The implant your surgeon chooses for an ACL, rotator cuff or shoulder-dislocation repair matters, but the research shows technique, implant placement and rehabilitation matter as much as the implant itself. This guide explains each type of arthroscopy implant, what the published evidence says about it, and how surgeons at Sports Orthopedics Institute, HSR Layout, Bengaluru match implants to patients.

Arthroscopy (keyhole surgery) works through incisions of roughly 5–10 mm, so soft-tissue damage is small and recovery is usually faster than with open surgery. Inside the joint, a small anchor, screw or button holds the repaired tissue to bone while it heals. If that fixation fails, the repair can loosen and may need revision surgery.

Quick answer:

Titanium — strong, permanent, visible on X-ray; causes some local MRI artefact.
PEEK — strong, permanent, invisible on X-ray, no metal artefact on MRI; does not bond to bone.
Biocomposite — slowly dissolves and is partly replaced by bone; how fast depends on the polymer, often more than two years.
All-suture — the smallest drill hole and saves bone; biomechanically comparable to other anchors in lab studies.
Knotted vs knotless — no clear difference in clinical outcomes for Bankart repair; knotless is usually quicker to place.

What are arthroscopy implants?

Arthroscopy implants are small devices placed through keyhole portals to hold ligaments, tendons, labrum or meniscus in position until they heal to bone. An ideal anchor is easy to handle, holds firmly, does not abrade the suture, and, if absorbable, dissolves without a tissue reaction (Cho et al., 2021).

They do one of three jobs:

Fixation — securing a tendon graft inside a bone tunnel, e.g. screws and buttons in ACL reconstruction.
Reattachment — anchoring torn soft tissue back to its footprint on bone, e.g. suture anchors in rotator cuff or Bankart repair.
Reconstruction — rebuilding lost bone or stability, e.g. titanium screws fixing the coracoid bone block in a Latarjet procedure.

Suture anchors: the workhorse of shoulder, knee and ankle arthroscopy

A suture anchor is a small body fixed into bone with one or more high-strength sutures attached; the sutures are passed through the torn tissue and tied (or locked) to pull it back to bone. They are used in Bankart and labral repair, rotator cuff repair, SLAP repair, ankle ligament (ATFL/CFL) repair and proximal hamstring reattachment. Anchors differ mainly in the material of the body.

Titanium (metal) anchors

Metal anchors were the first suture anchors and remain the benchmark for holding strength (Cho et al., 2021). They are easy to see on X-ray, which helps follow-up. Their downsides are possible suture abrasion on a sharp eyelet, local MRI artefact and harder revision if one has to be removed (Yang et al., 2023).

In a 2023 network meta-analysis of lab studies, biocomposite and all-suture anchors moved (displaced) more under cyclic loading than metal anchors (Yang et al., 2023). That is one reason some surgeons favour metal or large PEEK anchors in older patients with soft, osteoporotic bone, where anchor pull-out is a recognised problem (anchor pull-out review, 2022).

PEEK (polyether-ether-ketone) anchors

PEEK is a strong, non-absorbable plastic whose stiffness is closer to bone than metal's. It is invisible on X-ray and leaves no metal artefact on MRI, so the repair can be assessed clearly; it also cannot cause degradation-related problems because it does not dissolve (Cho et al., 2021). Its pull-out strength in lab testing is similar to metal (Yang et al., 2023).

The main limitation is that PEEK does not bond with bone (poor osseointegration), which is what drove development of biocomposites (Cho et al., 2021). PEEK suits younger, active patients who are likely to need a post-operative MRI, for example after SLAP or posterior labral repair. At Sports Orthopedics Institute, PEEK and PEEK-titanium hybrid anchors are used routinely in Bankart and SLAP repair.

Bioabsorbable and biocomposite anchors

Bioabsorbable anchors slowly dissolve, in theory leaving bone in their place. The first material, polyglycolic acid (PGA), broke down within weeks and its by-products could trigger synovitis and bone cysts. Pure poly-L-lactic acid (PLLA) degraded far more slowly but stayed visible on imaging for up to seven years (Yoon et al., 2025 review, preprint).

Modern biocomposites mix a polymer (PLLA or PLGA) with a bone-forming ceramic such as beta-tricalcium phosphate (β-TCP) (Cho et al., 2021). Resorption is slower than marketing often suggests:

PLLA/β-TCP anchors: 90% were still visible on MRI at about 2.3 years after rotator cuff repair (Sgroi et al., 2019).
PLGA/β-TCP/calcium sulfate anchors: half were fully resorbed at about 21 months, with osteolysis in 2.4% (Vonhoegen et al., 2018).

Complications such as osteolysis, cyst formation and synovitis have been reported with PLLA as well as PGA anchors, but they are rare relative to the number implanted (Dhawan et al., 2012; Nusselt et al., 2010). Careful insertion technique prevents many of them.

All-suture anchors

All-suture anchors have no rigid body: a sleeve of suture material (UHMWPE) bunches up inside a small drill hole and locks against the bone cortex. That smaller hole preserves bone and lets the surgeon place several anchors in a tight space, such as the glenoid rim (Yang et al., 2023).

In lab testing, all-suture anchors had higher failure loads than biocomposite anchors and similar stiffness to conventional anchors, though they ranked higher for anchor pull-out (Yang et al., 2023). They are fully radiolucent. Because they rely on cortical bone, they are less suited to very soft or osteoporotic bone.

Suture anchors at a glance

Anchor type	Typical uses	Material	X-ray	MRI	Key trade-off
Titanium	Large rotator cuff tears, revision, osteoporotic bone	Titanium alloy (Ti-6Al-4V)	Visible	MR conditional; local artefact	Strongest hold; harder to revise
PEEK	Young active patients, SLAP/posterior labrum, MRI follow-up	PEEK polymer	Invisible	No metal artefact	Permanent; does not bond to bone
Biocomposite	Rotator cuff, Bankart, ankle ligament	PLLA or PLGA + β-TCP	Invisible (partly)	No metal artefact	Replaced by bone over years; rare cysts
All-suture	Glenoid rim, small joints, bone preservation	UHMWPE suture	Invisible	No metal artefact	Smallest hole; needs good cortical bone

Interference screws and cortical buttons for ACL reconstruction

In ACL and PCL reconstruction, a tendon graft is passed through tunnels drilled in the femur and tibia and then fixed at each end. The two main fixation methods are interference screws, which wedge the graft against the tunnel wall, and cortical suspension buttons, which hang the graft from the outer surface of the bone. Read more on our ACL Treatment Options page.

Titanium interference screws

Titanium screws give strong, permanent fixation and are a common choice for bone–patellar tendon–bone (BTB) grafts and some revision cases. Like titanium anchors, they leave local artefact on MRI and must be dealt with if the knee ever needs revision surgery.

Biocomposite interference screws

Biocomposite screws combine a polylactide polymer with β-TCP or hydroxyapatite and are widely used with hamstring and BTB grafts. Long-term CT studies show the polymer matters:

A PLLA/PGA/β-TCP screw had fully degraded with no remnant at about 3 years; bone-like ossification was seen in 81% of tunnels (Barber et al., 2011).
A PLDLA/β-TCP screw was replaced by calcified material at a mean of 42 months, with osteoconductivity in 85% of tunnels (Barber & Dockery, 2020).
Older pure-PLLA screws were studied at 7 or more years after surgery as a slow-resorbing baseline (Barber & Dockery, 2006).

So "dissolves in 2–4 years" is true only for some formulations; ask your surgeon which screw is planned.

PEEK interference screws

PEEK screws are permanent but radiolucent, so they give metal-free MRI while avoiding the uncertainty of resorption. They are a reasonable option where a clear MRI of the graft is a priority, for example in competitive athletes.

Cortical suspension devices (Endobutton, TightRope)

A cortical button is a small titanium (or PEEK) plate attached to a loop of high-strength suture or tape. It is pulled through the tunnel and flipped to sit on the outer cortex, suspending the graft. Adjustable-loop designs let the surgeon tension the graft during surgery, and the small footprint preserves bone for any future revision.

A common construct, and the standard at Sports Orthopedics Institute, is an adjustable titanium button on the femur with a biocomposite interference screw in the tibia. The same button-and-tape principle is used in AC joint reconstruction to hold the clavicle down to the coracoid (see our AC Joint Reconstruction page).

Meniscal repair devices

Saving a torn meniscus is preferred over removing it when the tear can heal, because the meniscus protects the knee's cartilage. Healing depends heavily on blood supply: in one series of vertical longitudinal tears, repairs in the outer, well-vascularised "red-red" zone failed in 4% versus 33% in the "red-white" zone; early repair and not smoking also improved healing (medial meniscus repair series, 2017).

There are three main techniques:

All-inside devices — two small PEEK or absorbable implants joined by a pre-tied suture, placed entirely through the arthroscopy portals. Best suited to the posterior horn and body.
Inside-out sutures — sutures passed from inside the joint and tied through a small skin incision. Often used for longer or more anterior tears.
Outside-in sutures — mainly for anterior-horn tears.

Meniscal repair still fails in a meaningful minority of patients. A meta-analysis with at least 5 years' follow-up found an overall failure (re-operation) rate of about 19%, and over a third of failures happened after year two (5-year meta-analysis, 2022). Another long-term review found modern all-inside and inside-out repairs performed similarly (15.8% vs 14.2%), medial repairs failed more often than lateral (23.9% vs 12.6%), and older first-generation all-inside devices did worst (systematic review, 2022).

Repair is usually first choice for repairable tears in younger, active patients who will follow a protected rehabilitation programme. Radial and root tears need specific repair techniques. For combined ACL and meniscus injuries, see our Arthroscopy Knee page.

Knotless anchors

Knotless anchors lock the suture inside the anchor body, so the surgeon does not need to tie arthroscopic knots. They are used in double-row (suture-bridge) rotator cuff repair, Bankart repair and ankle ligament repair with suture-tape augmentation ("internal brace").

The clinical evidence is reassuring for both designs. A 2024 systematic review of 720 patients found no clear difference between knotted and knotless Bankart repair in function, pain, redislocation or revision (Arthroscopy, 2024). A 2025 meta-analysis of 729 patients reached a similar conclusion, with slightly shorter operating time for knotless repair (Wang et al., 2025). In practice, the choice is driven by the surgeon's technique and the tissue being repaired.

How surgeons choose the right implant

No single implant is best for everyone; the choice balances bone quality, age, imaging needs, revision risk and the joint involved.

Factor	What it favours	Why
Soft or osteoporotic bone	Titanium or larger PEEK anchors	Metal anchors displaced least in lab testing; pull-out is a known risk in poor bone
Young, active patient likely to need MRI	PEEK, biocomposite or all-suture	No metal artefact over the repair
Possible future revision	Titanium or PEEK (permanent) or fully resorbing biocomposite	Permanent implants are easy to locate; slow-resorbing ones can leave tunnels or cysts
Limited bone stock or many anchors in a small space	All-suture anchors	Smallest drill holes
High-demand pivoting athlete	Implant chosen for the graft and tunnel; return decided by testing	Fixation is only one part of re-injury risk

Whatever the implant, the tendon or graft still needs time to heal to bone, so rehabilitation milestones are set by the repair, not by the anchor material.

Implants by procedure: a practical summary

ACL reconstruction. Commonly a titanium adjustable button on the femur and a biocomposite or titanium interference screw on the tibia; all-inside techniques may use buttons at both ends. Graft type (hamstring, BTB, quadriceps) also guides the choice.

Rotator cuff repair. Small tears: single-row repair with PEEK, biocomposite or all-suture anchors. Larger tears: double-row or suture-bridge repair, usually with knotless lateral-row anchors. Older patients with soft bone: titanium or larger anchors for hold.

Bankart repair (shoulder instability). Typically three or more anchors along the glenoid rim (PEEK, biocomposite or all-suture; knotted or knotless). Glenoid bone loss changes the plan: 20% was the classic "critical" threshold, but poor outcomes are now reported from about 13.5%, and anterior bone reconstruction such as the Latarjet (fixed with titanium screws) is considered in active patients above roughly 15% or with an off-track Hill-Sachs lesion (Shaha et al., 2015; Bone & Joint Journal review, 2024). See our Bankart Repair and Latarjet Procedure pages.

Ankle ligament reconstruction. Anatomical ATFL/CFL repair with PEEK, biocomposite or all-suture anchors in the fibula; a knotless anchor with suture tape can be added as an internal brace. See our Ankle Ligament Surgery page.

Are arthroscopy implants safe? What the research says

Modern arthroscopy implants have a good long-term safety record when they are correctly chosen and placed.

Titanium is permanent and well tolerated. It is non-ferromagnetic, and reviews of orthopaedic implants conclude MRI is safe with respect to implant movement and torque (Mosher et al., 2018).
PEEK is chemically and biologically resistant and does not degrade, so it avoids degradation-related reactions (Cho et al., 2021).
Bioabsorbable and biocomposite implants can rarely cause osteolysis, cysts or synovitis, with PGA- and PLLA-based anchors both implicated; reported cases are a small fraction of the anchors implanted (Dhawan et al., 2012).
All-suture anchors are made of the same UHMWPE used in high-strength sutures and have no rigid body to break down; their main trade-off is fixation in soft bone (Yang et al., 2023).

MRI after surgery with a metal implant

The common advice to wait six weeks does not apply to most arthroscopy implants. MRI safety guidance states that a patient with a passive, non-ferromagnetic implant can be scanned immediately after surgery at 3 Tesla or less, and that rigidly fixed, weakly magnetic orthopaedic implants can also be scanned immediately, unless the implant's labelling says otherwise (Shellock, MRI safety guidelines).

The practical issue is image quality: metal creates a local artefact that can blur the repair itself. Keep your implant card or operation note, and show it to the MRI centre.

Arthroscopy implants in India: what patients in Bengaluru should know

Every medical device sold in India must be licensed under the Medical Devices Rules, 2017, which sort devices into risk Classes A to D. Manufacture of higher-risk Class C and D devices, and import of all devices, is licensed centrally by CDSCO (SCC Online; Mondaq). Indian manufacturers now make many arthroscopy implants; some also carry CE marking or US FDA clearance, but not all, so ask what approvals your specific implant has.

Bengaluru's large, active working population plays cricket, football, badminton and runs, and the conditions we treat most often are ACL tears, meniscal injuries, rotator cuff tears, shoulder instability and ankle ligament injuries. Implant choice affects the cost of surgery: titanium, PEEK and biocomposite implants, and Indian versus imported brands, are priced differently. Surgeons at Sports Orthopedics Institute explain these options and their costs during the pre-operative consultation. For more on joint conditions, visit our Bone and Joint School.

Frequently asked questions

What implant is most commonly used in ACL reconstruction in India?

A common construct is an adjustable titanium cortical button on the femoral side with a biocomposite interference screw on the tibial side. It combines strong suspensory fixation at the femur with a screw that is gradually replaced by bone at the tibia. Your surgeon may change this for your graft type, bone quality or a revision.

Do bioabsorbable implants dissolve completely?

Usually, but more slowly than often claimed, and it depends on the polymer. Some PLGA-based biocomposite screws have fully degraded by about 3 years, whereas 90% of PLLA/β-TCP anchors were still visible on MRI at about 2.3 years (Barber et al., 2011; Sgroi et al., 2019). Serious reactions are rare.

Can I have an MRI after surgery if I have a titanium implant?

Yes. Titanium arthroscopy implants are non-ferromagnetic and typically labelled MR Conditional; MRI safety guidance allows scanning immediately after surgery at 3 Tesla or less unless the implant's labelling states a wait (Shellock). The metal may blur the image close to the implant, so if MRI follow-up is planned your surgeon may prefer PEEK, biocomposite or all-suture implants.

What is the cost difference between titanium and bioabsorbable implants in India?

Cost depends on the material, the manufacturer (Indian or imported) and how many implants your repair needs. All implants sold in India must be licensed under the Medical Devices Rules, 2017. Your surgeon will give you a cost estimate for the specific implants planned during your consultation.

How long does surgery take, and when can I return to sport?

Most arthroscopic procedures take about 30–120 minutes. After ACL reconstruction, returning to pivoting sport before 9 months is linked to more re-injuries: each month of delay up to 9 months cut the re-injury rate by 51%, and patients who failed objective return-to-sport tests had 38% re-injuries versus 5.6% for those who passed (Grindem et al., 2016). Return after rotator cuff or Bankart repair depends on the tear, your sport and your rehabilitation, and is usually measured in months rather than weeks.

What happens if an implant fails or loosens?

Failure is uncommon. It is usually caused by technical issues, poor bone quality (anchor pull-out) or overloading the repair too early. Most failures can be revised. Permanent implants are easy to locate on imaging, and fully resorbed biocomposites leave bone behind; your surgeon will plan revision around what was used first.

Is arthroscopic surgery available for all age groups in Bengaluru?

Yes. Sports Orthopedics Institute in HSR Layout, Bengaluru treats adolescents (with growth-plate-sparing techniques where needed) through to older adults. Implant choice is tailored to age, bone quality and activity goals.

This article is for general information and does not replace a consultation. Your surgeon will recommend implants based on your examination, imaging and goals. To book, contact Sports Orthopedics Institute, HSR Layout, Bengaluru.

References

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Yang et al. Biomechanical comparison of different suture anchors used in rotator cuff repair surgery: a systematic review and network meta-analysis. J Exp Orthop. 2023;10:45.
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Arthroscopy Implants Explained: Titanium, PEEK, Biocomposite and All-Suture — What Your Surgeon Chooses and Why