end zone. He finished three catches short of his career best of 17, set in Week 5 against Buffalo.

He’d already had one scare earlier. In the third quarter, after a deep incompletion, Nacua went into the blue medical tent for a concussion check, was cleared, and came straight back. “I called in for concussion protocol,” he said afterward. “It was a deep ball and I fell down, but nothing to do with a head injury.” The knee, not the head, turned out to be the problem.

Washington fell to 2-5-1. Jayden Daniels threw for 274 yards and a touchdown on 24 of 35 passing, but the Commanders couldn’t find a second straight win.

What’s next for Los Angeles

The Rams don’t get a soft landing. They visit Arizona on Sunday, November 15, at 4:05 p.m. ET at State Farm Stadium in Glendale — the same team that beat them 18-16 in Week 6 and knocked Adams out. After that comes the Week 11 bye, then a short week: Green Bay visits SoFi Stadium on Wednesday, November 25, the night before Thanksgiving.

At 5-4, Los Angeles sits third in the NFC West and outside the playoff picture for now. Seattle holds the No. 8 seed on a division-record tiebreaker, which leaves the Rams at No. 9 — close enough that a month without Nacua could decide whether they climb back in or fade out.

McVay has already answered the question honestly, and the answer doesn’t change the math. The Rams won on Sunday. Their hardest stretch of the season starts now, and they’ll play it without the player who carried them there.

FAQ

How long is Puka Nacua expected to be out?

At least a month, per Sean McVay. On injured reserve, as expected, he must miss a minimum of four games, with Week 15 against Dallas on December 20 the earliest return.

What exactly did Puka Nacua injure?

An MRI on Monday, November 9, showed sprains to both the MCL and the PCL in his right knee, plus turf toe. The team did not believe he tore his ACL, and no ACL tear has been reported since the scan.

How did the Puka Nacua injury happen?

On the Rams’ final offensive snap, with 1:44 left in a 20-13 game. Nacua took a jet-sweep handoff on third-and-11, gained five yards, and was tackled low around his right knee by Commanders safety Jeremy Reaves.

Who replaces Puka Nacua in the Rams’ lineup?

Nobody on the roster matches him. Tutu Atwell, Konata Mumpfield, Jordan Whittington, and C.J. Daniels are next up, and Davante Adams could return from his hamstring injury as early as Week 12. McVay has also said the Rams will look at outside help before Tuesday’s trade deadline.