0001425450-23-000114 | 10-Q | XBRL Viewer

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

9 Months Ended

Sep. 30, 2023

Business Combination and Asset Acquisition [Abstract]

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

Rhino Pediatric Orthopedic Designs, Inc.

On July 1, 2023, the Company completed an acquisition of assets, including inventory and certain intangible assets, of Rhino Pediatric Orthopedic Designs, Inc. ("Rhino"). Rhino's product portfolio included several pediatric orthopedic products in the bracing and soft goods space, including the Cruiser TM, Kicker TM, and Rhino Stomper TM. The Company paid $1,024 in total consideration for the assets which was comprised of $546 of cash, including $46 of transactions costs, and 11,133 shares of the Company’s common stock, par value $0.00025 per share, representing approximately $478 (based on closing price of $42.91 on July 1, 2023).

Medtech Concepts LLC

On May 1, 2023, the Company purchased all of the issued and outstanding membership interest of Medtech Concepts LLC, a Delaware limited liability company (“MedTech”). MedTech has developed an early-stage, pre-commercial enabling technology platform designed to increase efficiency in the perioperative environment. The solution combines hardware, software, and data analytics to help streamline operative care and support better decision making in the operating room. In the future, the Company believes this enabling technology platform will provide valuable intraoperative resources for surgeons that will improve decision making, drive operating room efficiency, and ultimately improve healthcare for children. The Company also expects that the acquisition will further support future market share gains for its implant systems, similar to what the Company has experienced with the FIREFLY® Technology and the 7D Surgical FLASHTM Navigation platform. The Company does not anticipate material revenue contributions from the platform in 2023.

The sellers of MedTech are being paid a purchase price of approximately $15,274 in the following manner: (i) cash in the aggregate amount of $3,000 was paid on May 1, 2023, the transaction closing date (the “Closing Date”); (ii) 43,751 unregistered shares of the Company’s common stock, par value $0.00025 per share, representing approximately $2,274 (based on a closing share price of $51.98 on May 1, 2023), were issued on the Closing Date; and (iii) an aggregate of $2,500 payable 50% in cash and 50% in shares of unregistered common stock, will be paid on each of the first four anniversaries of the Closing Date, all subject to the conditions set forth in the Membership Interest Purchase Agreement (the "Purchase Agreement"), as amended, relating to the transaction.

The Company concluded that the business acquired did not comprise an integrated set of activities that meet the definition of a business and therefore did not result in the acquisition of a business. Instead, the Company accounted for the transaction as an asset acquisition for accounting purposes.

Under the Purchase Agreement, a number of future payments in the form of common stock are contingent on continued service through each applicable payment anniversary date. As such, these amounts have been excluded from measuring the cost of the acquisition. The result is $4,500 of stock compensation which will be recognized on a straight-line basis over the four year service period. Future cash payments and stock issuances that are not contingent on continuous service are included in the calculation of consideration. The total consideration is $10,043 after discounting the future guaranteed fixed payments to their present value. Additionally, since this was treated as an asset acquisition, the Company included $97 of transaction costs in the total consideration. The table below reconciles the payments and issuances to total consideration transferred after discounting the future payments to present value.


	Consideration		Present Value
Cash consideration	$	3,000	$	3,000
Issuance of common stock	2,274		2,274
Anniversary payments	5,500		4,672
Transaction costs	97		97
Total consideration transferred	$	10,871	$	10,043

As result of this asset acquisition, the Company recorded a trademark asset in the amount of $520 with an indefinite useful life and an intellectual property asset relating to software acquired of $9,523 which will be amortized over a useful life of ten years.

Kevin Unger, a member of the Company’s Board of Directors (the “Board”) through April 28, 2023, was one of the sellers in the transaction. As a result, the Board formed a special committee comprised of independent and disinterested directors (the “Special Committee”) with the exclusive authority to review, evaluate, and negotiate, or reject, the potential MedTech acquisition. The Purchase Agreement and the transactions contemplated thereby were approved by both the Special Committee and the full Board (with Mr. Unger abstaining).

Pega Medical

On July 1, 2022, the Company purchased all of the issued and outstanding share capital of Pega Medical Inc., a corporation incorporated under the Canada Business Corporations Act (“Pega Medical”). Pega Medical has developed and sells a portfolio of trauma and deformity correction devices for children, including the Fassier-Duval Telescopic Intramedullary System, a well-recognized, innovative implant designed to treat bone deformities in children with osteogenesis imperfecta without disrupting their normal growth. Pega's product portfolio increases our total systems and increases the percentage of total trauma and deformity cases we can treat.

The Company acquired Pega Medical for approximately $32,042 in cash. Approximately $1,052 of the cash consideration was deposited into escrow and will be held for a period of up to eighteen (18) months to cover certain indemnification obligations of the selling shareholders of Pega Medical. Final purchase consideration is subject to certain working capital adjustments yet to be finalized. Additionally, 34,899 shares of unregistered common stock, $0.00025 par value per share, of the Company, representing approximately $1,497 (based on the July 1, 2022 closing share price of $42.90) were issued to the selling shareholders. The common stock issued to the selling shareholders is not considered part of the purchase consideration and is subject to a repurchase right. The Company will recognize expense over the three-year service period at which point the right to repurchase will expire. In the event the repurchase right is triggered, the Company will have the right to repurchase the shares of common stock issued to such selling shareholder at a price of $0.10 per share. As of September 30, 2023, 23,266 of these shares were still subject to the repurchase feature. Pursuant to the terms of the transaction, the Company also issued $499 in restricted stock units to employees of Pega Medical, which are subject to an approximate three-year vesting schedule. The restricted stock units are not considered part of the purchase consideration.

The following table summarizes the total consideration paid for Pega Medical and the final allocation of purchase price to the estimated fair value of the assets acquired and liabilities assumed at the acquisition date:


Fair value of estimated total acquisition consideration	$	32,042
Assets
Cash	312
Accounts receivable - trade	2,100
Inventories	4,875
Prepaid expenses and other current assets	509
Property and equipment	600
Amortizable intangible assets	12,286
Other intangible assets	3,878
Total assets	24,560
Liabilities
Accounts payable-trade	1,682
Other current liabilities	1,393
Deferred tax liability	4,035
Total liabilities	7,110
Less: total net assets	17,450
Goodwill	$	14,592

The fair value of identifiable intangible assets was based on valuations using a combination of the income and cost approach, inputs which would be considered Level 3 under the fair value hierarchy. The estimated fair value and useful life of identifiable intangible assets are as follows:


	Amount		Remaining Economic Useful Life
Trademarks / Names	$	3,878	Indefinite
Patents	3,545		10 years

Customer Relationships & Other	8,741		15 years
	$	16,164

The fair value estimates and purchase price allocation included above are considered final. For the three and nine month periods ended September 30, 2023, the Company recorded measurement period adjustments. The adjustments were primarily the result of updated valuations of the intangible assets and updated estimates of certain liabilities and assets. The adjustment to the intangible assets also resulted in an adjustment to the deferred tax liability. Additionally, the increase in the value of intangible assets resulted in additional amortization expense of approximately $133 for the nine months ended September 30, 2023. Goodwill declined as a net result of these adjustments.

MD Orthopaedics

On April 1, 2022, OrthoPediatrics Iowa Holdco, Inc., a newly-formed, wholly-owned subsidiary of the Company, merged with and into MD Orthopaedics, Inc., an Iowa corporation (“MD Ortho”). MD Ortho has developed and manufactures a portfolio of orthopedic clubfoot products. The acquisition expands our total addressable market, serving as a specialty bracing platform company within our Trauma and Deformity business.

Under the terms of the related merger agreement, the Company paid to the indirect, sole shareholder of MD Ortho consideration of (a) $8,781 in cash, after adjusting for closing net working capital, and (b) 173,241 shares of unregistered common stock, $0.00025 par value per share, of the Company, representing approximately $9,707 (based on the April 1, 2022 closing share price of $56.03).

The following table summarizes the total consideration paid for MD Ortho and the final allocation of purchase price to the estimated fair value of the assets acquired and liabilities assumed at the acquisition date:


Fair value of estimated total acquisition consideration	$	18,487
Assets
Cash	420
Accounts receivable - trade	1,062
Inventories	1,126
Prepaid expenses and other current assets	100
Property and equipment	2,444
Amortizable intangible assets	9,120
Other intangible assets	2,410
Total assets	16,682
Liabilities
Accounts payable and accrued liabilities	45
Other current liabilities	586
Deferred tax liability	3,014
Total liabilities	3,645
Less: total net assets	13,037
Goodwill	$	5,450

The fair value of identifiable intangible assets was based on final valuations using a combination of the income and cost approach, inputs which would be considered Level 3 under the fair value hierarchy. The estimated fair value and useful life of identifiable intangible assets are as follows:


	Amount		Remaining Economic Useful Life
Trademarks / Names	$	2,410	Indefinite
Patents	2,660		10 years
Customer Relationships	6,460		15 years
	$	11,530

The following table represents the pro forma net revenue and net (loss) income assuming the acquisitions of MD Ortho and Pega Medical occurred on January 1, 2022.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022
Net revenue	$	39,972	$	34,950	$	111,119	$	98,779
Net (loss) income	$	(4,591)	$	18,539	$	(14,283)	$	10,013

STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($)	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-based Compensation Arrangement by Share-based Payment Award
Options, granted (in shares)			0	0
Stock-based compensation			$ 7,779,000	$ 4,978,000
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award
Options, granted (in shares)			0	0
Vesting period (in years)			3 years
Stock-based compensation expense	$ 0	$ 0	$ 0	$ 0
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award
Unrecognized compensation expense	15,857,000		$ 15,857,000
Unrecognized compensation expense, weighted average period of recognition (in years)			1 year 9 months 18 days
Stock-based compensation	$ 2,368,000	$ 1,682,000	$ 7,779,000	$ 4,978,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

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+ Details

GOODWILL AND INTANGIBLE ASSETS - Changes in Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Goodwill
Goodwill, beginning balance	$ 86,821
Pega Medical measurement period adjustment	(1,936)
Foreign currency translation impact	(3,991)
Goodwill, ending balance	$ 80,894

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

FAIR VALUE OF FINANCIAL INSTRUMENTS

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

FAIR VALUE OF FINANCIAL INSTRUMENTS

The Company measures certain financial assets and liabilities at fair value. The accounting standards related to fair value measurements define fair value and provide a consistent framework for measuring fair value under the authoritative literature. A fair value hierarchy was established, which prioritizes the inputs used in measuring fair value into three broad levels.

Level 1 – Quoted prices in active markets for identical assets or liabilities;

Level 2 – Observable market-based inputs or unobservable inputs that are corroborated by market data; and

Level 3 – Significant unobservable inputs that are not corroborated by market data. Generally, these fair value measures are model-based valuation techniques such as discounted cash flows, and are based on the best information available, including our own data.

The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of September 30, 2023 and December 31, 2022.


	September 30, 2023
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Certificates of Deposit	$	—	$	25,527	$	—	$	25,527
Exchange Trade Mutual Funds	$	35,991	$	—	$	—	$	35,991
Treasury Bonds	$	10,261	$	—	$	—	$	10,261

Other	$	1	$	—	$	—	$	1
Financial Liabilities
Contingent Consideration	$	—	$	—	$	6	$	6

	December 31, 2022
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Certificates of Deposit	$	—	$	25,148	$	—	$	25,148
Exchange Trade Mutual Funds	$	18,939	$	—	$	—	$	18,939
Treasury Bonds	$	65,040	$	—	$	—	$	65,040

Other	$	172	$	—	$	—	$	172
Financial Liabilities
Contingent Consideration	$	—	$	—	$	2,980	$	2,980

The Company's Level 1 assets consist of short-term, liquid investments with original maturity of three months or less at inception and other short-term investments which are comprised of exchange traded mutual funds and marketable securities with a maturity date greater than 3 months.

The Company's Level 2 assets pertain to certain asset-backed securities, collateralized by non-mortgage-related consumer debt, or certificates of deposit. These securities are predominately priced by third parties, either by a pricing vendor or dealer with significant inputs observable in active markets.

The Company's Level 3 instruments consist of contingent consideration. The fair value of the contingent consideration liability assumed in business combinations is recorded as part of the purchase price consideration of the acquisition and is determined using a discounted cash flow model or probability simulation model. The significant inputs of such models are not always observable in the market, such as forecasted annual revenues, expected volatility and discount rates. The adjustments in the fair value of the contingent consideration payments included an income adjustment of $0 and $23,010 for the three months ended September 30, 2023 and September 30, 2022, respectively, and $2,974 and $25,450 for the nine months ended September 30, 2023 and September 30, 2022, respectively, which are recorded in other (income) expenses on the condensed consolidated statements of operations.

The following table summarizes the change in fair value of Level 3 instruments in 2023:


	Total
Balance at January 1, 2023	$	2,980

Change in fair value of contingent consideration	(2,974)
Balance at September 30, 2023	$	6

The recurring Level 3 fair value measurements of contingent consideration liabilities associated with commercial sales milestones include the following significant unobservable inputs as of September 30, 2023 and December 31, 2022:


	September 30, 2023		December 31, 2022
Valuation techniques	Discounted cash flow, Monte Carlo
Present value discount rate(1)	15.5	%	16.6	%
Volatility factor	38.1	%	48.0	%
Expected years	0.6 years		1.4 years

(1) The present value discount rate includes estimated risk premium.

The estimated fair value reflects assumptions made by management as of September 30, 2023; however, the actual amount ultimately paid could be higher or lower than the fair value of the remaining contingent consideration.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

EMPLOYEE BENEFIT PLAN - Narrative (Details)	9 Months Ended
EMPLOYEE BENEFIT PLAN - Narrative (Details)	Sep. 30, 2023
Business Acquisition
Employer contribution as a percentage of employees' salary (as a percent)	4.00%
MD Orthopaedics
Business Acquisition
Employer contribution as a percentage of employees' salary (as a percent)	3.00%

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	9 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	Sep. 30, 2023
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of OrthoPediatrics Corp. and its wholly-owned subsidiaries (collectively, the “Company,” “we,” “our” or “us”). All intercompany balances and transactions have been eliminated. Unaudited Interim Condensed Consolidated Financial Statements We have prepared the accompanying condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying condensed consolidated financial statements are unaudited and should be read in conjunction with the annual consolidated financial statements as of and for the year ended December 31, 2022 and related notes thereto contained in our Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC") on March 1, 2023. The financial data and other financial information disclosed in the notes to the accompanying condensed consolidated financial statements are also unaudited. As such, certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to applicable rules and regulations thereunder. The unaudited condensed consolidated financial statements have been prepared on the same basis as the audited consolidated financial statements as of and for the year ended December 31, 2022 and, in management’s opinion, include all adjustments, consisting of only normal recurring adjustments, necessary for the fair presentation of the financial statements for the interim periods. The results of operations for the three and nine months ended September 30, 2023 are not necessarily indicative of the results to be expected for the full fiscal year or for any other period. The accompanying condensed consolidated financial statements have been prepared assuming our Company will continue as a going concern. We have experienced recurring losses from operations since our inception and had an accumulated deficit of $191,051 and $176,768 as of September 30, 2023 and December 31, 2022, respectively. Management continues to monitor cash flows and liquidity on a regular basis. We believe that our cash balance, including short-term investments, at September 30, 2023 and expected cash flows from operations for the next twelve months subsequent to the issuance of the accompanying condensed consolidated financial statements, are sufficient to enable us to maintain current and essential planned operations for more than the next twelve months. Use of Estimates Preparation of our condensed consolidated financial statements requires the use of estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, as of the date of the condensed consolidated financial statements. By their nature, these judgments are subject to an inherent degree of uncertainty. We use historical experience and other assumptions as the basis for our judgments and estimates. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in our consolidated financial statements. Significant Accounting Policies There have been no changes in the Company's significant accounting polices as disclosed in Note 2 to the audited consolidated financial statements included in the 2022 Annual Report on Form 10-K, except as disclosed below. Financial Instruments and Concentration of Credit Risk Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds. Recent Accounting Pronouncements In June 2016, the FASB issued ASU No. 2016-13 "Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments". The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financials assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. This applies to the Company when trade receivables are recorded. At that point in time, they become subject to the new credit loss model and estimates of expected credit losses on trade receivables over their contractual life will be required to be recorded at inception. Additionally, to the extent that any of the securities investments classified as available-for-sale are in an unrealized loss position, the Company will also be required record an estimate, if any, of those losses driven by credit losses. The Company adopted ASU 2016-16 effective January 1, 2023. The adoption is on a prospective basis and did not have a material impact to the result of operations. In October 2021, the FASB issued ASU No. 2021-08 "Business Combinations (Topic 805)-Accounting for Contract Assets and Contract Liabilities from Contracts with Customers". The amendments in this ASU address diversity and inconsistency related to the recognition and measurement of contract assets and contract liabilities acquired in a business combination. The amendments in this ASU require that an acquirer recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Topic 606, Revenue from Contracts with Customers. For public business entities, the amendments in this ASU are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. For all other entities, the amendments are effective for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years. The amendments in this ASU should be applied prospectively to business combinations occurring on or after the effective date of the amendments. Early adoption of the amendments is permitted, including adoption in an interim period. An entity that early adopts in an interim period should apply the amendments (1) retrospectively to all business combinations for which the acquisition date occurs on or after the beginning of the fiscal year that includes the interim period of early application and (2) prospectively to all business combinations that occur on or after the date of initial application. The Company adopted ASU 2021-08 effective January 1, 2023 prospectively, resulting in no material impacts to the condensed consolidated financial statements. In October 2023, the FASB issued ASU No. 2023-06 "Disclosure Improvements - Codification Amendments in Response to SEC's Disclosure Update and Simplification Initiative". This amendment modifies the disclosure or presentation requirements of a variety of Topics in the Codification. Certain of the amendments represent clarifications to or technical corrections of the current requirements. For entities subject to the SEC's existing disclosure requirements and entities required to file or furnish financial statements with or to the SEC in preparation for the sale of or for purposes of issuing securities that are not subject to contractual restrictions on transfer, the effective date for each amendment will be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. For all other entities, the amendments will be effective two years later. Amendments in this Update should be applied prospectively. The Company continues to analyze this ASU. The update is specific to disclosures and, therefore, is not expected to have a material impact to the condensed consolidated financial statements.

GOODWILL AND INTANGIBLE ASSETS - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Business Acquisition
Other intangible assets	$ 15,008		$ 15,008		$ 14,921
Trademark impairment	985	$ 3,609	985	$ 3,609
Trademarks
Business Acquisition
Other intangible assets	$ 15,008		15,008		$ 14,921
Trademarks \| ApiFix Ltd
Business Acquisition
Trademark impairment		$ 3,609	$ 985	$ 3,609

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Medtech	ApiFix Ltd	MD Ortho	Rhino	Common Stock	Common Stock Medtech	Common Stock ApiFix Ltd	Common Stock MD Ortho	Common Stock Rhino	Additional Paid-in Capital	Additional Paid-in Capital Medtech	Additional Paid-in Capital ApiFix Ltd	Additional Paid-in Capital MD Ortho	Additional Paid-in Capital Rhino	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Beginning balance at Dec. 31, 2021	$ 225,369					$ 5					$ 394,899					$ (178,026)	$ 8,491
Beginning balance (in shares) at Dec. 31, 2021						19,677,214
Increase (Decrease) in Stockholders' Equity
Net (loss) income	(9,100)															(9,100)
Other comprehensive loss	(2,751)																(2,751)
Restricted stock	1,526										1,526
Restricted stock (in shares)						144,084
Ending balance at Mar. 31, 2022	215,044					$ 5					396,425					(187,126)	5,740
Ending balance (in shares) at Mar. 31, 2022						19,821,298
Beginning balance at Dec. 31, 2021	225,369					$ 5					394,899					(178,026)	8,491
Beginning balance (in shares) at Dec. 31, 2021						19,677,214
Increase (Decrease) in Stockholders' Equity
Net (loss) income	9,106
Other comprehensive loss	(15,586)
Ending balance at Sep. 30, 2022	383,330					$ 6					559,339					(168,920)	(7,095)
Ending balance (in shares) at Sep. 30, 2022						22,896,031
Beginning balance at Mar. 31, 2022	215,044					$ 5					396,425					(187,126)	5,740
Beginning balance (in shares) at Mar. 31, 2022						19,821,298
Increase (Decrease) in Stockholders' Equity
Net (loss) income	(333)															(333)
Other comprehensive loss	(9,424)																(9,424)
Restricted stock	1,770										1,770
Restricted stock (in shares)						57,180
Consideration for MedTech and MD Ortho acquisition				$ 9,707										$ 9,707
Consideration for MedTech and MD Ortho acquisition (in shares)									173,241
Stock portion of ApiFix anniversary installment			$ 10,410										$ 10,410
Stock portion of ApiFix anniversary installment (in shares)								185,811
Stock option exercise	42										42
Stock option exercise (in shares)						1,340
Ending balance at Jun. 30, 2022	227,216					$ 5					418,354					(187,459)	(3,684)
Ending balance (in shares) at Jun. 30, 2022						20,238,870
Increase (Decrease) in Stockholders' Equity
Net (loss) income	18,539															18,539
Other comprehensive loss	(3,411)																(3,411)
Restricted stock	1,682										1,682
Restricted stock (in shares)						5,342
Issuance of common stock, net of issuance cost	139,283					$ 1					139,282
Issuance of common stock, net of issuance cost (in shares)						2,616,250
Stock option exercise	21										21
Stock option exercise (in shares)						670
Issuance of unregistered shares (in shares)						34,899
Ending balance at Sep. 30, 2022	383,330					$ 6					559,339					(168,920)	(7,095)
Ending balance (in shares) at Sep. 30, 2022						22,896,031
Beginning balance at Dec. 31, 2022	$ 378,648					$ 6					560,810					(176,768)	(5,400)
Beginning balance (in shares) at Dec. 31, 2022	22,877,962					22,877,962
Increase (Decrease) in Stockholders' Equity
Net (loss) income	$ (6,806)															(6,806)
Other comprehensive loss	(646)																(646)
Restricted stock	1,959										1,959
Restricted stock (in shares)						264,156
Ending balance at Mar. 31, 2023	373,155					$ 6					562,769					(183,574)	(6,046)
Ending balance (in shares) at Mar. 31, 2023						23,142,118
Beginning balance at Dec. 31, 2022	$ 378,648					$ 6					560,810					(176,768)	(5,400)
Beginning balance (in shares) at Dec. 31, 2022	22,877,962					22,877,962
Increase (Decrease) in Stockholders' Equity
Net (loss) income	$ (14,283)
Other comprehensive loss	(6,766)
Ending balance at Sep. 30, 2023	$ 374,329					$ 6					577,540					(191,051)	(12,166)
Ending balance (in shares) at Sep. 30, 2023	23,350,976					23,350,976
Beginning balance at Mar. 31, 2023	$ 373,155					$ 6					562,769					(183,574)	(6,046)
Beginning balance (in shares) at Mar. 31, 2023						23,142,118
Increase (Decrease) in Stockholders' Equity
Net (loss) income	(2,886)															(2,886)
Other comprehensive loss	(1,865)																(1,865)
Restricted stock	3,456										3,456
Restricted stock (in shares)						14,591
Consideration for MedTech and MD Ortho acquisition		$ 2,274										$ 2,274
Consideration for MedTech and MD Ortho acquisition (in shares)							43,751
Stock portion of ApiFix anniversary installment			$ 6,178										$ 6,178
Stock portion of ApiFix anniversary installment (in shares)								140,003
Ending balance at Jun. 30, 2023	380,312					$ 6					574,677					(186,460)	(7,911)
Ending balance (in shares) at Jun. 30, 2023						23,340,463
Increase (Decrease) in Stockholders' Equity
Net (loss) income	(4,591)															(4,591)
Other comprehensive loss	(4,255)																(4,255)
Restricted stock	2,364										2,364
Restricted stock (in shares)						(1,290)
Consideration for MedTech and MD Ortho acquisition					$ 478										$ 478
Consideration for MedTech and MD Ortho acquisition (in shares)										11,133
Stock option exercise	21										21
Stock option exercise (in shares)						670
Ending balance at Sep. 30, 2023	$ 374,329					$ 6					$ 577,540					$ (191,051)	$ (12,166)
Ending balance (in shares) at Sep. 30, 2023	23,350,976					23,350,976

RELATED PARTY TRANSACTIONS (Details) $ in Thousands	3 Months Ended		9 Months Ended
RELATED PARTY TRANSACTIONS (Details) $ in Thousands	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($) supplier	Sep. 30, 2022 USD ($)
Structure Medical, LLC \| Supplier
Related Party Transaction
Payments to related party \| $	$ 234	$ 218	$ 628	$ 768
Affiliated Entity
Related Party Transaction
Number of related party suppliers \| supplier			1

GOODWILL AND INTANGIBLE ASSETS

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the nine months ended September 30, 2023 were as follows:


	Total



Goodwill at January 1, 2023	$	86,821
Pega Medical measurement period adjustment	(1,936)
Foreign currency translation impact	(3,991)
Goodwill at September 30, 2023	$	80,894

Intangible Assets

As of September 30, 2023, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	11.5 years	$	44,044	$	(9,830)	$	34,214
Intellectual Property & Capitalized Software	9.4 years	16,027		(2,154)		13,873
Customer Relationships & Other	12.6 years	18,632		(2,884)		15,748
License Agreements	3.9 years	10,483		(4,805)		5,678
Total amortizable assets		$	89,186	$	(19,673)	$	69,513

As of December 31, 2022, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	12.2 years	$	46,005	$	(7,953)	$	38,052
Intellectual Property & Capitalized Software	9.8 years	5,859		(1,382)		4,477
Customer Relationships & Other	13.4 years	17,262		(1,805)		15,457
License Agreements	4.5 years	10,697		(3,703)		6,994
Total amortizable assets		$	79,823	$	(14,843)	$	64,980

Licenses are tied to product launches and do not begin amortizing until the product is launched to the market.

Trademarks are non-amortizing intangible assets which were $15,008 and $14,921 as of September 30, 2023 and December 31, 2022, respectively. Trademarks are recorded in Other intangible assets on the condensed consolidated balance sheets. The change in balance during the nine months ended September 30, 2023 was the result of the measurement period adjustments associated with Pega Medical, the trademarks recorded as a result of the MedTech and Rhino acquisitions, foreign currency translation adjustments and the impairment of the ApiFix trademark.

During 2022, management determined that a triggering event occurred, indicating that it was more likely than not the fair value of the ApiFix trademark asset was less than the carrying value. As such, the

Company completed a quantitative analysis whereby we determined the fair value of the ApiFix trademark asset was below the carrying value. The primary reason for the impairment is the lower forecasted revenue of our ApiFix product than previously expected. We recorded a $3,609 partial impairment charge during the three and nine months ended September 30, 2022 to reduce the carrying amount of the intangible asset to its estimated fair value. During the three and nine months ended September 30, 2023, we determined that a triggering event had occurred, indicating it was more likely than not the fair value of the ApiFix trademark was less than the associated carrying value. Subsequently, the Company completed a quantitative analysis and concluded that the fair value was in fact less than the carrying value and a partial impairment loss of $985 was recorded in the period ended September 30, 2023.

DEBT AND CREDIT ARRANGEMENTS

9 Months Ended

Sep. 30, 2023

Debt Disclosure [Abstract]

DEBT AND CREDIT ARRANGEMENTS

Long-term debt consisted of the following:


	September 30, 2023		December 31, 2022



Mortgage payable to affiliate	$	800	$	907

Less: current maturities	150		144
Long-term debt with affiliate, net of current maturities	$	650	$	763

The Company is party to a Fourth Amended and Restated Loan and Security Agreement with Squadron Capital LLC (“Squadron”), as amended from time to time (as amended, the “Loan Agreement”), which provides the Company with a $50,000 revolving credit facility. As of September 30, 2023 and December 31, 2022, there was no outstanding indebtedness under the Loan Agreement.

Borrowings under the credit facility accrue interest at an annual rate equal to the greater of (a) six month SOFR plus 8.69% and (b) 10.0%, and the Company is permitted to make interest only payments on amounts outstanding. Prior to December 31, 2021, the interest rate on the facility had been equal to the greater of (a) three month LIBOR plus 8.61% and (b) 10.0%. The Company pays Squadron an unused commitment fee in an amount equal to the per annum rate of 0.50% (computed on the basis of a year of 360 days and the actual number of days elapsed) times the daily unused portion of the revolving credit commitment. The unused commitment fee is payable quarterly in arrears.

Borrowings under the revolving credit facility are made under a Second Amended and Restated Revolving Note, dated June 13, 2022 (the “Amended Revolving Note”), payable, jointly and severally, by the Company and each of its subsidiaries party thereto. The Amended Revolving Note matures at the earlier of: (i) the date on which any person or persons acquire (x) capital stock of the Company possessing the voting power to elect a majority of the Company’s Board of Directors (whether by merger, consolidation, reorganization, combination, sale or transfer), or (y) all or substantially all of the Company’s assets, determined on a consolidated basis; and (ii) January 1, 2024.

Borrowings under the Loan Agreement are secured by substantially all of the Company's assets and are unconditionally guaranteed by each of its subsidiaries with the exception of Vilex. There are no traditional financial covenants associated with the Loan Agreement. However, there are negative covenants that prohibit us from, among other things, transferring any of our material assets, merging with or acquiring another entity, entering into a transaction that would result in a change of control, incurring additional indebtedness, creating any lien on our property, making investments in third parties and redeeming stock or paying dividends, in each case subject to certain exceptions.

In connection with the purchase of our office and warehouse space in Warsaw, Indiana in August 2013, we entered into a mortgage note payable to Tawani Enterprises Inc. ("Tawani"), an affiliate of Squadron. Pursuant to the terms of the mortgage note, we pay Tawani monthly principal and interest installments of $16 with interest compounded at 5% until maturity in 2028, at which time a final payment of remaining principal and interest is due. The mortgage is secured by the related real estate and building. At September 30, 2023, the mortgage balance was $800 of which current principal of $150 was included in the current portion of long-term debt. As of December 31, 2022, the mortgage balance was $907 of which current principal due of $144 was included in the current portion of long-term debt.

The aggregate interest expense relating to the notes payable to Squadron and the mortgage note payable to Tawani was $10 and $12 for the three months ended September 30, 2023 and 2022, respectively, and $32 and $512 for the nine months ended September 30, 2023 and 2022, respectively.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Paragraph 1E
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1E

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,412	$ 1,056
Common stock, par value (in dollars per share)	$ 0.00025	$ 0.00025
Common stock, shares authorized (in shares)	50,000,000	50,000,000
Common stock, shares issued (in shares)	23,350,976	22,877,962
Common stock, shares outstanding (in shares)	23,350,976	22,877,962

BUSINESS SEGMENT (Tables)

9 Months Ended

Sep. 30, 2023

Segment Reporting [Abstract]

Schedule of Product Sales by Geographic Location

Product sales by source were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2023		2022		2023		2022
U.S.	$	29,360	$	26,539	$	82,748	$	69,687
International	10,612		8,411		28,371		21,608
Total	$	39,972	$	34,950	$	111,119	$	91,295

Schedule of Product Sales by Category


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2023		2022		2023		2022
Trauma and deformity	$	28,806	$	23,892	$	79,715	$	62,976
Scoliosis	10,304		9,979		28,270		25,383
Sports medicine/other	862		1,079		3,134		2,936
Total	$	39,972	$	34,950	$	111,119	$	91,295

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Discounting the Future Payments (Details) - Medtech Concepts LLC $ in Thousands	May 01, 2023 USD ($)
Business Acquisition
Cash consideration	$ 3,000
Issuance of common stock	2,274
Anniversary payments	5,500
Transaction costs	97
Total consideration transferred	10,871
Present Value
Business Acquisition
Cash consideration	3,000
Issuance of common stock	2,274
Anniversary payments	4,672
Transaction costs	97
Total consideration transferred	$ 10,043

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
OPERATING ACTIVITIES
Net (loss) income	$ (14,283)	$ 9,106
Adjustments to reconcile net loss to net cash used in operating activities:
Trademark impairment	985	3,609
Depreciation and amortization	12,198	9,579
Stock-based compensation	7,779	4,978
Fair value adjustment of contingent consideration	(2,974)	(25,450)
Accretion of acquisition installment payable	1,092	1,926
Deferred income taxes	(899)	(4,804)
Changes in certain operating assets and liabilities:
Accounts receivable - trade	(12,878)	(5,567)
Inventories	(22,198)	(14,812)
Prepaid expenses and other current assets	(196)	696
Accounts payable - trade	11,492	(389)
Accrued expenses and other liabilities	3,288	1,800
Other	(2,909)	903
Net cash used in operating activities	(19,503)	(18,425)
INVESTING ACTIVITIES
Sale of short-term marketable securities	89,040	45,529
Purchase of short-term marketable securities	(48,600)	(85,029)
Purchases of property and equipment	(13,042)	(10,554)
Net cash provided by (used in) investing activities	23,755	(90,144)
FINANCING ACTIVITIES
Proceeds from issuance of debt with affiliate	0	31,000
Installment payment for ApiFix	(2,000)	(3,234)
Payments on debt with affiliate	0	(31,000)
Proceeds from issuance of common stock, net of issuance costs	0	139,282
Proceeds from exercise of stock options	21	63
Payments on mortgage notes	(107)	(102)
Net cash (used in) provided by financing activities	(2,086)	136,009
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(396)	426
NET INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH	1,770	27,866
Cash, cash equivalents and restricted cash, beginning of year	10,462	9,006
Cash, cash equivalents and restricted cash, end of period	12,232	36,872
SUPPLEMENTAL DISCLOSURES
Cash paid for interest	32	512
Transfer of instruments between property and equipment and inventory	431	(193)
Right-of-use assets obtained in exchange for lease liabilities	367	116
MD Ortho
INVESTING ACTIVITIES
Business acquisitions	0	(8,360)
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	0	9,707
Pega Medical
INVESTING ACTIVITIES
Business acquisitions	0	(31,730)
Rhino
INVESTING ACTIVITIES
Asset Acquisition	(546)	0
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	478	0
Medtech
INVESTING ACTIVITIES
Asset Acquisition	(3,097)	0
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	2,274	0
ApiFix Ltd
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	$ 6,178	$ 10,410

NET LOSS PER SHARE

9 Months Ended

Sep. 30, 2023

Earnings Per Share [Abstract]

NET LOSS PER SHARE

The following is a reconciliation of basic and diluted net loss per share:


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2023		2022		2023		2022
Net (loss) income	$	(4,591)	$	18,539	$	(14,283)	$	9,106
Less: Earnings allocated to participating securities	—		353		—		174
Net income available to common shareholders	$	(4,591)	$	18,186	$	(14,283)	$	8,932

Denominator for basic and diluted net (loss) income per share:
Weighted average shares outstanding for basic	22,762,823		21,150,219		22,646,087		20,703,883
Weighted average shares outstanding for diluted	22,762,823		21,295,323		22,646,087		20,958,503

(Loss) earnings per share:
Basic	$	(0.20)	$	0.88	$	(0.63)	$	0.44
Diluted	$	(0.20)	$	0.87	$	(0.63)	$	0.43

Our basic and diluted net loss per share is computed using the two-class method. For purposes of our equity disclosures and calculation of weighted average shares for basic earnings per share calculations,

the two-class method is an earnings allocation that determines net income per share for each class of common stock and participating securities according to their participation rights in dividends and undistributed earnings or losses. Non-vested restricted stock that includes non-forfeitable rights to dividends are considered participating securities. For the periods presented with a net loss the weighted average shares outstanding remains consistent between basic and diluted as the effect would have been anti-dilutive. The Company had 578,872 and zero contingently issuable and convertible equity shares excluded from the calculation of diluted net (loss) earnings per share as of September 30, 2023 and 2022, respectively, because their effect would have been anti-dilutive. The contingently issuable shares in the paragraph above do not include shares of our common stock associated with our obligation to issue a variable number of our common shares as a result of our recent acquisitions of Pega Medical, ApiFix or MedTech. See Note 3 for additional information regarding our commitment to issue future equity under each of the Pega Medical and MedTech acquisitions. Additionally, as a component of the acquisition of ApiFix, the Company is obligated to make anniversary installment payments on the second, third and fourth anniversary of the acquisition date. Also on the fourth anniversary, the Company is potentially subject to a system sales payment. These payments included a minimum cash component with the remaining settled in common stock. See Note 3 under Item 8 in the Company's Annual Report on Form 10-K for additional information regarding this business combination.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Accumulated deficit	$ (191,051)	$ (176,768)

- Definition

Amount of accumulated undistributed earnings (deficit).

+ References + Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Jul. 01, 2022	Apr. 01, 2022	Sep. 30, 2023	Dec. 31, 2022
Liabilities
Goodwill			$ 80,894	$ 86,821
Pega Medical
Business Acquisition
Fair value of estimated total acquisition consideration	$ 32,042
Assets
Cash	312
Accounts receivable - trade	2,100
Inventories	4,875
Prepaid expenses and other current assets	509
Property and equipment	600
Amortizable intangible assets	12,286
Other intangible assets	3,878
Total assets	24,560
Liabilities
Accounts payable-trade	1,682
Other current liabilities	1,393
Deferred tax liability	4,035
Total liabilities	7,110
Less: total net assets	17,450
Goodwill	$ 14,592
MD Orthopaedics
Business Acquisition
Fair value of estimated total acquisition consideration		$ 18,487
Assets
Cash		420
Accounts receivable - trade		1,062
Inventories		1,126
Prepaid expenses and other current assets		100
Property and equipment		2,444
Amortizable intangible assets		9,120
Other intangible assets		2,410
Total assets		16,682
Liabilities
Accounts payable and accrued liabilities		45
Other current liabilities		586
Deferred tax liability		3,014
Total liabilities		3,645
Less: total net assets		13,037
Goodwill		$ 5,450

COVER - shares	9 Months Ended
COVER - shares	Sep. 30, 2023	Oct. 27, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-38242
Entity Registrant Name	OrthoPediatrics Corp
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	26-1761833
Entity Address, Address Line One	2850 Frontier Drive
Entity Address, City or Town	Warsaw
Entity Address, State or Province	IN
Entity Address, Postal Zip Code	46582
City Area Code	574
Local Phone Number	268-6379
Title of Each Class	Common Stock, $0.00025 par value per share
Trading Symbol(s)	KIDS
Name of each exchange on which registered	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		23,353,384
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Central Index Key	0001425450
Current Fiscal Year End Date	--12-31

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	9 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation and Unaudited Interim Condensed Consolidated Financial Statements	Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of OrthoPediatrics Corp. and its wholly-owned subsidiaries (collectively, the “Company,” “we,” “our” or “us”). All intercompany balances and transactions have been eliminated. Unaudited Interim Condensed Consolidated Financial Statements We have prepared the accompanying condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying condensed consolidated financial statements are unaudited and should be read in conjunction with the annual consolidated financial statements as of and for the year ended December 31, 2022 and related notes thereto contained in our Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC") on March 1, 2023. The financial data and other financial information disclosed in the notes to the accompanying condensed consolidated financial statements are also unaudited. As such, certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to applicable rules and regulations thereunder. The unaudited condensed consolidated financial statements have been prepared on the same basis as the audited consolidated financial statements as of and for the year ended December 31, 2022 and, in management’s opinion, include all adjustments, consisting of only normal recurring adjustments, necessary for the fair presentation of the financial statements for the interim periods. The results of operations for the three and nine months ended September 30, 2023 are not necessarily indicative of the results to be expected for the full fiscal year or for any other period. The accompanying condensed consolidated financial statements have been prepared assuming our Company will continue as a going concern.
Use of Estimates	Use of EstimatesPreparation of our condensed consolidated financial statements requires the use of estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, as of the date of the condensed consolidated financial statements. By their nature, these judgments are subject to an inherent degree of uncertainty. We use historical experience and other assumptions as the basis for our judgments and estimates. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in our consolidated financial statements.
Financial Instruments	Financial Instruments and Concentration of Credit Risk Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.
Concentration of Credit Risk	Financial Instruments and Concentration of Credit Risk Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In June 2016, the FASB issued ASU No. 2016-13 "Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments". The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financials assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. This applies to the Company when trade receivables are recorded. At that point in time, they become subject to the new credit loss model and estimates of expected credit losses on trade receivables over their contractual life will be required to be recorded at inception. Additionally, to the extent that any of the securities investments classified as available-for-sale are in an unrealized loss position, the Company will also be required record an estimate, if any, of those losses driven by credit losses. The Company adopted ASU 2016-16 effective January 1, 2023. The adoption is on a prospective basis and did not have a material impact to the result of operations. In October 2021, the FASB issued ASU No. 2021-08 "Business Combinations (Topic 805)-Accounting for Contract Assets and Contract Liabilities from Contracts with Customers". The amendments in this ASU address diversity and inconsistency related to the recognition and measurement of contract assets and contract liabilities acquired in a business combination. The amendments in this ASU require that an acquirer recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Topic 606, Revenue from Contracts with Customers. For public business entities, the amendments in this ASU are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. For all other entities, the amendments are effective for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years. The amendments in this ASU should be applied prospectively to business combinations occurring on or after the effective date of the amendments. Early adoption of the amendments is permitted, including adoption in an interim period. An entity that early adopts in an interim period should apply the amendments (1) retrospectively to all business combinations for which the acquisition date occurs on or after the beginning of the fiscal year that includes the interim period of early application and (2) prospectively to all business combinations that occur on or after the date of initial application. The Company adopted ASU 2021-08 effective January 1, 2023 prospectively, resulting in no material impacts to the condensed consolidated financial statements. In October 2023, the FASB issued ASU No. 2023-06 "Disclosure Improvements - Codification Amendments in Response to SEC's Disclosure Update and Simplification Initiative". This amendment modifies the disclosure or presentation requirements of a variety of Topics in the Codification. Certain of the amendments represent clarifications to or technical corrections of the current requirements. For entities subject to the SEC's existing disclosure requirements and entities required to file or furnish financial statements with or to the SEC in preparation for the sale of or for purposes of issuing securities that are not subject to contractual restrictions on transfer, the effective date for each amendment will be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. For all other entities, the amendments will be effective two years later. Amendments in this Update should be applied prospectively. The Company continues to analyze this ASU. The update is specific to disclosures and, therefore, is not expected to have a material impact to the condensed consolidated financial statements.

GOODWILL AND INTANGIBLE ASSETS - Amortizable Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Net [Abstract]
Gross Intangible Assets	$ 89,186	$ 79,823
Accumulated Amortization	(19,673)	(14,843)
Net Intangible Assets	$ 69,513	$ 64,980
Patents
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	11 years 6 months	12 years 2 months 12 days
Gross Intangible Assets	$ 44,044	$ 46,005
Accumulated Amortization	(9,830)	(7,953)
Net Intangible Assets	$ 34,214	$ 38,052
Intellectual Property & Capitalized Software
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	9 years 4 months 24 days	9 years 9 months 18 days
Gross Intangible Assets	$ 16,027	$ 5,859
Accumulated Amortization	(2,154)	(1,382)
Net Intangible Assets	$ 13,873	$ 4,477
Customer Relationships & Other
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	12 years 7 months 6 days	13 years 4 months 24 days
Gross Intangible Assets	$ 18,632	$ 17,262
Accumulated Amortization	(2,884)	(1,805)
Net Intangible Assets	$ 15,748	$ 15,457
License Agreements
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	3 years 10 months 24 days	4 years 6 months
Gross Intangible Assets	$ 10,483	$ 10,697
Accumulated Amortization	(4,805)	(3,703)
Net Intangible Assets	$ 5,678	$ 6,994

BUSINESS SEGMENT

9 Months Ended

Sep. 30, 2023

Segment Reporting [Abstract]

BUSINESS SEGMENT

Operating segments are defined as components of an enterprise for which separate financial information is available that is evaluated regularly by the chief operating decision maker, or decision making group, in deciding how to allocate resources and in assessing performance. We have one operating and reportable segment, which designs, develops and markets anatomically appropriate implants and devices for children with orthopedic problems. Our chief operating decision-maker, our Chief Executive Officer, reviews financial information presented on a consolidated basis for purposes of making operating decisions and assessing financial performance, accompanied by disaggregated revenue information by product category. We determined that disaggregating revenue into these categories achieves the disclosure objective of illustrating the differences in the nature, timing and uncertainty of our revenue streams. We do not assess the performance of our individual product categories on measures of profit or loss, or other asset-based metrics. Therefore, the information below is presented only for revenue by category and geography.

Product sales attributed to a country or region includes product sales to hospitals, physicians and distributors and is based on the final destination where the products are sold. No customers accounted for more than 10% of total product sales for the three and nine months ended September 30, 2023 or 2022. No customer accounted for more than 10% of consolidated accounts receivable as of September 30, 2023 and December 31, 2022.

Product sales by source were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2023		2022		2023		2022
U.S.	$	29,360	$	26,539	$	82,748	$	69,687
International	10,612		8,411		28,371		21,608
Total	$	39,972	$	34,950	$	111,119	$	91,295


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2023		2022		2023		2022
Trauma and deformity	$	28,806	$	23,892	$	79,715	$	62,976
Scoliosis	10,304		9,979		28,270		25,383
Sports medicine/other	862		1,079		3,134		2,936
Total	$	39,972	$	34,950	$	111,119	$	91,295

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

EMPLOYEE BENEFIT PLAN	9 Months Ended
EMPLOYEE BENEFIT PLAN	Sep. 30, 2023
Retirement Benefits [Abstract]
EMPLOYEE BENEFIT PLAN	EMPLOYEE BENEFIT PLANWe have a defined-contribution plan, OrthoPediatrics 401(k) Retirement Plan (the “401(k) Plan”), which includes a cash or deferral (Section 401(k)) arrangement. The 401(k) Plan covers those employees who meet certain eligibility requirements and elect to participate. Employee contributions are limited to the annual amounts permitted under the Internal Revenue Code. The 401(k) Plan allows us to make a discretionary matching contribution. Discretionary matching contributions are determined annually by management. We have elected to match our employees' 401(k) contributions up to 4% of employees' salary. Additionally, employees of MD Ortho receive contribution matches up to 3% of their salary.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Narratives (Details) - USD ($) $ / shares in Units, $ in Thousands					9 Months Ended
	Jul. 01, 2023	May 01, 2023	Jul. 01, 2022	Apr. 01, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Business Acquisition
Common stock, par value (in dollars per share)					$ 0.00025		$ 0.00025
Medtech Concepts LLC
Business Acquisition
Total consideration transferred		$ 15,274
Cash consideration		3,000
Asset acquisition		97
Issuance of common stock		$ 2,274
Business combination, consideration paid In cash (as a percent)		50.00%
Stock based compensation capitalized		$ 4,500
Stock based compensation service period		4 years
Total consideration transferred		$ 10,871
Rhino Pediatric Orthopedic Designs, Inc.
Business Acquisition
Total consideration transferred	$ 1,024
Cash consideration	546
Asset acquisition	46
Issuance of common stock	$ 478
Present Value \| Medtech Concepts LLC
Business Acquisition
Cash consideration		3,000
Asset acquisition		97
Issuance of common stock		2,274
Total consideration transferred		$ 10,043
Intellectual Property & Capitalized Software \| Medtech Concepts LLC
Business Acquisition
Finite-lived intangible assets acquired			$ 9,523
Intangible asset, useful life (in years)			10 years
Trademarks / Names \| Medtech Concepts LLC
Business Acquisition
Indefinite-lived intangible assets acquired			$ 520
Common Stock \| Medtech Concepts LLC
Business Acquisition
Asset acquisition, consideration (in shares)		43,751
Common stock, par value (in dollars per share)		$ 0.00025
Asset Acquisition, acquisition price (per share)		$ 51.98
Aggregate value of equity consideration		$ 2,500
Business combination, consideration of unregistered common stock (as a percent)		50.00%
Common Stock \| Rhino Pediatric Orthopedic Designs, Inc.
Business Acquisition
Asset acquisition, consideration (in shares)	11,133
Common stock, par value (in dollars per share)	$ 0.00025
Asset Acquisition, acquisition price (per share)	$ 42.91
Pega Medical
Business Acquisition
Consideration transferred			32,042
Cash paid to acquire			32,042		$ 0	$ 31,730
Contingent consideration			$ 1,052
Contingent consideration liability term (in months)			18 months
Service period (years)			3 years
Contingent repurchase price, per share (in dollars per share)			$ 0.1
Shares subject to repurchase (in shares)					23,266
Amortization of intangible assets					$ 133
Pega Medical \| Restricted Stock Units (RSUs)
Business Acquisition
Issuance of common stock			$ 499
Vesting period (in years)			3 years
Pega Medical \| Trademarks / Names
Business Acquisition
Indefinite-lived intangible assets acquired			$ 3,878
Pega Medical \| Common Stock
Business Acquisition
Common stock, par value (in dollars per share)			$ 0.00025
Consideration for acquisition (in shares)			34,899
Issuance of common stock			$ 1,497
Common stock (in dollars per share)			$ 42.9
MD Orthopaedics
Business Acquisition
Common stock, par value (in dollars per share)				$ 0.00025
Consideration transferred				$ 18,487
Cash paid to acquire				$ 8,781
Consideration for acquisition (in shares)				173,241
Issuance of common stock				$ 9,707
Common stock (in dollars per share)				$ 56.03
MD Orthopaedics \| Trademarks / Names
Business Acquisition
Indefinite-lived intangible assets acquired				$ 2,410

GOODWILL AND INTANGIBLE ASSETS (Tables)

9 Months Ended

Sep. 30, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill

Changes in the carrying amount of goodwill for the nine months ended September 30, 2023 were as follows:


	Total



Goodwill at January 1, 2023	$	86,821
Pega Medical measurement period adjustment	(1,936)
Foreign currency translation impact	(3,991)
Goodwill at September 30, 2023	$	80,894

Schedule of the Balances of Amortizable Intangible Assets

As of September 30, 2023, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	11.5 years	$	44,044	$	(9,830)	$	34,214
Intellectual Property & Capitalized Software	9.4 years	16,027		(2,154)		13,873
Customer Relationships & Other	12.6 years	18,632		(2,884)		15,748
License Agreements	3.9 years	10,483		(4,805)		5,678
Total amortizable assets		$	89,186	$	(19,673)	$	69,513

As of December 31, 2022, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	12.2 years	$	46,005	$	(7,953)	$	38,052
Intellectual Property & Capitalized Software	9.8 years	5,859		(1,382)		4,477
Customer Relationships & Other	13.4 years	17,262		(1,805)		15,457
License Agreements	4.5 years	10,697		(3,703)		6,994
Total amortizable assets		$	79,823	$	(14,843)	$	64,980

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-Publisher FASB
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

FAIR VALUE OF FINANCIAL INSTRUMENTS (Tables)

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of September 30, 2023 and December 31, 2022.


	September 30, 2023
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Certificates of Deposit	$	—	$	25,527	$	—	$	25,527
Exchange Trade Mutual Funds	$	35,991	$	—	$	—	$	35,991
Treasury Bonds	$	10,261	$	—	$	—	$	10,261

Other	$	1	$	—	$	—	$	1
Financial Liabilities
Contingent Consideration	$	—	$	—	$	6	$	6

	December 31, 2022
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Certificates of Deposit	$	—	$	25,148	$	—	$	25,148
Exchange Trade Mutual Funds	$	18,939	$	—	$	—	$	18,939
Treasury Bonds	$	65,040	$	—	$	—	$	65,040

Other	$	172	$	—	$	—	$	172
Financial Liabilities
Contingent Consideration	$	—	$	—	$	2,980	$	2,980

Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

The following table summarizes the change in fair value of Level 3 instruments in 2023:


	Total
Balance at January 1, 2023	$	2,980

Change in fair value of contingent consideration	(2,974)
Balance at September 30, 2023	$	6

Schedule of Fair Value Measurement Inputs and Valuation Techniques


	September 30, 2023		December 31, 2022
Valuation techniques	Discounted cash flow, Monte Carlo
Present value discount rate(1)	15.5	%	16.6	%
Volatility factor	38.1	%	48.0	%
Expected years	0.6 years		1.4 years

(1) The present value discount rate includes estimated risk premium.

STOCKHOLDERS' EQUITY

9 Months Ended

Sep. 30, 2023

Share-Based Payment Arrangement [Abstract]

STOCKHOLDERS' EQUITY

STOCKHOLDERS’ EQUITY

Stock Options

The fair value for options granted at the time of issuance were estimated at the date of grant using a Black-Scholes options pricing model. Significant assumptions included in the option value model include the fair value of our common stock at the grant date, weighted average volatility, risk-free interest rate, dividend yield and the forfeiture rate. There were no stock options granted in any of the periods presented.

Our stock option activity and related information are summarized as follows:


		Weighted-Average		Remaining Contractual Terms
	Options	Exercise Price		(in Years)
Outstanding at January 1, 2023	3,556	$	30.97	0.7
Exercised	(670)	30.97
Forfeited or expired	(2,886)	—
Outstanding at September 30, 2023	—	$	—	—

Options generally included a time-based vesting schedule permitting the options to vest ratably over three years. At December 31, 2022, all options were fully vested.

There was no stock-based compensation expense on stock options for the three and nine months ended September 30, 2023 and 2022, respectively. As of September 30, 2023 all options were either exercised or cancelled.

Restricted Stock

Our restricted stock activity and related information are summarized as follows:


		Weighted-Average		Weighted-Average
	Restricted	Remaining	Restricted	Remaining
	Stock	Contractual Terms	Stock	Contractual Terms
	Awards	(in Years)	Units	(in Years)
Outstanding at January 1, 2023	403,324	1.4	10,080	2.5
Granted	283,585		4,005
Forfeited	(6,128)		(234)
Vested	(115,760)		—
Outstanding at September 30, 2023	565,021	1.8	13,851	1.9

At September 30, 2023, there was $15,857 of unrecognized compensation expense remaining related to our service-based restricted stock awards and restricted stock units. The unrecognized compensation cost is expected to be recognized over a weighted-average period of 1.8 years or earlier upon an elimination of the restriction period as a result of a change in control event.

Stock-based compensation expense on restricted stock amounted to $2,368 and $1,682 for the three months ended September 30, 2023 and 2022, respectively, and $7,779 and $4,978 for the nine months ended September 30, 2023 and 2022, respectively. The increase in the stock compensation for the three and nine months ended September 30, 2023 is primarily due to increase in plan participants as we continue to hire employees to support the continued expansion of our business. Additionally, stock was issued as a component of both the Pega Medical and MedTech acquisitions. A portion of these shares have a service-based restriction, resulting in an increase in stock compensation over the life of the required years of service.

BUSINESS	9 Months Ended
BUSINESS	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS	BUSINESSOrthoPediatrics Corp., a Delaware corporation, is a medical device company committed to designing, developing and marketing anatomically appropriate implants and devices for children with orthopedic conditions, giving pediatric orthopedic surgeons and caregivers the ability to treat children with technologies specifically designed to meet their needs. We sell our specialized products, including PediLoc®, PediPlates®, Cannulated Screws, PediFlexTM nail, PediNailTM, PediLoc® Tibia, ACL Reconstruction System, Locking Cannulated Blade, Locking Proximal Femur, Spica Tables, RESPONSETM Spine, BandLoc Duo®, Pediatric Nailing Platform \| Femur, Devise Rail, Orthex®, The Fassier-Duval Telescopic Intramedullary System®, ApiFix® Mid-C System and Mitchell Ponseti® specialized bracing products to various hospitals and medical facilities throughout the United States and various international markets. We currently use a contract manufacturing model for the manufacturing of implants and related surgical instrumentation. We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis and sports medicine product offering to the pediatric orthopedic market in order to improve the lives of children with orthopedic conditions. We design, develop and commercialize innovative orthopedic implants, instruments and specialized braces to meet the needs of pediatric surgeons or orthotists and their patients, who we believe have been largely neglected by the orthopedic industry. We currently serve three of the largest categories in this market.

NET LOSS PER SHARE - Narrative (Details) - shares	9 Months Ended
NET LOSS PER SHARE - Narrative (Details) - shares	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Antidilutive securities excluded from computation of earnings per share (in shares)	578,872	0

FAIR VALUE OF FINANCIAL INSTRUMENTS - Fair Value Measurements of Contingent Consideration (Details) - Level 3 - Fair Value, Recurring - Discounted cash flow, Monte Carlo	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Expected years	7 months 6 days	1 year 4 months 24 days
Present value discount rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent consideration, measurement input (as a percent)	15.50%	16.60%
Volatility factor
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent consideration, measurement input (as a percent)	38.10%	48.00%

FAIR VALUE OF FINANCIAL INSTRUMENTS - Schedule of Assets and Liabilities Measured at Fair Value (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent Consideration	$ 6	$ 2,980
Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	25,527	25,148
Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	35,991	18,939
Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	10,261	65,040
Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	1	172
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent Consideration	0	0
Level 1 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 1 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	35,991	18,939
Level 1 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	10,261	65,040
Level 1 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	1	172
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent Consideration	0	0
Level 2 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	25,527	25,148
Level 2 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 2 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 2 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent Consideration	6	2,980
Level 3 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 3 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 3 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 3 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	$ 0	$ 0

STOCKHOLDERS' EQUITY - Stock Options (Details) - $ / shares	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Options
Forfeited or expired (in shares)	(2,886)
Weighted-Average Exercise Price
Forfeited or expired, Weighted-Average Exercise Price (in dollars per share)	$ 0
Stock Option
Options
Outstanding at period start (in shares)	3,556
Exercised (in shares)	(670)
Outstanding at period end (in shares)	0	3,556
Weighted-Average Exercise Price
Outstanding at period start, weighted-average exercise price (in dollars per share)	$ 30.97
Exercised, weighted-average exercise price (in dollars per share)	30.97
Outstanding at period end, weighted-average exercise price (in dollars per share)	$ 0	$ 30.97
Contractual Terms (in Years)
Contractual terms (in years)		8 months 12 days

STOCKHOLDERS' EQUITY - Restricted Stock (Details) - shares	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Restricted Stock
Restricted Stock
Outstanding at period start (in shares)	403,324
Granted (in shares)	283,585
Forfeited (in shares)	(6,128)
Vested (in shares)	(115,760)
Outstanding at period end (in shares)	565,021	403,324
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)	1 year 9 months 18 days	1 year 4 months 24 days
Restricted Stock Units (RSUs)
Restricted Stock
Outstanding at period start (in shares)	10,080
Granted (in shares)	4,005
Forfeited (in shares)	(234)
Vested (in shares)	0
Outstanding at period end (in shares)	13,851	10,080
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)	1 year 10 months 24 days	2 years 6 months

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 10,640	$ 8,991
Restricted cash	1,592	1,471
Short-term investments	71,780	109,299
Accounts receivable - trade, net of allowances of $1,412 and $1,056, respectively	37,647	24,800
Inventories, net	100,533	78,192
Prepaid expenses and other current assets	3,980	3,966
Total current assets	226,172	226,719
Property and equipment, net	40,236	34,286
Other assets:
Amortizable intangible assets, net	69,513	64,980
Goodwill	80,894	86,821
Other intangible assets	15,008	14,921
Other non-current assets	621	0
Total other assets	166,036	166,722
Total assets	432,444	427,727
Current liabilities:
Accounts payable - trade	22,587	11,150
Accrued compensation and benefits	8,671	6,744
Current portion of long-term debt with affiliate	150	144
Current portion of acquisition installment payable	9,937	7,815
Other current liabilities	6,582	5,018
Total current liabilities	47,927	30,871
Long-term liabilities:
Long-term debt with affiliate, net of current portion	650	763
Acquisition installment payable, net of current portion	3,489	8,019
Contingent consideration	0	2,980
Deferred income taxes	5,492	5,954
Other long-term liabilities	557	492
Total long-term liabilities	10,188	18,208
Total liabilities	58,115	49,079
Stockholders' equity:
Common stock, $0.00025 par value; 50,000,000 shares authorized; 23,350,976 shares and 22,877,962 shares issued as of September 30, 2023 and December 31, 2022, respectively	6	6
Additional paid-in capital	577,540	560,810
Accumulated deficit	(191,051)	(176,768)
Accumulated other comprehensive loss	(12,166)	(5,400)
Total stockholders' equity	374,329	378,648
Total liabilities and stockholders' equity	$ 432,444	$ 427,727

FAIR VALUE OF FINANCIAL INSTRUMENTS - Change in Fair Value of Level 3 Instruments (Details) - Contingent Consideration Liability - Fair Value, Recurring $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation
Contingent consideration, beginning balance	$ 2,980
Change in fair value of contingent consideration	(2,974)
Contingent consideration, ending balance	$ 6

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net (loss) income	$ (4,591)	$ (2,886)	$ (6,806)	$ 18,539	$ (333)	$ (9,100)	$ (14,283)	$ 9,106

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-Publisher FASB
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 323
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-Section 50
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Net (loss) income	$ (4,591)	$ 18,539	$ (14,283)	$ 9,106
Other comprehensive income (loss):
Foreign currency translation adjustment	(3,947)	(4,164)	(6,767)	(15,661)
Unrealized gain (loss) on short-term investments	251	(452)	861	(1,130)
Adjustment for realized (gain) loss on securities	(559)	1,205	(860)	1,205
Other comprehensive loss, net of tax	(4,255)	(3,411)	(6,766)	(15,586)
Comprehensive (loss) income	$ (8,846)	$ 15,128	$ (21,049)	$ (6,480)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

COMMITMENTS AND CONTINGENCIES	9 Months Ended
COMMITMENTS AND CONTINGENCIES	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES Leases As of September 30, 2023, the Company has recorded a lease liability of $434 and corresponding right-of-use-asset of $497 on its condensed consolidated balance sheet. Legal Proceedings From time to time, we are involved in various legal proceedings arising in the ordinary course of our business. IMED Surgical - Software Ownership Dispute On October 16, 2020, the Company, its wholly-owned subsidiary, Orthex, LLC (“Orthex”), the Company’s largest investor, Squadron Capital, LLC (“Squadron”), and certain other defendants, were named in a lawsuit filed by IMED Surgical, LLC, a New Jersey company (the “Plaintiff”), in Broward County, Florida Circuit Court. In the lawsuit, the Plaintiff claims, among other things, that it is the rightful owner of certain patented point-and-click planning software being used by the Company, Orthex and Squadron (specifically, U.S. Patent No. 10,258,377 (titled “Point and click alignment method for orthopedic surgeons, and surgical and clinical accessories and devices,” issued on April 16, 2019) (hereinafter, the “’377 Patent”). In June 2019, the Company purchased all the issued and outstanding units of membership interests in Orthex, and all the issued and outstanding shares of stock of Vilex in Tennessee, Inc. for $60,000 in total consideration. Vilex and Orthex are primarily manufacturers of foot and ankle surgical implants, including cannulated screws, fusion devices, surgical staples and bone plates, as well as the Orthex Hexapod technology, a system of rings, struts, implants, hardware accessories, and the Point & Click Software used to treat congenital deformities and limb length discrepancies. On December 31, 2019, the Company divested substantially all of the assets relating to Vilex's adult product offerings to a wholly-owned subsidiary of Squadron, in exchange for a $25,000 reduction in a term note owed to Squadron in connection with the initial acquisition. As part of the sale, the Company also executed an exclusive license arrangement with Squadron providing for perpetual access to certain intellectual property, including the ‘377 Patent. According to the lawsuit, the other defendants, who are unrelated to the Company, assigned the ‘377 Patent to Orthex in violation of certain agreements with the Plaintiff. The Plaintiff, among other things, requests that the defendants be ordered to convey and assign to Plaintiff all of their rights, title and interests in and to the ’377 Patent and seeks certain compensatory, consequential and unjust enrichment damages from Orthex and the unrelated defendants. On May 13, 2021, the Court ordered the lawsuit stayed pending arbitration. To the extent the Plaintiff desires to further pursue the matter, it must first do so through a separate arbitration proceeding. In mid-November 2021, the Plaintiff initiated an arbitration proceeding; however, the Plaintiff failed to pay the fees it was required to pay for the arbitration to continue, resulting in the arbitration panel terminating the arbitration proceedings in mid-October 2022. In connection with the stay order, the Court also ordered the Company, Orthex and Squadron to give notice to the Plaintiff before any attempt to dispose, assign, sell or otherwise encumber the ‘377 Patent. The Company, Orthex and Squadron filed an appeal of this component of the order, but the appellate court affirmed the lower court’s decision. The Company, Orthex and Squadron have not sought to further pursue an appeal of the subject order. Although we believe the Company has strong defenses to the IMED lawsuit and we intend to vigorously defend the claims asserted against us, arbitration and litigation can involve complex factual and legal questions, and an adverse resolution of such proceedings could have a material adverse effect on our business, operating results and financial condition. Wishbone Medical, Inc. – Patent Infringement Litigation On October 30, 2020, OrthoPediatrics, along with its wholly-owned subsidiary, Orthex, LLC, filed a lawsuit in federal district court (N.D. Indiana, South Bend Division, Case No. 3:20-cv-00929) against Wishbone Medical, Inc. and Nick A. Deeter (collectively “Wishbone”), claiming infringement of ’377 Patent, unfair competition, false advertising, breach of contract, defamation per se, tortious interference with contractual relationships, and tortious interference with prospective contractual relationships. In early January 2021, OrthoPediatrics amended its lawsuit by adding a declaratory judgment claim of infringement of the ‘377 Patent against Wishbone. Thereafter, in January 2021, Wishbone filed a motion to dismiss all OrthoPediatrics’ causes of action. In late August 2021, the Court denied Wishbone's motion to dismiss with respect to OrthoPediatrics’ infringement and breach of contract claims and dismissed OrthoPediatrics' remaining causes of action. In late September 2021, Wishbone filed its answer and counterclaims, in part, seeking declaratory judgment of non-infringement and invalidity of the ‘377 Patent, and alleging OrthoPediatrics patent infringement claim(s) against Wishbone was made in bad faith. In mid-October 2021, OrthoPediatrics filed its answer to Wishbone’s counterclaims, denying all of them. In late January 2023, Wishbone amended its counterclaims to add a breach of contract claim against OrthoPediatrics. In early February 2023, OrthoPediatrics filed its answer to Wishbone's amended counterclaims, denying all of them. Additionally, in late March 2023, Wishbone filed a motion for judgment on the pleadings regarding the patent eligibility of the '377 patent. In mid-April 2023, OrthoPediatrics filed its response to Wishbone's late March 2023 motion. In mid-June 2023, the Court denied Wishbone's motion for judgment on the pleadings. In September 2023, the Company and Wishbone Medical, Inc. reached a settlement of all claims against one another, resulting in a payment to the Company that was not material. However, OrthoPediatrics’ breach of contract claim against Mr. Deeter and Mr. Deeter’s breach of contract counterclaim remain. Although we believe the Company has strong defenses to Mr. Deeter’s counterclaims and we intend to vigorously defend the claims asserted against us, litigation can involve complex factual and legal questions, and an adverse resolution of this proceeding could have an adverse effect on our business, operating results and financial condition. We are not presently a party to any other legal proceedings the outcome of which, if determined adversely to us, would individually or in the aggregate materially affect our financial position or results of operations or cash flows. Purchase Obligations and Performance Requirements As a result of entering into a license agreement for the exclusive distribution of the 7D Surgical FLASHTM Navigation platform during 2021, the Company agreed to a minimum purchase commitment for the first twelve months of that agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of September 30, 2023, the remaining purchase commitment under the agreement was $1,345 for the year ended December 31, 2023 and $2,340 for the year ended December 31, 2024. On July 20, 2021, we entered into an amended license agreement, resulting in a five-year extension of our exclusive distribution rights of the FIREFLY Technology. As a component of the agreement the Company is required to meet minimum performance metrics, measured by the number of spine procedures in the fiscal year which used the FIREFLY products against the annual requirement in the agreement. This includes any scheduled surgeries whereby the Company has committed to payment of the product. The number of required surgeries varies each year of the agreement. The Company analyzes its projected achievement of these performance metrics and accrues for any estimated shortfall. During the nine months ended September 30, 2023, the Company recorded an expense of $1,053 based on current estimates. The Company recorded $442 of expense for the nine months ended September 30, 2022. Royalties As of September 30, 2023, we are contracted to pay royalties to individuals and entities that provide research and development services, which range from 0.5% to 20% of sales. We have products in development that have royalty commitments. In any development project, there are significant variables that will affect the amount and timing of these payments and as of September 30, 2023, we have not been able to determine the amount and timing of payments. We do not anticipate these future payments will have a material impact on our financial results.

NET LOSS PER SHARE - Reconciliation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Earnings Per Share [Abstract]
Net (loss) income	$ (4,591)	$ (2,886)	$ (6,806)	$ 18,539	$ (333)	$ (9,100)	$ (14,283)	$ 9,106
Less: Earnings allocated to participating securities - Basic	0			353			0	174
Less: Earnings allocated to participating securities - Diluted	0			353			0	174
Net income available to common shareholders - Basic	(4,591)			18,186			(14,283)	8,932
Net income available to common shareholders - Diluted	$ (4,591)			$ 18,186			$ (14,283)	$ 8,932
Denominator for basic and diluted net (loss) income per share:
Weighted average shares outstanding for basic (in shares)	22,762,823			21,150,219			22,646,087	20,703,883
Weighted average shares outstanding for diluted (in shares)	22,762,823			21,295,323			22,646,087	20,958,503
(Loss) earnings per share - basic (in dollars per share)	$ (0.20)			$ 0.88			$ (0.63)	$ 0.44
(Loss) earnings per share - diluted (in dollars per share)	$ (0.20)			$ 0.87			$ (0.63)	$ 0.43

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

NET LOSS PER SHARE (Tables)

9 Months Ended

Sep. 30, 2023

Earnings Per Share [Abstract]

Schedule of Reconciliation of Basic and Diluted Net Loss Per Share Attributable to Common Stockholders

The following is a reconciliation of basic and diluted net loss per share:


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2023		2022		2023		2022
Net (loss) income	$	(4,591)	$	18,539	$	(14,283)	$	9,106
Less: Earnings allocated to participating securities	—		353		—		174
Net income available to common shareholders	$	(4,591)	$	18,186	$	(14,283)	$	8,932

Denominator for basic and diluted net (loss) income per share:
Weighted average shares outstanding for basic	22,762,823		21,150,219		22,646,087		20,703,883
Weighted average shares outstanding for diluted	22,762,823		21,295,323		22,646,087		20,958,503

(Loss) earnings per share:
Basic	$	(0.20)	$	0.88	$	(0.63)	$	0.44
Diluted	$	(0.20)	$	0.87	$	(0.63)	$	0.43

COMMITMENTS AND CONTINGENCIES (Details) - USD ($) $ in Thousands			1 Months Ended	3 Months Ended		9 Months Ended
	Jul. 20, 2021	Dec. 31, 2019	Jun. 30, 2019	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Long-term Purchase Commitment
Operating lease liability				$ 434		$ 434
Operating Lease, Right-of-Use Asset				$ 497		$ 497
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]				Other long-term liabilities		Other long-term liabilities				Other long-term liabilities
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]				Assets, Noncurrent, Excluding Property, Plant And Equipment		Assets, Noncurrent, Excluding Property, Plant And Equipment
Payments on debt with affiliate						$ 0	$ 31,000
Cost of revenue				$ 9,019	$ 9,061	$ 26,580	21,859
Forecast
Long-term Purchase Commitment
Purchase commitment, remaining minimum amount committed								$ 2,340	$ 1,345
Minimum
Long-term Purchase Commitment
Royalty agreement percentage (as a percent)						0.50%
Maximum
Long-term Purchase Commitment
Royalty agreement percentage (as a percent)						20.00%
Firefly Technology \| License Agreements
Long-term Purchase Commitment
Finite lived intangible asset useful life extension period (in years)	5 years
Cost of revenue						$ 1,053
Trademark impairment							$ 442
Squadron Capital LLC \| Team Note B \| Affiliated Entity
Long-term Purchase Commitment
Payments on debt with affiliate		$ 25,000
Vilex and Orthex
Long-term Purchase Commitment
Fair value of estimated total acquisition consideration			$ 60,000

RELATED PARTY TRANSACTIONS	9 Months Ended
RELATED PARTY TRANSACTIONS	Sep. 30, 2023
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONSIn addition to the debt and credit agreements and mortgage with Squadron and its affiliate (see Note 6), we currently use Structure Medical, LLC (“Structure Medical”) as one of our suppliers. Structure Medical is affiliated with Squadron and a supplier with which we maintain certain long-term agreements. We made aggregate payments to Structure Medical for inventory purchases of $234 and $218 for the three months ended September 30, 2023 and 2022, respectively, and $628 and $768 for the nine months ended September 30, 2023 and 2022, respectively.

- Definition

The entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.

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+ Details

DEBT AND CREDIT ARRANGEMENTS (Tables)

9 Months Ended

Sep. 30, 2023

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

Long-term debt consisted of the following:


	September 30, 2023		December 31, 2022



Mortgage payable to affiliate	$	800	$	907

Less: current maturities	150		144
Long-term debt with affiliate, net of current maturities	$	650	$	763

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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-Section S99
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+ Details

DEBT AND CREDIT ARRANGEMENTS - Narrative (Details) - USD ($)		3 Months Ended		9 Months Ended
	Jun. 13, 2022	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Mortgage payable to affiliate
Debt Instrument
Interest rate (as a percent)		5.00%		5.00%
Monthly interest and principal installments				$ 16,000
Long-term debt		$ 800,000		800,000		$ 907,000
Current portion of long-term debt with affiliate		150,000		150,000		$ 144,000
Note payable to Squadron
Debt Instrument
Interest expense		$ 10,000	$ 12,000	$ 32,000	$ 512,000
Revolving Credit Facility \| Fourth Amended Loan Agreement
Debt Instrument
Revolving credit facility	$ 50,000,000
Interest rate (as a percent)	10.00%
Unused commitment fee percentage (as a percent)	0.50%
Revolving Credit Facility \| Fourth Amended Loan Agreement \| Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Debt Instrument
Debt instrument, basis spread on variable rate (as a percent)	8.69%
Revolving Credit Facility \| Fourth Amended Loan Agreement \| Three Month LIBOR
Debt Instrument
Debt instrument, basis spread on variable rate (as a percent)	8.61%

STOCKHOLDERS' EQUITY (Tables)

9 Months Ended

Sep. 30, 2023

Share-Based Payment Arrangement [Abstract]

Schedule of Stock Option Activity

Our stock option activity and related information are summarized as follows:


		Weighted-Average		Remaining Contractual Terms
	Options	Exercise Price		(in Years)
Outstanding at January 1, 2023	3,556	$	30.97	0.7
Exercised	(670)	30.97
Forfeited or expired	(2,886)	—
Outstanding at September 30, 2023	—	$	—	—

Schedule of Restricted Stock Activity

Our restricted stock activity and related information are summarized as follows:


		Weighted-Average		Weighted-Average
	Restricted	Remaining	Restricted	Remaining
	Stock	Contractual Terms	Stock	Contractual Terms
	Awards	(in Years)	Units	(in Years)
Outstanding at January 1, 2023	403,324	1.4	10,080	2.5
Granted	283,585		4,005
Forfeited	(6,128)		(234)
Vested	(115,760)		—
Outstanding at September 30, 2023	565,021	1.8	13,851	1.9

BUSINESS SEGMENT - Schedule of Revenue by Geographical Location (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues from External Customers and Long-Lived Assets
Total	$ 39,972	$ 34,950	$ 111,119	$ 91,295
U.S.
Revenues from External Customers and Long-Lived Assets
Total	29,360	26,539	82,748	69,687
International
Revenues from External Customers and Long-Lived Assets
Total	$ 10,612	$ 8,411	$ 28,371	$ 21,608

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

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-Section S99
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-Subparagraph (SAB Topic 11.L)
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+ Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Business Acquisition, Pro Forma Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Net revenue	$ 39,972	$ 34,950	$ 111,119	$ 98,779
Net (loss) income	$ (4,591)	$ 18,539	$ (14,283)	$ 10,013

BUSINESS SEGMENT - Schedule of Revenue by Category (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information
Total	$ 39,972	$ 34,950	$ 111,119	$ 91,295
Trauma and deformity
Segment Reporting Information
Total	28,806	23,892	79,715	62,976
Scoliosis
Segment Reporting Information
Total	10,304	9,979	28,270	25,383
Sports medicine/other
Segment Reporting Information
Total	$ 862	$ 1,079	$ 3,134	$ 2,936

- Definition

+ References

+ Details

DEBT AND CREDIT ARRANGEMENTS - Schedule of Long-term Debt (Details) - Mortgage payable to affiliate - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument
Mortgage payable to affiliate	$ 800	$ 907
Less: current maturities	150	144
Long-term debt with affiliate, net of current maturities	$ 650	$ 763

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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+ Details

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS (Tables)

9 Months Ended

Sep. 30, 2023

Business Combination and Asset Acquisition [Abstract]

Schedule of Total Consideration Transferred after Discounting Future Payments

The table below reconciles the payments and issuances to total consideration transferred after discounting the future payments to present value.


	Consideration		Present Value
Cash consideration	$	3,000	$	3,000
Issuance of common stock	2,274		2,274
Anniversary payments	5,500		4,672
Transaction costs	97		97
Total consideration transferred	$	10,871	$	10,043

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed


Fair value of estimated total acquisition consideration	$	32,042
Assets
Cash	312
Accounts receivable - trade	2,100
Inventories	4,875
Prepaid expenses and other current assets	509
Property and equipment	600
Amortizable intangible assets	12,286
Other intangible assets	3,878
Total assets	24,560
Liabilities
Accounts payable-trade	1,682
Other current liabilities	1,393
Deferred tax liability	4,035
Total liabilities	7,110
Less: total net assets	17,450
Goodwill	$	14,592


Fair value of estimated total acquisition consideration	$	18,487
Assets
Cash	420
Accounts receivable - trade	1,062
Inventories	1,126
Prepaid expenses and other current assets	100
Property and equipment	2,444
Amortizable intangible assets	9,120
Other intangible assets	2,410
Total assets	16,682
Liabilities
Accounts payable and accrued liabilities	45
Other current liabilities	586
Deferred tax liability	3,014
Total liabilities	3,645
Less: total net assets	13,037
Goodwill	$	5,450

Schedule of Indefinite-Lived Intangible Assets Acquired as Part of Business Combination


	Amount		Remaining Economic Useful Life
Trademarks / Names	$	3,878	Indefinite
Patents	3,545		10 years

Customer Relationships & Other	8,741		15 years
	$	16,164


	Amount		Remaining Economic Useful Life
Trademarks / Names	$	2,410	Indefinite
Patents	2,660		10 years
Customer Relationships	6,460		15 years
	$	11,530

Schedule of Business Acquisition, Pro Forma Information

The following table represents the pro forma net revenue and net (loss) income assuming the acquisitions of MD Ortho and Pega Medical occurred on January 1, 2022.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022
Net revenue	$	39,972	$	34,950	$	111,119	$	98,779
Net (loss) income	$	(4,591)	$	18,539	$	(14,283)	$	10,013

INCOME TAXES (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
INCOME TAXES (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income tax benefit	$ (849)	$ 4,143	$ 126	$ 4,899
Effective income tax rate (as a percent)			0.90%	(116.40%)

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Net revenue	$ 39,972	$ 34,950	$ 111,119	$ 91,295
Cost of revenue	9,019	9,061	26,580	21,859
Gross profit	30,953	25,889	84,539	69,436
Operating expenses:
Sales and marketing	13,582	11,919	38,963	34,108
General and administrative	18,507	15,116	55,827	42,829
Trademark impairment	985	3,609	985	3,609
Research and development	2,387	2,206	7,449	5,980
Total operating expenses	35,461	32,850	103,224	86,526
Operating loss	(4,508)	(6,961)	(18,685)	(17,090)
Other (income) expenses:
Interest expense	21	708	105	2,485
Fair value adjustment of contingent consideration	0	(23,010)	(2,974)	(25,450)
Other (income) loss	(787)	945	(1,407)	1,668
Total other income	(766)	(21,357)	(4,276)	(21,297)
(Loss) income before income taxes	(3,742)	14,396	(14,409)	4,207
Provision for income taxes (benefit)	849	(4,143)	(126)	(4,899)
Net (loss) income	$ (4,591)	$ 18,539	$ (14,283)	$ 9,106
Weighted average shares outstanding - basic (in shares)	22,762,823	21,150,219	22,646,087	20,703,883
Weighted average shares outstanding - diluted (in shares)	22,762,823	21,295,323	22,646,087	20,958,503
Net (loss) income per share - basic (in dollars per share)	$ (0.20)	$ 0.88	$ (0.63)	$ 0.44
Net (loss) income per share - diluted (in dollars per share)	$ (0.20)	$ 0.87	$ (0.63)	$ 0.43

FAIR VALUE OF FINANCIAL INSTRUMENTS - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Fair Value Disclosures [Abstract]
Fair value adjustment of contingent consideration	$ 0	$ (23,010)	$ (2,974)	$ (25,450)

INCOME TAXES	9 Months Ended
INCOME TAXES	Sep. 30, 2023
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The Company utilizes an estimated annual effective tax rate to determine its provision or benefit for income taxes for interim periods. The income tax provision or benefit is computed by multiplying the estimated annual effective tax rate by the year-to-date pre-tax book income (loss). For the nine months ended September 30, 2023, the income tax benefit was $126 compared to $4,899 for the nine months ended September 30, 2022. Our effective income tax rate was 0.9% and (116.4)% for the nine months ended September 30, 2023 and 2022, respectively. The deferred tax assets were fully offset by a valuation allowance at September 30, 2023 and December 31, 2022, with the exception of certain deferred tax liabilities recognized in a foreign jurisdiction as a result of fair value adjustments recorded upon the acquisition of ApiFix and Pega Medical. The Company has recorded a tax expense and tax benefit during the period ended September 30, 2023 for losses generated in Canada and Israel, respectively.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Indefinite-Lived Intangible Assets Acquired as Part of Business Combination (Details) - USD ($) $ in Thousands	Jul. 01, 2022	Apr. 01, 2022
Pega Medical
Business Acquisition
Fair value of identifiable intangible assets	$ 16,164
Pega Medical \| Patents
Business Acquisition
Finite-lived intangible assets acquired	$ 3,545
Remaining economic useful life (in years)	10 years
Pega Medical \| Customer Relationships & Other
Business Acquisition
Finite-lived intangible assets acquired	$ 8,741
Remaining economic useful life (in years)	15 years
Pega Medical \| Trademarks / Names
Business Acquisition
Indefinite-lived intangible assets acquired	$ 3,878
MD Orthopaedics
Business Acquisition
Fair value of identifiable intangible assets		$ 11,530
MD Orthopaedics \| Patents
Business Acquisition
Finite-lived intangible assets acquired		$ 2,660
Remaining economic useful life (in years)		10 years
MD Orthopaedics \| Customer Relationships & Other
Business Acquisition
Finite-lived intangible assets acquired		$ 6,460
Remaining economic useful life (in years)		15 years
MD Orthopaedics \| Trademarks / Names
Business Acquisition
Indefinite-lived intangible assets acquired		$ 2,410

BUSINESS SEGMENT - Narrative (Details)	9 Months Ended
BUSINESS SEGMENT - Narrative (Details)	Sep. 30, 2023 segment
Segment Reporting [Abstract]
Number of operating segments	1
Number of reportable segments	1