Like the previous game, the story takes place between two movies; Saw II and Saw III. This time around we follow Michael Tapp, son of the last game's protagonist, who in his search for his father ends up in a lethal game of Jigsaw's.
This game has examples of:
- Action Commands: Combat against most opponents (save the bullfight minibosses) have to be fought this way.
- Big First Choice: A decision made early in the game determines who survives at the end.
- Bullfight Boss: Characters with their hands bound behind their backs wearing either a spiked helmet or spiked helmet and spiked vest are this. You have to either dodge them to cause them to rush into an elevator shaft, into a room you can lock them in, into electrified walls, or drop a shipping crate on them.
- Decoy Protagonist: The first level has you play as a character named Campbell. After the first level, however, your perspective switches to Michael Tapp, the son of David Tapp (the protagonist from the first Saw video game, and the cop from the first movie) for the rest of the game. This isn't to say Campbell's section has no impact on the rest of the game, though - whether he lives or dies in his final test determines which ending you receive.
- Diegetic Interface: There are no interface elements that show on the screen at all times. Michael's health is displayed in how much blood has seeped through the bandage on his arm.
- Everything Trying to Kill You: The occupants of Jigsaw's game are supposedly all criminals that Michael Tapp's father had put in jail, and therefore don't like you very much.
- Eye Scream: Much like in the second movie, the first trap is the Venus Flytrap, in which the victim has to retrieve a key that has been sewn into the back of their eye socket to free themselves. Unlike the second movie, actually cutting out the eye isn't necessary - Campbell just needs to cut the stitches under his eye to get the key out.
- First-Person Ghost: There is a brief first person section near the beginning which utilizes this technique. Also when interacting with puzzles and traps, your view switches to a first person perspective. While in this perspective you don't see your body interacting with the pieces of the puzzle.
- Foregone Conclusion: Much like the first game, we all know Jigsaw will still be at large by the end.
- Head Crushing: When Michael finds Joseph, Joseph is in a device that would crush various body parts one by one in vices. The last body part of Joseph's to be crushed is his skull if you don't solve the puzzle in time.
- Multiple Endings: The game has two endings, depending on whether or not Decoy Protagonist Campbell survives his final test.
- If Campbell makes it through the Spikes of Doom and enters the elevator, he shows up at the end when Michael makes it to the end of his own Spikes of Doom room, preventing Michael's escape and ensuring his death (since the elevator is occupied and cannot be opened). Jigsaw then congratulates Campbell, tells him that his son is fine (he claimed to have kidnapped him earlier) and allows him to leave. Campbell, traumatized by everything he went through, tries to attack Jigsaw - and falls prey to a trap.
- If Campbell dies, he's obviously not in the elevator, thus allowing Michael to enter the elevator and escape. At the end of his ride, Jigsaw presents him with two doors, just like Tapp was shown. One door leads to freedom, allowing Michael to take the files his father collected and print a story about the drug cartel his father discovered as well as his own kidnapping by Jigsaw, while the other has the pigman costume - implying that Jigsaw is offering Michael a chance to become his apprentice. The screen cuts out before we see Michael's choice.
- "Shaggy Dog" Story: The Path of Blood ending. After everything he went through, Michael reaches a glass elevator at the end of a hallway with spiked walls, only to find out that Campbell is in it, meaning he can't escape the Spikes of Doom and dies. Then Campbell, upon reaching the surface, decides to attack Jigsaw, only to be killed by a trap. In other words, one protagonist had to die so the other could live, and the surviving protagonist died almost immediately after.
- Spikes of Doom: Used several times.
- Ungrateful Bastard: Aside from Solomon being a jerk to Michael after he saves him, Henry and Joseph outright try to kill Michael later on after he saves them to eliminate anyone who knows about their drug cartel. Notably averted with Griff and Anton, who do show gratitude if you save them.
- The Walls Are Closing In: Used a lot, adding spikes into the mix.
- Why Am I Ticking?: Michael has to put on a metallic vest with shotgun shells on the back primed to fire. There are several points during the game where there are machines that interact with the vest. If you get too close to them, the vest will start beeping, and if you fail to solve a puzzle and shut down the machine quick enough, then the shells will fire directly into your back, killing you instantly.