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GOODWILL AND INTANGIBLE ASSETS - Schedule of Changes in Goodwill (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($)
Goodwill
Goodwill, beginning balance	$ 83,699
Foreign currency translation impact	(1,579)
Goodwill, ending balance	93,844
Boston O&P acquisition
Goodwill
Acquisitions	8,357
Other clinic acquisitions
Goodwill
Acquisitions	$ 3,367

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 49
-Publisher FASB
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Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
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-Name Accounting Standards Codification
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Reference 3: http://www.xbrl.org/2003/role/exampleRef
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Reference 4: http://www.xbrl.org/2003/role/exampleRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
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-URI https://asc.fasb.org/1943274/2147482598/350-20-45-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Paragraph 1
-Subparagraph (a)
-Publisher FASB
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
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-Publisher FASB
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+ Details

SIGNIFICANT ACCOUNTING POLICIES - Restricted Cash (Details) € in Thousands, $ in Thousands	Dec. 31, 2024 USD ($)	Dec. 31, 2024 EUR (€)	Dec. 31, 2023 USD ($)
Accounting Policies [Abstract]
Escrow deposit	$ 1,250		$ 1,250
Restricted cash	$ 1,957	€ 625	$ 1,972

SIGNIFICANT ACCOUNTING POLICIES - Cash, Cash Equivalents and Short Term Investments (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Realized gain on investment	$ 119	$ 1,437	$ 1,550

RESTRUCTURING

12 Months Ended

Dec. 31, 2024

Restructuring and Related Activities [Abstract]

RESTRUCTURING

In the fourth quarter of 2024, we initiated a global restructuring plan (the "2024 Restructuring Plan"). The 2024 Restructuring Plan aims to improve operational efficiency, exit our physical site in Israel, and reduce costs by integrating the ApiFix product into the broader OP Scoliosis portfolio, and effect additional staff reduction across all of OrthoPediatrics Corp. The 2024 Restructuring Plan is expected to result in total restructuring charges of approximately $3,877. In 2024, we recognized expenses of $3,653 related to reducing the ApiFix portfolio inventory, reserving for excess inventory, and employee termination benefits. In 2025, we expect to expense $246 of retention bonuses as part of the 2024 Restructuring Plan.

The Company's restructuring expenses are comprised of the following:


	Year Ended December 31, 2024
Severance and employee costs	$	1,196
Write-down of inventory and property and equipment	1,771
Other exit costs	686
Balance at December 31, 2024	$	3,653

The following table summarizes the changes in our accrued restructuring balance, which is included in accrued expenses and other current liabilities in the accompanying consolidated balance sheets. Such costs are all expected to be paid by December 31, 2025.


	Accrued Restructuring Balance
Balance at December 31, 2023	$	—
Restructuring charges	1,306
Payments	(234)
Balance at December 31, 2024	$	1,072

CONSOLIDATED BALANCE SHEETS € in Thousands, $ in Thousands	Dec. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)
Current assets:
Cash	$ 43,820	$ 31,055
Restricted cash	1,957	1,972
Short-term investments	25,013	49,251
Accounts receivable - trade, net of allowances of $1,145 and $1,373, respectively	42,357	34,617
Inventories, net	117,005	105,851
Prepaid expenses and other current assets	7,021	3,750
Total current assets	237,173	226,496
Property and equipment, net	50,596	41,048
Other assets:
Amortizable intangible assets, net	64,427	69,275
Goodwill	93,844	83,699
Other intangible assets	16,752	15,287
Other non-current assets	10,417	2,940
Total other assets	185,440	171,201
Total assets	473,209	438,745
Current liabilities:
Accounts payable - trade	8,908	12,649
Accrued compensation and benefits	13,888	11,325
Current portion of long-term debt with affiliate	160	152
Current portion of acquisition installment payable	1,347	10,149
Other current liabilities	9,659	7,391
Total current liabilities	33,962	41,666
Long-term liabilities:
Long-term convertible note	47,913	0
Other long-term debt, net of current portion	635	0
Acquisition installment payable, net of current portion	2,452	3,551
Deferred income taxes	3,381	5,483
Other long-term liabilities	5,892	1,112
Total long-term liabilities	84,681	20,054
Total liabilities	118,643	61,720
Commitments and contingencies (Note 17)
Stockholders' equity:
Common stock, $0.00025 par value; 50,000,000 shares authorized; 24,217,508 shares and 23,378,408 shares issued and outstanding as of December 31, 2024 and December 31, 2023, respectively	6	6
Additional paid-in capital	600,897	580,287
Accumulated deficit	(235,564)	(197,742)
Accumulated other comprehensive loss	(10,773)	(5,526)
Total stockholders' equity	354,566	377,025
Total liabilities and stockholders' equity	473,209	438,745
Nonrelated Party
Long-term liabilities:
Long-term term loan	23,957	9,297
Related Party
Long-term liabilities:
Long-term term loan	$ 451	$ 611

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	M D Ortho	ApiFix	Common Stock	Common Stock M D Ortho	Common Stock ApiFix	Additional Paid-in Capital	Additional Paid-in Capital M D Ortho	Additional Paid-in Capital ApiFix	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Balance at Dec. 31, 2021	$ 225,369			$ 5			$ 394,899			$ (178,026)	$ 8,491
Balance (in shares) at Dec. 31, 2021				19,677,214
Increase (Decrease) in Stockholders' Equity
Net (loss) income	1,258									1,258
Stock option exercise	$ 63						63
Stock option exercise (in shares)	2,010			2,010
Restricted stock	$ 6,449						6,449
Restricted stock (in shares)				188,537
Consideration for acquisitions		$ 9,707						$ 9,707
Consideration for acquisitions (in shares)					208,140
Stock portion of ApiFix anniversary installment payment			$ 10,410						$ 10,410
Stock portion of Apifix anniversary installment payment (in shares)						185,811
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
Other comprehensive loss	(13,891)										(13,891)
Balance at Dec. 31, 2022	378,648			$ 6			560,810			(176,768)	(5,400)
Balance (in shares) at Dec. 31, 2022				22,877,962
Increase (Decrease) in Stockholders' Equity
Net (loss) income	(20,974)									(20,974)
Stock option exercise	$ 21						21
Stock option exercise (in shares)	670			670
Restricted stock	$ 10,526						10,526
Restricted stock (in shares)				304,889
Consideration for acquisitions	2,752						2,752
Consideration for acquisitions (in shares)				54,884
Stock portion of ApiFix anniversary installment payment			6,178						6,178
Stock portion of Apifix anniversary installment payment (in shares)						140,003
Other comprehensive loss	(126)										(126)
Balance at Dec. 31, 2023	$ 377,025			$ 6			580,287			(197,742)	(5,526)
Balance (in shares) at Dec. 31, 2023	23,378,408			23,378,408
Increase (Decrease) in Stockholders' Equity
Net (loss) income	$ (37,822)									(37,822)
Restricted stock	13,548						13,548
Restricted stock (in shares)				589,000
Consideration for acquisitions	133						133
Consideration for acquisitions (in shares)				4,288
Stock portion of ApiFix anniversary installment payment			$ 6,929						$ 6,929
Stock portion of Apifix anniversary installment payment (in shares)						245,812
Other comprehensive loss	(5,247)										(5,247)
Balance at Dec. 31, 2024	$ 354,566			$ 6			$ 600,897			$ (235,564)	$ (10,773)
Balance (in shares) at Dec. 31, 2024	24,217,508			24,217,508

SIGNIFICANT ACCOUNTING POLICIES (Tables)

12 Months Ended

Dec. 31, 2024

Accounting Policies [Abstract]

Schedule of Activity in Allowance for Doubtful Accounts

The following table summarizes activity in our reserves recorded against accounts receivable:


	December 31,
	2024		2023		2022
Balance at beginning of year	$	1,373	$	1,056	$	347
Adjustments charged to expense (income)	101		499		723
Write-offs & other adjustments	(1,132)		(182)		(174)
Carrying amount as a result of acquisitions	803		—		160
Balance at end of year	$	1,145	$	1,373	$	1,056

Schedule of Property and Equipment, Depreciable Lives

Sample inventory is carried at cost less accumulated depreciation.

Depreciable lives are generally as follows:


Building and building improvements			25 to 30 years
Furniture and fixtures			5 to 7 years
Computer equipment			3 to 5 years
Business software			3 years
Office and other equipment			5 to 7 years
Instruments			5 years
Sample inventory			2 years

Property and equipment, net consisted of the following:


	December 31,
	2024		2023
Land	$	2,350	$	1,725
Building and building improvements	11,318		5,870
Computer equipment and software	5,029		5,828
Office and other equipment	6,377		5,821
Instruments	60,878		53,093
Sample inventory	3,419		2,780
Construction in progress	7,342		5,519
	96,713		80,636
Less: accumulated depreciation	(46,117)		(39,588)
Total property and equipment, net	$	50,596	$	41,048

Schedule of Reclassifications

The following tables present the impact of the reclassification on our consolidated statements of operations for the years ended December 31, 2023 and 2022:


	Year Ended December 31,
	2023		2022
Sales and marketing (prior presentation)	$	51,402	$	45,053

Reclassification	1,422		1,041
Sales and marketing (new presentation)	$	52,824	$	46,094


	Year Ended December 31,
	2023		2022
General and administrative (prior presentation)	$	75,421	$	59,383
Reclassification	(2,121)		(1,479)
General and administrative (new presentation)	$	73,300	$	57,904


	Year Ended December 31,
	2023		2022
Research and development (prior presentation)	$	10,196	$	8,014
Reclassification	699		438
Research and development (new presentation)	$	10,895	$	8,452

FAIR VALUE OF FINANCIAL INSTRUMENTS - Fair Value Measurements of Contingent Consideration (Details) - Fair Value, Recurring - Level 3 - Valuation Technique, Discounted Cash Flow [Member]	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Expected Years	4 months 24 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	0.00%	16.60%
Volatility factor
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Contingent consideration, measurement input	0.00%	48.00%

STOCKHOLDERS' EQUITY

12 Months Ended

Dec. 31, 2024

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:


	Options	Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Terms (in Years)
Outstanding at January 1, 2022	6,638	$	30.97	1.3
Forfeited or expired	(1,072)	$	30.97
Exercised	(2,010)	$	30.97
Outstanding at December 31, 2022	3,556	$	30.97	0.7
Forfeited or expired	(2,886)	$	30.97
Exercised	(670)	$	30.97
Outstanding at December 31, 2023	—	$	—	—
Outstanding at December 31, 2024	—	$	—	—

Options generally include a time-based vesting schedule permitting the options to vest ratably over three years. At December 31, 2024 and 2023, all options were fully vested. No stock options were granted during any of the years presented.

There was no stock-based compensation expense on stock options for all periods presented.

Restricted Stock

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


	Restricted Stock Awards	Weighted-Average Remaining Contractual Terms (in Years)	Restricted Stock Units	Weighted-Average Remaining Contractual Terms (in Years)
Outstanding at January 1, 2022	368,446	1.1	—	—
Granted	216,881		11,634
Forfeited	(28,344)		(1,554)
Outstanding at Vested	(153,659)		—
Outstanding at December 31, 2022	403,324	1.4	10,080	2.5
Granted	311,689		4,005
Forfeited	(6,800)		(234)
Outstanding at Vested	(115,760)		—
Outstanding at December 31, 2023	592,453	1.6	13,851	1.7
Granted	560,252		7,900
Forfeited	(12,503)		(200)
Vested	(96,009)		—
Outstanding at December 31, 2024	1,044,193	1.5	21,551	1.2

At December 31, 2024, there was $18,753 of unrecognized compensation expense remaining related to our service-based restricted stock awards. The unrecognized compensation cost is expected to be recognized over a weighted average period of 1.5 years.

Stock-based compensation expense on restricted stock amounted to $13,548, $10,526 and $6,679 for the years ended December 31, 2024, 2023 and 2022, respectively, and is classified as follows:


	Year Ended December 31,
	2024		2023		2022
Sales and marketing	$	1,774	$	1,422	$	1,041
General and administrative	10,502		8,405		5,200
Research and development	1,170		699		438
Restructuring	102		—		—
Total	$	13,548	$	10,526	$	6,679

In connection with its approval of the Term Loan Agreement, Purchase Agreement, the Indenture and Notes, on August 2, 2024, the Board of Directors of the Company also approved a stock repurchase program of up to $5,000 in aggregate investment of the Company’s outstanding common stock, contingent upon the closing of the Term Loan and the Notes. The stock repurchases may, at the discretion of management, be made from time to time, through solicited or unsolicited transactions in the open market, in privately negotiated transactions or pursuant to a Rule 10b5-1 plan all as effected in accordance with Rule 10b-18 under the Securities Exchange Act of 1934, as amended. The Company is not obligated to purchase any shares under the program, and the program may be discontinued at any time. No shares have been purchased under this program as of December 31, 2024. The dollar limit on repurchases under the program after December 31, 2024 was reduced to $250 per annum.

Warrants

On August 15, 2022, the Company completed a public offering of securities that included the issuance and sale to Squadron of pre-funded warrants to purchase up to 1,525,000 shares of the Company’s common stock. The price per warrant was equal to the price per share at which common shares were concurrently sold to the public, minus $0.00025, which nominal amount was the exercise price of each warrant. The warrants issued to Squadron were exercised on September 20, 2022, following the expiration of all waiting periods under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended (the “HSR Act”), that were applicable to Squadron as a result of it beneficially owning shares of the Company’s common stock with a value in excess of the HSR Act notification threshold.

SIGNIFICANT ACCOUNTING POLICIES - Stock-Based Compensation (Details) - shares	1 Months Ended	12 Months Ended
	Apr. 30, 2018	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award
Options, granted (in shares)		0	0	0
Stock options
Share-based Compensation Arrangement by Share-based Payment Award
Vesting period (in years)		3 years	3 years
Options, granted (in shares)		0	0	0
Stock options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award
Vesting period (in years)		3 years
Restricted stock
Share-based Compensation Arrangement by Share-based Payment Award
Vesting period (in years)	6 years	3 years
2007 Plan
Share-based Compensation Arrangement by Share-based Payment Award
Shares available for award (in shares)		1,585,000
2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award
Shares available for award (in shares)		1,832,460
New 2017 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award
Shares available for award (in shares)		1,629,000
2024 Plan
Share-based Compensation Arrangement by Share-based Payment Award
Shares available for grant (in shares)		1,231,564

BUSINESS SEGMENT - Narrative (Details)	12 Months Ended
BUSINESS SEGMENT - Narrative (Details)	Dec. 31, 2024 segment
Segment Reporting [Abstract]
Number of operating segments	1
Number of reportable segments	1

INCOME TAXES - Components of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Current:
Federal	$ 0	$ 0	$ 0
State	104	85	68
Foreign	525	740	17
Current income tax expense (benefit)	629	825	85
Deferred:
Federal	0	0	0
State	0	0	0
Foreign	(2,107)	(1,163)	(2,018)
Decrease in valuation allowance	(2,629)	0	(3,014)
Total income tax benefit	$ (4,107)	$ (338)	$ (4,947)

SIGNIFICANT ACCOUNTING POLICIES (Policies)

12 Months Ended

Dec. 31, 2024

Accounting Policies [Abstract]

Basis of Presentation

The accompanying 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.

Use of Estimates

Preparation of our 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 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.

Foreign Currency Transactions

We currently bill our international stocking distributors in U.S. dollars, resulting in minimal foreign exchange transaction expense.

countries we serve under the agency model include the United Kingdom, Ireland, Australia, New Zealand, Canada, Belgium, the Netherlands, Poland, Italy, Israel, Germany, Switzerland, and Austria. In order to further enhance our operations in Europe, we established operating companies in the Netherlands and Germany in March 2019 and April 2022, respectively. In 2023 and 2024, we hired operating and sales representatives in Germany and Australia, respectively, to better serve our customers. In 2024, we opened warehouses in Germany and Australia, and hired a European operations director to continue our growth in the European market. The financial statements of our foreign subsidiaries are accounted for in local functional currencies and have been translated into U.S. dollars using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. Foreign currency translation adjustments have been recorded as a separate component of the consolidated statements of comprehensive loss.

Fair Value of Financial Instruments

The accounting standards related to fair value measurements define fair value and provide a consistent framework for measuring fair value under the authoritative literature. Valuation techniques are based on observable and unobservable inputs. Observable inputs reflect readily obtainable data from independent sources, while unobservable inputs reflect market assumptions. This guidance only applies when other standards require or permit the fair value measurement of assets and liabilities. The guidance does not expand the use of fair value measurements. 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 Company's financial instruments include cash, restricted cash, cash equivalents, short-term investments, accounts receivable, accounts payable, acquisition installment payables, contingent consideration and long-term debt. The carrying amounts of accounts receivable, accounts payable, acquisition installment payables and long-term debt approximate the fair value due to the short-term nature or market rates of these instruments. The company bases the fair value of short-term investments on quoted market prices for identical or comparable assets except for investments classified as asset backed securities or certificates of deposit which we identify as Level 2. These securities are predominately priced by third parties, either a pricing vendor or dealer. When a quoted price in an active market for an identical security is not available these third parties will utilize an alternative market approach, such as a recent trade or matrix pricing, or an income approach, such as a discounted cash flow pricing model that calculates values from observable inputs such as quoted interest rates, yield curves and other observable market information. Contingent consideration represents the system sales payment the Company is obligated to make. The fair value of the contingent consideration payment is considered a level 3 fair value measurement and was determined with the assistance of an independent valuation specialist at the original issuance date and as of the balance sheet date.

Revenue from Contracts with Customers

In accordance with ASC 606, "Revenue from Contracts with Customers," revenue is recognized when our performance obligations under the terms of a contract with our customer are satisfied. This typically occurs when we transfer control of our products to the customers. The amount of revenue recognized reflects the consideration to which the Company expects to be entitled to receive in exchange for these goods or services, and excludes any sales incentives or taxes collected from a customer which are subsequently remitted to government authorities.

Revenue Recognition – United States

Revenue in the United States is generated primarily from the sale of our implants, specialized braces, O&P clinic services and, to a much lesser extent, from the sale of our instruments. Sales of our implants and instruments in the United States are primarily to hospital accounts through independent sales agencies. We recognize revenue

when our performance obligations under the terms of a contract with our customer are satisfied. For our implants and instruments, this typically occurs when we transfer control of our products to the customer, generally upon implantation or when title passes upon shipment. The products are generally consigned to our independent sales agencies, and revenue is recognized when the products are used by or shipped to the hospital for surgeries on a case by case basis. On rare occasions, hospitals purchase product for their own inventory, and revenue is recognized when the hospital obtains control of the product, typically either upon shipment or delivery of the product dependent on the terms of the contract. Sales of our bracing products are sold to stocking distributors, hospitals, orthotist and other medical professionals or directly to end customers. For such sales, we consider our performance obligation to be settled upon shipment, and revenue is recognized at that time. For our O&P clinics, we recognize revenue when our custom manufactured braces or other products are fitted to and accepted by patients. Revenue from these O&P clinics is primarily derived from contracts with third party payors. At, or subsequent to delivery, an invoice is issued to the third-party payor, which primarily consists of commercial insurance companies, Medicare, Medicaid and private or patient pay individuals. Revenue is recognized for the amounts expected to be received from payors based on contractual reimbursement rates, which are net of estimated contractual discounts and other implicit price concessions. These revenue amounts are further revised as claims are adjudicated, which may result in additional disallowances, which are considered as part of the transaction price and recorded as a reduction of revenues.

Revenue Recognition – International

Outside of the United States, we sell our products, including our specialized braces, directly to hospitals through independent sales agencies or to independent stocking distributors. Generally, the distributors are allowed to return products, and some are thinly capitalized. Based on a history of reliable collections, we have concluded that a contract exists and revenue should be recognized when we transfer control of our products to the customer, generally when title passes upon shipment. Additionally, based on our history of immaterial returns from international customers, we have historically estimated no reserve for returns.

Beginning in early 2017 and continuing through 2024, we expanded operations and established legal entities outside the United States, permitting us to sell under an agency model direct to local hospitals internationally. The products are generally consigned to our independent sales agencies, and revenue is recognized when the products are used by or shipped to the hospital for surgeries on a case by case basis. On rare occasions, hospitals purchase products for their own inventory, and revenue is recognized when title passes upon shipment.

Cash, Cash Equivalents and Short Term Investments

We maintain cash in bank deposit accounts which, at times, may exceed federally insured limits. To date, we have not experienced any loss in such accounts. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents. The carrying amounts reported in the balance sheets for cash are valued at cost, which approximates fair value.

The Company invests in both certificate of deposits and available-for-sale short term investments. The Company has the ability, if necessary, to liquidate without penalty any of its short term investments to meet its liquidity needs in the next twelve months. As such, those investments with contractual maturities greater than one year from the date of purchase are classified as short-term on the accompanying consolidated balance sheets. The Company includes unrealized gains or losses, as a component of other comprehensive income in stockholders' equity. If the adjustment to fair value reflects a decline in the value of the investment, the Company evaluates whether any impairment is a result of a credit loss or other factors. This evaluation includes, but is not limited to, significant quantitative and qualitative assessments and estimates regarding credit ratings, significance of a security's loss position, adverse conditions specifically related to the security, and the payment structure of the security. There were no such losses recognized in the accompanying consolidated statements of operations. Additionally, the Company recognizes any previously unrealized gain or loss at the time the Company liquidates any of its investments based on the value at the time of liquidation. In 2024, 2023, and 2022, the Company recognized gains of $119, $1,437, and $1,550, respectively, that were previously unrealized.

Restricted Cash

In conjunction with the sale of Vilex, $1,250 was placed into a separate escrow account. This cash is reported as restricted cash on the December 31, 2024 and 2023 consolidated balance sheets. These funds were to remain restricted until August 31, 2021 at which time, they were to be released to the Company subject to no claims related to the purchase; however, due to the pending IMED Surgical litigation, the cash remains reported as

restricted until the conclusion of the legal matter. See Note 17 - Commitments and Contingencies for further detail. The Company also maintains restricted cash of 625 Euro at its Netherlands entity for potential Italian tenders.

Accounts Receivable

Accounts receivable are uncollateralized customer obligations due under normal trade terms, generally requiring payment within 30 days from the invoice date in the United States and within 90 days internationally. Account balances with invoices over 30 or 90 days past due for domestic and international accounts, respectively, are considered delinquent. For O&P clinic goods and services, accounts receivables are adjusted for unapplied cash and estimated allowances for implicit price concessions (like disallowed revenue and patient non-payments). These allowances are based on historical collection experience for different primary payor class groups (Medicare and non-Medicare). Management uses historical data to estimate collections by aging category and adjusts these estimates as needed based on trends and new information. No interest is charged on past due accounts. Payments of accounts receivable are applied to the specific invoices identified on the customer's remittance advice or, if unspecified, to the customer's account as an unapplied credit.

The carrying amount of accounts receivable is reduced by an allowance that reflects management's best estimate of the amounts that will not be collected, determined principally on the basis of historical experience, management's assessment of the collectability of specific customer accounts and the aging of the accounts receivable. All accounts or portions thereof deemed to be uncollectible or to require an excessive collection cost are written off against the established reserve.

Inventories, net

Inventories are stated at the lower of cost or net realizable value, with cost determined using the first-in-first-out method. Inventories, which consist of implants and instruments held in our warehouses, with third-party independent sales agencies or distributors, or consigned directly with hospitals, are considered finished goods and are purchased from third parties.

We evaluate the carrying value of our inventories in relation to the estimated forecast of product demand, which takes into consideration the life cycle of the product. A significant decrease in demand could result in an increase in the amount of excess inventory on hand, which could lead to additional charges for excess and obsolete inventory.

The need to maintain substantial levels of inventory impacts our estimates for excess and obsolete inventory. Each of our implant systems are designed to include implantable products that come in different sizes and shapes to accommodate the surgeon’s needs. Typically, a small number of the set components are used in each surgical procedure. Certain components within each set may become obsolete before other components based on the usage patterns. We adjust inventory values, as needed, to reflect these usage patterns and life cycle.

In addition, we continue to introduce new products, which may require us to take additional charges for excess and obsolete inventory in the future.

Property and Equipment, net

Property and equipment are carried at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful life of the assets. When assets are retired or otherwise disposed of, costs and related accumulated depreciation are removed from the accounts, and any resulting gain or loss is recognized in operations for the period. Maintenance and repairs that prolong or extend the useful life are capitalized, whereas standard maintenance, replacements, and repair costs are expensed as incurred.

Instruments are hand-held devices, specifically designed for use with our implants and are used by surgeons during surgery. Instruments deployed in the field are carried at cost less accumulated depreciation and are recorded in property and equipment, net on the consolidated balance sheets.

Sample inventory consists of our implants and instruments, and is maintained to market and promote our products. Sample inventory is carried at cost less accumulated depreciation.

Depreciable lives are generally as follows:


Building and building improvements			25 to 30 years
Furniture and fixtures			5 to 7 years
Computer equipment			3 to 5 years
Business software			3 years
Office and other equipment			5 to 7 years
Instruments			5 years
Sample inventory			2 years

Amortizable Intangible Assets, net

Amortizable intangible assets include fees necessary to secure various patents and licenses, including Band-Lok, the value of internally developed software, customer relationships, and non-competition agreements related to the acquisition of Orthex, and customer relationships and non-competition agreements related to the acquisitions of Telos, ApiFix, MD Ortho, Pega Medical, MedTech Concepts, Rhino, Boston O&P, and O&P clinics. Amortization is calculated on a straight-line basis over the estimated useful life of the asset. Amortization for patents and licenses commences at the time of patent approval, and for licenses upon market launch, respectively. Amortization for assets acquired commences upon acquisition. Intangible assets are amortized over a 3 to 20 year period.

Amortizable intangible assets are assessed for impairment upon triggering events that indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net undiscounted cash flows expected to be generated by the associated asset. If such assets are determined to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the intangible assets.

Goodwill and Other Intangible Assets

Our goodwill represents the excess of the cost over the fair value of net assets acquired. The determination of the value of goodwill and intangible assets arising from acquisitions requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of net tangible and intangible assets acquired. Goodwill is not amortized and is assessed for impairment using fair value measurement techniques on an annual basis or more frequently if facts and circumstances warrant such a review. Goodwill is tested at the reporting unit level as defined in the Glossary to ASC 350. Per this definition, a reporting unit is an operating segment or one level below an operating segment. The Company has determined the reporting units to be our legacy surgical

implants unit and the bracing reporting unit established with the acquisition of MD Ortho, Boston O&P and O&P clinics. The goodwill is considered to be impaired if we determine that the carrying value of either of our reporting units exceeds its respective fair value. No impairment charges were recorded in any of the years presented.

The Company tests goodwill for impairment annually in the fourth quarter by either performing a qualitative evaluation or a quantitative test. The quantitative assessment for goodwill requires us to estimate the fair value of our two reporting units using either an income or market approach or a combination thereof.

We have indefinite-lived trademark assets that are reviewed for impairment by performing a quantitative analysis, which occurs annually in the fourth quarter, utilizing balances as of October 1, or whenever events or changes in circumstances indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net discounted cash flows expected to be generated by the associated asset. If such assets are determined to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the assets. The calculation of the fair value of the trademark assets involves Level 3 fair value measurements. To estimate the fair value of the trademark asset and associated impairment, we utilized the relief-from-royalty method, which is a form of the income approach. This approach requires us to make significant estimates and assumptions including preparation of forecasted revenue, selection of a royalty rate and discount rate and estimate of the terminal year revenue growth rate.

Investments in Privately Held Companies

The Company determines whether its investments in privately held companies are debt or equity based on their characteristics. The Company also evaluates the investee to determine if the entity is a variable interest entity (“VIE”) and, if so, whether the Company is the primary beneficiary of the VIE, in order to determine whether consolidation of the VIE is required. If consolidation is not required and the Company does not have voting control of the entity, the investment is evaluated to determine if the equity method of accounting should be applied. The equity method applies to investments in common stock or in substance common stock where the Company exercises significant influence over the investee.

Investments in privately held companies determined to be equity securities are accounted for as non-marketable securities. The Company adjusts the carrying value of its non-marketable equity securities for changes from observable transactions for identical or similar investments of the same issuer, less impairment. All gains and losses on non-marketable equity securities, realized and unrealized, are recognized as a component of other expenses (income) in the consolidated statements of operations.

Investments in privately held companies determined to be debt securities are accounted for as available-for-sale or held-to-maturity securities unless the fair value option is elected.

Acquisition Payable and Contingent Consideration

Upon the completion of an acquisition the Company may record an acquisition installment payable, contingent consideration or both. Both are recorded at their fair values as determined by management with the assistance of an independent valuation specialist at the original issuance date and are adjusted on a recurring basis. Accretion of interest expense attributable to the acquisition installment payable are recorded as a component of interest expense (income), net. Changes in the fair value of the contingent consideration are included in fair value adjustments of contingent consideration. Both are included as a component of other expenses (income) on the consolidated statements of operations.

Shipping and Handling Costs

Shipping and handling costs that are billed to the customer are included in net revenue and were $1,385, $1,244 and $1,027, for the years ended December 31, 2024, 2023 and 2022, respectively. Shipping and handling costs that are not billed to the customer are included in sales and marketing expenses and were $6,827, $5,655 and $4,270, for the years ended December 31, 2024, 2023 and 2022, respectively.

Cost of Revenue

Cost of revenue consists primarily of products purchased from third-party suppliers, excess and obsolete inventory adjustments, inbound freight, royalties, material, labor and overhead related to the manufacturing of our braces. Our implants and instruments are manufactured to our specifications by third-party suppliers who meet our manufacturer qualifications standards. We purchase the raw materials to make our specialized bracing products in our facilities in Wayland, IA and Boston, MA. Our manufacturing sites as well as our third-party manufacturers are required to meet Food and Drug Administration (the “FDA”), International Organization for Standardization and other country-specific quality standards. The majority of our implants, instruments, and braces are produced in the United States.

Sales and Marketing Expenses

Sales and marketing expenses primarily consist of commissions to our domestic and select international independent sales agencies and consignment distributors, as well as compensation, commissions, benefits and other related costs, including stock-based compensation, for personnel we employ. Commissions and bonuses are generally based on a percentage of sales. Our international independent stocking distributors purchase instrument sets and replenishment stock for resale, and we do not pay commissions or any other sales related costs for international sales to distributors.

Advertising Costs

Research and Development Costs

Research and development costs are expensed as incurred. Our research and development expenses primarily consist of costs associated with engineering, product development, consulting services, outside prototyping services, outside research activities, materials, development and protection of our intellectual property portfolio, as well as other costs associated with development of our products. Research and development costs also include related personnel and consultants’ compensation expense, including stock-based compensation.

Stock-Based Compensation

Prior to our IPO, we maintained an Amended and Restated 2007 Equity Incentive Plan (the “2007 Plan”) that provides for grants of options and restricted stock to employees, directors and associated third-party representatives of our company as determined by the Board of Directors. The 2007 Plan had authorized 1,585,000 shares for award.

Immediately prior to our IPO, we adopted our 2017 Incentive Award Plan (the “2017 Plan”) which replaced the 2007 Plan. The 2017 Plan provides for grants of options and restricted stock to officers, employees, consultants or directors of our Company. The 2017 Plan has authorized 1,832,460 shares for award.

In 2024 we adopted the 2024 Incentive Award Plan (the "2024 Plan") which replaced the 2017 Plan. The 2024 Plan provides for grants of options and restricted stock to officers, employees, consultants or directors of the Company. The 2024 Plan has authorized 1,629,000 shares for award. As of December 31, 2024, the 2024 Plan had 1,231,564 shares available for issuance.

Options holders, upon vesting, may purchase common stock at the exercise price, which is the estimated fair value of our common stock on the date of grant. Option grants generally vest immediately or over a three-year period. No stock options were granted in any of the periods presented.

Restricted stock may not be transferred prior to the expiration of the restricted period. The restricted stock that has been granted under the 2007 Plan has restriction periods that generally last until the earlier of six years from the date of grant, or an initial public offering or change in control, as defined in the 2007 Plan. All restricted stock granted prior to May 2014 vested upon our IPO and the remaining grants under the 2007 Plan vested in April 2018. The restricted stock that has been granted under the 2017 Plan typically vests at the end of a three-year period. Remaining grants under the 2017 Plan will vest by February 2027. Generally under the 2024 Plan, restricted stock vests at the end of a three-year period. We have elected to recognize the reversal of stock compensation expense when a restricted stock forfeiture occurs as opposed to estimating future forfeitures.

We record the fair value of restricted stock at the grant date. Stock-based compensation is recognized ratably over the requisite service period, which is generally the restriction period for restricted stock.

Comprehensive Loss

Comprehensive loss is defined as the change in equity during a period from transactions and other events and circumstances from non-owner sources. Comprehensive loss includes foreign currency translation adjustments and unrealized gains (losses) on marketable securities.

Income Taxes

We account for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, we determine deferred tax assets and liabilities on the basis of the differences between the financial statement and tax bases of assets and liabilities by using enacted tax rates in effect for the year in which the differences are expected to reverse. The effect of a change in tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date.

We recognize deferred tax assets to the extent that we believe that these assets are more likely than not to be realized. In making such a determination, we consider all available positive and negative evidence. If we determine that we would be able to realize our deferred tax assets in the future in excess of their net recorded amount, we would make an adjustment to the valuation allowance.

We record uncertain tax positions on the bases of a two-step process in which (1) we determine whether it is more likely than not that the tax positions will be sustained on the basis of the technical merits of the positions and (2) for those tax positions that do not meet the more-likely-than-not recognition threshold, we recognize the largest amount of tax benefit that is more than 50% likely to be realized upon ultimate settlement with the related tax authority.

Litigation and Contingencies

Accruals for litigation and contingencies are reflected in the consolidated financial statements based on

management’s assessment, including advice of legal counsel, of the expected outcome of litigation or other dispute resolution proceedings and/or the expected resolution of contingencies. Liabilities for estimated losses are accrued if the potential loss from any claim or legal proceeding is considered probable and the amount can be reasonably estimated. Significant judgment is required in both the determination of probability of loss and the determination as to whether the amount is reasonably estimable. Accruals are based only on information available at the time of the assessment due to the uncertain nature of such matters. As additional information becomes available, management reassesses potential liabilities related to pending claims and litigation and may revise its previous estimates, which could materially affect the Company’s results of operations in a given period.

Debt Issuance Costs

Debt issuance costs are deferred and presented as a reduction to long-term debt. Debt issuance costs are amortized using the effective interest rate method over the term of the loan. Amortization of deferred debt issuance costs are included within interest expense (income), net in the consolidated statements of operations.

Leases

At the inception of a contractual arrangement, the Company determines whether the contract is or contains a lease by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company calculates the associated lease liability and corresponding right-of-use asset upon lease commencement using a discount rate based on a borrowing rate commensurate with the term of the lease.

The Company has elected not to recognize leases with an original term of one year or less on the balance sheet. The Company typically only includes an initial lease term in its assessment of a lease arrangement. Options to renew a lease are not included in the Company’s assessment unless there is reasonable certainty that the Company will renew. Assumptions made by the Company at the commencement date are re-evaluated upon occurrence of certain events, including a lease modification. A lease modification results in a separate contract when the modification grants the lessee an additional right of use not included in the original lease and when lease payments increase commensurate with the standalone price for the additional right of use. When a lease modification results in a separate contract, it is accounted for in the same manner as a new lease.

Operating lease liabilities and their corresponding right-of-use assets are initially recorded based on the present value of lease payments over the expected remaining lease term. Certain adjustments to the right-of-use asset may be required for items such as incentives received. The interest rate implicit in lease contracts is typically not readily determinable. As a result, the Company utilizes its incremental borrowing rate to discount lease payments, which reflects the fixed rate at which the Company could borrow on a collateralized basis the amount of the lease payments in the same currency, for a similar term, in a similar economic environment. To estimate its incremental borrowing rate, the Company considers its current interest rate on its secured Term Loan, adjusted as necessary based on the lease term and the Company’s credit spread.

The Company records lease liabilities within current liabilities or long-term liabilities based upon the length of time associated with the lease payments. The Company records its operating lease right-of-use assets within other non-current assets. The Company has elected to account for lease and non-lease components together as a single lease component for all underlying assets.

Reclassification

In the consolidated financial statements, the Company has reclassified stock-based compensation to conform to the current period presentation. All stock-based compensation was previously recorded within general and administrative expenses, and such costs have now been allocated between general and administrative expenses, research and development expenses and sales and marketing expenses. The current presentation results in stock-based compensation expense being recorded in the same manner in which the award recipient's payroll costs are classified. This reclassification did not affect previously reported total operating expenses, loss before income taxes, or net loss in the consolidated statements of operations.

Recent Accounting Pronouncements

In October 2023, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("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 ASU 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 consolidated financial statements.

In November 2023, the FASB issued ASU No. 2023-07, "Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures." The standard requires disclosure of significant segment expenses that are regularly provided to the chief operating decision maker ("CODM") and included within each reported measure of segment profit or loss, an amount and description of its composition for other segment items to reconcile to segment profit or loss, and the title and position of the entity's CODM. The amendments in this update also expand the interim segment disclosure requirements. We adopted this ASU for the annual period ended December 31, 2024 retrospectively for all periods presented. See Note 13 - Business Segments for additional information.

In December 2023, the FASB issued ASU No. 2023-09, "Income Taxes (Topic 740): Improvements to Income Tax Disclosures" (ASU 2023-09), which enhances the transparency and decision usefulness of income tax disclosures. The ASU is effective for public companies for fiscal years beginning on or after December 15, 2024, with early adoption permitted. The amendments in ASU 2023-09 should be applied on a prospective basis. Retrospective application is permitted. We are currently evaluating the effect of this ASU on our consolidated financial statements and disclosures.

In November 2024, the FASB issued ASU No. 2024-03, "Disaggregation of Income Statement Expenses" which requires disaggregated disclosure of income statement expenses into specified categories in disclosures within the footnotes to the financial statements. The standard is effective for annual periods beginning after December 15, 2026. We are currently evaluating the effect of this ASU on our consolidated financial statements and disclosures.

DEBT AND CREDIT ARRANGEMENTS - Midcap Credit Agreement (Details) - USD ($) $ in Thousands				12 Months Ended
	Dec. 29, 2023	Jun. 13, 2022	Dec. 30, 2021	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument
Loss on early extinguishment of debt				$ 3,230	$ 0	$ 0
Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt instrument, maximum distribution per tranche	$ 50,000
Revolving Credit Facility \| Fourth Amended Loan Agreement
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]		Secured Overnight Financing Rate (SOFR) [Member]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)		8.69%	8.61%
Interest rate		10.00%	10.00%
Unused commitment fee percentage (as a percent)	0.50%		0.50%
Revolving Credit Facility \| Term Loan
Debt Instrument
Debt instrument, maximum distribution per tranche	$ 10,000
Debt instrument, debt repayment trigger, as a basis of capital stock ownership (percent)	35.00%
Revolving Credit Facility \| Security and Guaranty Agreement
Debt Instrument
Debt instrument, liquidity requirement				10,000
Loss on early extinguishment of debt				$ 3,230
Option One \| Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)	6.50%
Interest rate	9.00%
Option Two \| Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)	4.00%
Applicable debt rate (percent)	6.50%

EMPLOYEE BENEFIT PLAN (Details) - USD ($) $ in Thousands	12 Months Ended
EMPLOYEE BENEFIT PLAN (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Business Acquisition
Percentage of employees' contribution match (up to)	4.00%	4.00%	4.00%
Employee contributions matched	$ 1,130	$ 900	$ 718
MD Orthopaedics
Business Acquisition
Percentage of employees' contribution match (up to)	3.00%

PROPERTY AND EQUIPMENT, NET - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 10,948	$ 10,236	$ 7,121

SIGNIFICANT ACCOUNTING POLICIES - Accounts Receivable and Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Accounts Receivable, Allowance for Credit Loss
Balance at beginning of year	$ 1,373	$ 1,056	$ 347
Adjustments charged to expense (income)	101	499	723
Write-offs & other adjustments	(1,132)	(182)	(174)
Carrying amount as a result of acquisitions	803	0	160
Balance at end of year	$ 1,145	$ 1,373	$ 1,056

GOODWILL AND INTANGIBLE ASSETS - Future Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Year Ending December 31:
2025	$ 7,676
2026	7,669
2027	7,264
2028	6,319
2029	6,186
Thereafter	29,313
Net Intangible Assets	$ 64,427	$ 69,275

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Pro Forma Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Net revenue	$ 205,158	$ 176,154
Net loss	$ (37,849)	$ (20,510)

SIGNIFICANT ACCOUNTING POLICIES - Shipping and Handling Costs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
New Accounting Pronouncements or Change in Accounting Principle
Cost of revenue	$ 56,129	$ 37,479	$ 31,629
Shipping and Handling, Billed
New Accounting Pronouncements or Change in Accounting Principle
Cost of revenue	1,385	1,244	1,027
Shipping and Handling, Not Billed
New Accounting Pronouncements or Change in Accounting Principle
Cost of revenue	$ 6,827	$ 5,655	$ 4,270

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476173/280-10-65-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476173/280-10-65-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)(4)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 9
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482615/740-10-65-9

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 9
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482615/740-10-65-9

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 9
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482615/740-10-65-9

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 105
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 7
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479343/105-10-65-7

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (d)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 848
-SubTopic 10
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (a)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483550/848-10-65-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480016/944-40-65-2

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
-Subparagraph (g)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478666/740-323-65-2

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 323
-Name Accounting Standards Codification
-Section 65
-Paragraph 2
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-Topic 946
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Reference 99: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
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-Paragraph 1
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Reference 100: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
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-Section 65
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-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476166/350-60-65-1

+ Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Jan. 05, 2024	Dec. 31, 2024	Dec. 31, 2023
Liabilities:
Goodwill		$ 93,844	$ 83,699
Boston O&P acquisition
Business Acquisition
Fair value of estimated total acquisition consideration	$ 21,535
Assets:
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities:
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,617
Other non-current liabilities	1,803
Total liabilities	8,222
Less: total net assets	13,178
Goodwill	$ 8,357

SIGNIFICANT ACCOUNTING POLICIES

12 Months Ended

Dec. 31, 2024

Accounting Policies [Abstract]

SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation

We have prepared the accompanying consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying 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 $235,564 and $197,742 as of December 31, 2024 and 2023, respectively.

Use of Estimates

Foreign Currency Transactions

We currently bill our international stocking distributors in U.S. dollars, resulting in minimal foreign exchange transaction expense.

Fair Value of Financial Instruments

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

Revenue from Contracts with Customers

Revenue Recognition – United States

Revenue Recognition – International

Cash, Cash Equivalents and Short Term Investments

Restricted Cash

Accounts Receivable

The following table summarizes activity in our reserves recorded against accounts receivable:


	December 31,
	2024		2023		2022
Balance at beginning of year	$	1,373	$	1,056	$	347
Adjustments charged to expense (income)	101		499		723
Write-offs & other adjustments	(1,132)		(182)		(174)
Carrying amount as a result of acquisitions	803		—		160
Balance at end of year	$	1,145	$	1,373	$	1,056

Inventories, net

In addition, we continue to introduce new products, which may require us to take additional charges for excess and obsolete inventory in the future.

Charges for excess and obsolete inventory are included in cost of revenue and were $914, $995 and $1,011 for the years ended December 31, 2024, 2023 and 2022, respectively. We also incurred an additional charge during 2024 of $1,756 for excess and obsolete inventory in connection with our 2024 Restructuring Plan that is included within restructuring expense in the consolidated statement of operations. See Note 4 - Restructuring for additional information.

Costs Related to Common Stock Offerings

On August 15, 2022, we completed a public offering of our common stock and pre-funded warrants exercisable for an aggregate of up to 1,525,000 shares of common stock to Squadron Capital LLC (“Squadron”), our largest investor. Offering expenses of $293, primarily consisting of legal, accounting and other direct fees and costs related to the offering were recorded in stockholders' equity at the conclusion of our offering.

Property and Equipment, net

Sample inventory consists of our implants and instruments, and is maintained to market and promote our products. Sample inventory is carried at cost less accumulated depreciation.

Depreciable lives are generally as follows:


Building and building improvements			25 to 30 years
Furniture and fixtures			5 to 7 years
Computer equipment			3 to 5 years
Business software			3 years
Office and other equipment			5 to 7 years
Instruments			5 years
Sample inventory			2 years

Amortizable Intangible Assets, net

Goodwill and Other Intangible Assets

During 2024, 2023, and 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 associated 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 impairment charges of $1,836, $985, and $3,609 for the years ended December 31, 2024, 2023 and 2022, respectively, to reduce the carrying amount of the intangible asset to its estimated fair value. No impairment charges were recorded in any of the other periods presented or for any other indefinite-lived trademark assets.

Investments in Privately Held Companies

Investments in privately held companies determined to be debt securities are accounted for as available-for-sale or held-to-maturity securities unless the fair value option is elected. The Company has investments of $2,180 as and $1,855 of December 31, 2024 and 2023, respectively. which are recorded within other non-current assets on its consolidated balance sheet.

Acquisition Payable and Contingent Consideration

years ended December 31, 2024, 2023 and 2022, respectively related to the accretion of the acquisition installment payable. Adjustments in the fair value of the contingent consideration payment were recognized as income of $0, $2,980 and $25,930 for the years ended December 31, 2024, 2023 and 2022, respectively. Following the fourth year anniversary of our acquisition of ApiFix in April 2024, the sales performance period associated with our ApiFix system sales milestone ended, and no additional amounts were owed to the sellers. There is no additional contingent consideration owed as of December 31, 2024.

Shipping and Handling Costs

Cost of Revenue

Sales and Marketing Expenses

Advertising Costs

Advertising costs consist primarily of print advertising, trade shows, and other related expenses. Advertising costs are expensed as incurred and are recorded as a component of sales and marketing expense. Advertising costs were $2,395, $2,409 and $1,906 for the years ended December 31, 2024, 2023 and 2022, respectively.

Research and Development Costs

Stock-Based Compensation

Comprehensive Loss

Income Taxes

Litigation and Contingencies

Accruals for litigation and contingencies are reflected in the consolidated financial statements based on

Debt Issuance Costs

Leases

Reclassification

The following tables present the impact of the reclassification on our consolidated statements of operations for the years ended December 31, 2023 and 2022:


	Year Ended December 31,
	2023		2022
Sales and marketing (prior presentation)	$	51,402	$	45,053

Reclassification	1,422		1,041
Sales and marketing (new presentation)	$	52,824	$	46,094


	Year Ended December 31,
	2023		2022
General and administrative (prior presentation)	$	75,421	$	59,383
Reclassification	(2,121)		(1,479)
General and administrative (new presentation)	$	73,300	$	57,904


	Year Ended December 31,
	2023		2022
Research and development (prior presentation)	$	10,196	$	8,014
Reclassification	699		438
Research and development (new presentation)	$	10,895	$	8,452

Recent Accounting Pronouncements

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

NET (LOSS) EARNINGS PER SHARE

12 Months Ended

Dec. 31, 2024

Earnings Per Share [Abstract]

NET (LOSS) EARNINGS PER SHARE

The following is a reconciliation of basic and diluted net (loss) earnings per share attributable to common stockholders:


	Year Ended December 31,
	2024		2023		2022
Net (loss) income	$	(37,822)	$	(20,974)	$	1,258
Less: Earnings allocated to participating securities	—		—		23
Net (loss) income available to common shareholders	$	(37,822)	$	(20,974)	$	1,235

Denominator for basic and diluted net (loss) income per share
Weighted average shares outstanding for basic	23,077,704		22,675,477		20,704,556
Weighted average shares outstanding for diluted	23,077,704		22,675,477		20,947,727

(Loss) earnings per share:
Basic	$	(1.64)	$	(0.92)	$	0.06
Diluted	$	(1.64)	$	(0.92)	$	0.06

Our basic and diluted net income (loss) per share is computed using the two-class method. 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 following table shows the contingently issuable and convertible equity shares that were excluded from the calculation of diluted net earnings (loss) per share because their effect would have been anti-dilutive:


	Year Ended December 31,
	2024	2023	2022


Restricted stock	1,065,744	606,304	413,404
Stock options	—	—	3,556

	1,065,744	606,304	416,960

The contingently issuable shares in the table 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, or our convertible note. As of December 31, 2024, we are obligated to issue additional shares of our common stock to the sellers of MedTech. See Note 3 - Business Combinations and Asset Acquisitions for additional information. We are obligated to issue additional shares of our common stock to Braidwell in the event that our convertible note is converted into shares of common stock. See Note 9 - Debt and Credit Arrangements for additional information.

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Statement of Comprehensive Income [Abstract]
Net (loss) income	$ (37,822)	$ (20,974)	$ 1,258
Other comprehensive (loss) income:
Foreign currency translation adjustment	(5,090)	(1,631)	(14,570)
Unrealized (loss) gain on short term investments	(276)	68	(871)
Adjustment for realized gains	119	1,437	1,550
Other comprehensive loss, net of tax	(5,247)	(126)	(13,891)
Comprehensive loss	$ (43,069)	$ (21,100)	$ (12,633)

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income, attributable to parent entity. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

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

+ References

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+ Details

DEBT AND CREDIT ARRANGEMENTS - Squadron Revolver and Other Debt (Details) - USD ($)				12 Months Ended
	Dec. 29, 2023	Jun. 13, 2022	Dec. 30, 2021	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument
Mortgage balance				$ 77,483,000	$ 11,063,000
Less: current maturities				897,000	152,000
Interest expense				$ 35,000	42,000	$ 525,000
Mortgage payable to affiliate
Debt Instrument
Interest rate				5.00%
Monthly interest and principal installments				$ 16,000
Mortgage balance				611,000	763,000
Less: current maturities				$ 160,000	152,000
Revolving Credit Facility \| Fourth Amended Loan Agreement
Debt Instrument
Revolving credit facility					$ 50,000,000
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]		Secured Overnight Financing Rate (SOFR) [Member]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)		8.69%	8.61%
Interest rate		10.00%	10.00%
Unused commitment fee percentage (as a percent)	0.50%		0.50%

LEASES

12 Months Ended

Dec. 31, 2024

Leases [Abstract]

LEASES

As of December 31, 2024, and 2023 we have recorded an operating lease liability of $7,781 and $1,000, respectively, and a corresponding right-of-use asset of $8,237 and $1,084, respectively, on our consolidated balance sheets. The increase during 2024 is primarily the result of our Boston O&P acquisition and our subsequent O&P clinic acquisitions where office space is leased at or in close proximity to pediatric hospitals to better serve our patients.

Short-term lease costs were not material for the years ended December 31, 2024, 2023 or 2022. The components of lease expense and supplemental cash flow information were as follows for the years ended December 31, 2024, 2023 and 2022:


	For the Years Ended December 31,
	2024		2023		2022
Operating lease cost	$	1,776	$	263	$	148
Cash paid for amounts included in the measurement of lease liabilities	$	2,082	$	305	$	32
Right-of-use assets obtained in exchange for new lease liabilities, including leases assumed through business combinations	$	8,957	$	706	$	213

Supplemental balance sheet information related to our operating leases as of December 31, 2024 and 2023 includes:


	As of December 31,
	2024		2023
Right-of-use assets recognized in Other non-current assets	$	8,237	$	1,084
Lease liabilities recognized in Other current liabilities	2,120		340
Lease liabilities recognized in Other long-term liabilities	5,661		660
Weighted-average remaining lease term	4.5 years		3.3 years
Weighted-average discount rate	11.2%		11.7%

Our future minimum lease payments as of December 31, 2024 were:



For the Years Ended December 31,
2025	$	2,913
2026	2,397
2027	1,844
2028	1,468
2029	1,054
Thereafter	973
Total	10,649
Less imputed interest	2,868
Total	$	7,781

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Statement [Abstract]
Net revenue	$ 204,727	$ 148,732	$ 122,289
Cost of revenue	56,129	37,479	31,629
Gross profit	148,598	111,253	90,660
Operating expenses:
Sales and marketing	64,296	52,824	46,094
General and administrative	102,789	73,300	57,904
Tradename impairment	1,836	985	3,609
Restructuring	3,653	0	0
Research and development	11,034	10,895	8,452
Total operating expenses	183,608	138,004	116,059
Operating loss	(35,010)	(26,751)	(25,399)
Other expenses (income):
Interest expense (income), net	2,621	(198)	2,424
Loss on early extinguishment of debt	3,230	0	0
Fair value adjustment of contingent consideration	0	(2,980)	(25,930)
Other expense (income)	1,068	(2,261)	1,796
Total other expenses (income), net	6,919	(5,439)	(21,710)
Net loss before income taxes	(41,929)	(21,312)	(3,689)
Income tax benefit	(4,107)	(338)	(4,947)
Net (loss) income	$ (37,822)	$ (20,974)	$ 1,258
Weighted average shares outstanding
Basic (in shares)	23,077,704	22,675,477	20,704,556
Diluted (in shares)	23,077,704	22,675,477	20,947,727
Earnings Per Share [Abstract]
Basic (in dollars per share)	$ (1.64)	$ (0.92)	$ 0.06
Diluted (in dollars per share)	$ (1.64)	$ (0.92)	$ 0.06

ACCRUED COMPENSATION AND BENEFITS

12 Months Ended

Dec. 31, 2024

ACCRUED COMPENSATION AND BENEFITS

Accrued compensation and benefits consisted of the following:


	December 31,
	2024		2023
Accrued compensation and related costs	$	6,368	$	4,279
Accrued commissions	7,520		7,046
Total accrued compensation and benefits	$	13,888	$	11,325

SIGNIFICANT ACCOUNTING POLICIES - Schedule of Reclassifications (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Reclassification
Sales and marketing	$ 64,296	$ 52,824	$ 46,094
General and administrative	102,789	73,300	57,904
Research and development	$ 11,034	10,895	8,452
Previously Reported
Reclassification
Sales and marketing		51,402	45,053
General and administrative		75,421	59,383
Research and development		10,196	8,014
Reclassification
Reclassification
Sales and marketing		1,422	1,041
General and administrative		(2,121)	(1,479)
Research and development		$ 699	$ 438

RESTRUCTURING - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2025	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Restructuring Cost and Reserve
Restructuring and asset impairment charges		$ 3,653	$ 0	$ 0
2024 Restructuring Plan
Restructuring Cost and Reserve
Restructuring and related cost, expected cost remaining		3,877
Restructuring and asset impairment charges		3,653
Restructuring		$ 1,306
2024 Restructuring Plan \| Forecast
Restructuring Cost and Reserve
Restructuring	$ 246

- 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 + Details

LEASES (Tables)

12 Months Ended

Dec. 31, 2024

Leases [Abstract]

Schedule of Information on Leases


	For the Years Ended December 31,
	2024		2023		2022
Operating lease cost	$	1,776	$	263	$	148
Cash paid for amounts included in the measurement of lease liabilities	$	2,082	$	305	$	32
Right-of-use assets obtained in exchange for new lease liabilities, including leases assumed through business combinations	$	8,957	$	706	$	213

Supplemental balance sheet information related to our operating leases as of December 31, 2024 and 2023 includes:


	As of December 31,
	2024		2023
Right-of-use assets recognized in Other non-current assets	$	8,237	$	1,084
Lease liabilities recognized in Other current liabilities	2,120		340
Lease liabilities recognized in Other long-term liabilities	5,661		660
Weighted-average remaining lease term	4.5 years		3.3 years
Weighted-average discount rate	11.2%		11.7%

Schedule of Future Minimum Lease Payments for Operating Leases

Our future minimum lease payments as of December 31, 2024 were:



For the Years Ended December 31,
2025	$	2,913
2026	2,397
2027	1,844
2028	1,468
2029	1,054
Thereafter	973
Total	10,649
Less imputed interest	2,868
Total	$	7,781

BUSINESS SEGMENT - Schedule of Revenue by Category (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information
Total	$ 204,727	$ 148,732	$ 122,289
Trauma and deformity
Segment Reporting Information
Total	145,126	106,781	85,055
Scoliosis
Segment Reporting Information
Total	55,153	37,933	33,428
Sports medicine/other
Segment Reporting Information
Total	$ 4,448	$ 4,018	$ 3,806

- 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.

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+ Details

NET (LOSS) EARNINGS PER SHARE - Antidilutive Securities (Details) - shares	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share
Antidilutive securities excluded from computation of earnings per share (in shares)	1,065,744	606,304	416,960
Restricted stock
Antidilutive Securities Excluded from Computation of Earnings Per Share
Antidilutive securities excluded from computation of earnings per share (in shares)	1,065,744	606,304	413,404
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share
Antidilutive securities excluded from computation of earnings per share (in shares)	0	0	3,556

RESTRUCTURING - Schedule of Restructuring Reserve by Type of Cost (Details) - 2024 Restructuring Plan $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($)
Restructuring Charges
Beginning balance	$ 0
Restructuring	1,306
Payments	(234)
Ending balance	$ 1,072
Restructuring Charges, Statement of Income or Comprehensive Income [Extensible Enumeration]	Restructuring

SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Accounting Policies [Abstract]
Accumulated deficit	$ 235,564	$ 197,742

- Definition

Amount of accumulated undistributed earnings (deficit).

+ References + Details

Cover - USD ($) $ in Millions	12 Months Ended
Cover - USD ($) $ in Millions	Dec. 31, 2024	Mar. 01, 2025	Jun. 30, 2024
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2024
Current Fiscal Year End Date	--12-31
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 12(b) Security	Common Stock, $0.00025 par value per share
Trading Symbol	KIDS
Security Exchange Name	NASDAQ
Entity Well Known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Entity Public Float			$ 263.4
Entity Common Stock, Shares Outstanding		24,286,590
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s definitive proxy statement for its 2025 Annual Meeting of Stockholders are incorporated by reference into Part III of this Form 10-K.
Document Fiscal Period Focus	FY
Amendment Flag	false
Document Fiscal Year Focus	2024
Entity Central Index Key	0001425450

EMPLOYEE BENEFIT PLAN	12 Months Ended
EMPLOYEE BENEFIT PLAN	Dec. 31, 2024
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. OrthoPediatrics Corp. matches our employees' 401(k) contributions up to 4%. Employees of MD Ortho and Boston O&P receive contribution matches up to 3% of their salary. For the years ended December 31, 2024, 2023 and 2022, the total 401(k) match resulted in expense of $1,130, $900 and $718, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

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

INCOME TAXES (Tables)

12 Months Ended

Dec. 31, 2024

Income Tax Disclosure [Abstract]

Schedule of Components of Income Tax Benefit

Total income tax benefit for the years ended December 31, 2024, 2023 and 2022 was allocated as follows:


	2024		2023		2022
Total income tax benefit	$	(4,107)	$	(338)	$	(4,947)

The components of income tax benefit for the years ended December 31, 2024, 2023 and 2022 are as follows:


	2024		2023		2022
Current:
Federal	$	—	$	—	$	—
State	104		85		68
Foreign	525		740		17
	629		825		85

Deferred:
Federal	$	—	$	—	$	—
State	—		—		—
Foreign	(2,107)		(1,163)		(2,018)


Decrease in valuation allowance	(2,629)		—		(3,014)
Total income tax benefit	$	(4,107)	$	(338)	$	(4,947)

Schedule of Income before Income Tax, Domestic and Foreign

For the years ended December 31, 2024, 2023 and 2022 loss before taxes of the Company consists of the following:


	2024		2023		2022
Domestic	$	(27,327)	$	(12,582)	$	6,451
Foreign	(14,602)		(8,730)		(10,140)
Total	$	(41,929)	$	(21,312)	$	(3,689)

Schedule of Reconciliation Between the Effective Tax Rate and the Statutory Tax Rate

The reconciliation between the effective tax rate and the statutory tax rate is as follows:


	December 31,
	2024		2023		2022
Federal statutory rate	21.0	%	21.0	%	21.0	%
State statutory rate, net of federal benefit	1.8	%	1.2	%	(6.3)	%
Effect of foreign rates different from statutory	0.5	%	0.2	%	6.4	%
Change in state rate	0.4	%	(0.3)	%	0.9	%
Excess tax benefits from stock plans	(1.2)	%	(0.2)	%	9.6	%
Nondeductible/nontaxable or other items	9.3	%	(3.3)	%	(22.1)	%
Unborn foreign tax deduction	(1.7)	%	(0.5)	%	6.8	%
US benefit of foreign branches	8.0	%	8.6	%	64.4	%
Nondeductible executive compensation	(0.1)	%	(1.0)	%	(4.4)	%
Change in valuation allowance	(28.2)	%	(24.1)	%	57.8	%
Income tax benefit	9.8	%	1.6	%	134.1	%

Schedule of Deferred Tax Assets and Liabilities

The deferred tax assets and liabilities consisted of the following at December 31, 2024 and 2023:


	2024		2023
Deferred tax assets:
Inventories, net	$	4,236	$	5,979
Stock-based compensation	4,996		3,158
Loss carryforwards	50,831		42,199
Credit carryforwards	176		176
Interest carryforward	534		134

Lease liabilities	2,103		615
Other	1,360		507
Total deferred tax assets	64,236		52,768
Valuation allowance	(53,742)		(41,927)
Net deferred tax assets	10,494		10,841
Deferred tax liabilities:
Intangibles	(8,726)		(14,426)
Property and equipment	(2,933)		(1,898)
Right-of-use assets	(2,216)		—
Total deferred tax liabilities	(13,875)		(16,324)
Deferred tax liabilities, net	$	(3,381)	$	(5,483)

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Narrative (Details) $ / shares in Units, $ in Thousands				1 Months Ended	12 Months Ended
	Jan. 05, 2024 USD ($) individual $ / shares shares	Jul. 01, 2023 USD ($) $ / shares shares	May 01, 2023 USD ($) $ / shares shares	Apr. 30, 2018	Dec. 31, 2024 USD ($) $ / shares shares	Dec. 31, 2023 USD ($) $ / shares	Dec. 31, 2022 USD ($)
Business Acquisition
Cash paid to acquire					$ 20,225	$ 0	$ 0
Common stock, par value (in dollars per share) \| $ / shares					$ 0.00025	$ 0.00025
Domestic Clinics \| Boston O&P acquisition
Business Acquisition
Total consideration transferred					$ 4,818
Cash consideration					3,388
Goodwill acquired					3,367
Domestic Clinics \| Boston O&P acquisition \| Promissory Note Maturing December 2025
Business Acquisition
Notes payable					$ 1,430
Interest rate					5.00%
Payments to acquire intangible assets					$ 680
Rhino Pediatric Orthopedic Designs, Inc.
Business Acquisition
Total consideration transferred		$ 1,024
Cash consideration		546
Transaction costs		46
Issuance of common stock		$ 478
Rhino Pediatric Orthopedic Designs, Inc. \| Common Stock
Business Acquisition
Shares issued as compensation (shares) \| shares		11,133
Common stock, par value (in dollars per share) \| $ / shares		$ 0.00025
Asset acquisition, share price (per share) \| $ / shares		$ 42.91
Medtech Concepts LLC
Business Acquisition
Total consideration transferred			$ 10,871
Cash consideration			3,000
Transaction costs			97
Issuance of common stock			2,274
Asset acquisition, total compensation			$ 15,274
Business combination, consideration paid in cash (as a percent)			50.00%
Stock based compensation capitalized			$ 4,500
Stock based compensation service period			4 years
Asset acquisition, contingent consideration, cash consideration					$ 1,250
Asset acquisition, contingent consideration (in shares) \| shares					4,288,000
Asset acquisition, contingent consideration value					$ 133
Installment payable					3,799
Asset acquisition, contingent consideration, liability, current					$ 1,347
Medtech Concepts LLC \| Intellectual Property
Business Acquisition
Finite-lived intangible assets acquired			$ 9,523
Intangible asset, useful life (in years)			10 years
Medtech Concepts LLC \| Trademarks
Business Acquisition
Indefinite-lived intangible assets acquired			$ 520
Medtech Concepts LLC \| Present Value
Business Acquisition
Total consideration transferred			10,043
Cash consideration			3,000
Transaction costs			97
Issuance of common stock			$ 2,274
Medtech Concepts LLC \| Common Stock
Business Acquisition
Shares issued as compensation (shares) \| shares			43,751,000
Common stock, par value (in dollars per share) \| $ / shares			$ 0.00025
Asset acquisition, share price (per share) \| $ / shares			$ 51.98
Aggregate value of equity consideration			$ 2,500
Business combination, consideration of unregistered common stock (as a percent)			50.00%
Restricted stock
Business Acquisition
Vesting period (in years)				6 years	3 years
Share-Based Payment Arrangement \| Medtech Concepts LLC
Business Acquisition
Asset acquisition, contingent consideration (in shares) \| shares					38,594,000
Boston O&P acquisition
Business Acquisition
Cash paid to acquire	$ 21,535
Issuance of common stock	$ 2,500
Goodwill acquired					$ 8,357
Boston O&P acquisition \| Trademarks
Business Acquisition
Indefinite-lived intangible assets acquired					$ 3,610
Boston O&P acquisition \| Restricted stock
Business Acquisition
Vesting period (in years)	3 years
Business combination, number of individuals received restricted stock awards \| individual	170
Consideration for acquisition (in shares) \| shares	83,000
Common stock (in dollars per share) \| $ / shares	$ 30.12

SIGNIFICANT ACCOUNTING POLICIES - Costs Related to Common Stock Offerings (Details) - Public Offering - Squadron - Common Stock shares in Thousands, $ in Thousands	Aug. 15, 2022 USD ($) shares
Class of Stock
Warrants and rights outstanding (shares) \| shares	1,525
Initial public offering costs, capitalized \| $	$ 293

- 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

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
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Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(d))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
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-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Name Accounting Standards Codification
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-Paragraph 13
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-13

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-14

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Subparagraph (c)
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-URI https://asc.fasb.org/1943274/2147481112/505-10-50-18

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 210
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-Section S99
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 3
-Subparagraph (SX 210.6-03(i)(2)(ii))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479886/946-10-S99-3

+ Details

Insider Trading Policies and Procedures	12 Months Ended
Insider Trading Policies and Procedures	Dec. 31, 2024
Insider Trading Policies and Procedures [Line Items]
Insider Trading Policies and Procedures Adopted	true

LEASES - Schedule of Information on Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease cost	$ 1,776	$ 263	$ 148
Cash paid for amounts included in the measurement of lease liabilities	2,082	305	32
Right-of-use assets obtained in exchange for new lease liabilities, including leases assumed through business combinations	$ 8,957	$ 706	$ 213

NET (LOSS) EARNINGS PER SHARE - Reconciliation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Earnings Per Share [Abstract]
Net (loss) income	$ (37,822)	$ (20,974)	$ 1,258
Less: Earnings allocated to participating securities - basic			23
Less: Earnings allocated to participating securities - diluted	0	0	23
Net (loss) income available to common shareholders - basic	(37,822)	(20,974)	1,235
Net (loss) income available to common shareholders - diluted	$ (37,822)	$ (20,974)	$ 1,235
Denominator for basic and diluted net (loss) income per share
Weighted average shares outstanding for basic (in shares)	23,077,704	22,675,477	20,704,556
Weighted average shares outstanding for diluted (in shares)	23,077,704	22,675,477	20,947,727
(Loss) earnings per share:
Loss (earnings) per share - basic (in dollars per share)	$ (1.64)	$ (0.92)	$ 0.06
Loss (earnings) per share - diluted (in dollars per share)	$ (1.64)	$ (0.92)	$ 0.06

FAIR VALUE OF FINANCIAL INSTRUMENTS (Tables)

12 Months Ended

Dec. 31, 2024

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 December 31, 2024 and 2023, respectively.


	December 31, 2024
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term Investments
Corporate Bonds	$	10,598	$	—	$	—	$	10,598
Treasury Bonds	$	9,274	$	—	$	—	$	9,274
Asset-Backed Securities	$	4,889	$	—	$	—	$	4,889
Exchange Trade Mutual Funds	$	252	$	—	$	—	$	252


	December 31, 2023
	Level 1		Level 2		Level 3		Total
Financial Assets

Short term Investments
Certificates of Deposit	$	—	$	25,792	$	—	$	25,792
Exchange Trade Mutual Funds	$	5,015	$	—	$	—	$	5,015
Treasury Bonds	$	18,235	$	—	$	—	$	18,235

Other	$	207	$	—	$	—	$	207

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

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


	Total

Balance at December 31, 2022	$	2,980
Change in fair value of contingent consideration	(2,980)
Balance at December 31, 2023	—
Change in fair value of contingent consideration	—
Balance at December 31, 2024	$	—

Schedule of Fair Value Measurement Inputs and Valuation Techniques

The recurring Level 3 fair value measurements of the contingent consideration liability associated with the ApiFix system sales milestone include the following significant unobservable inputs as of December 31, 2023 and 2022, respectively:


	December 31, 2023		December 31, 2022
Valuation techniques
Present value discount rate(1)	—	%	16.6	%
Volatility factor	—	%	48.0	%
Expected Years	0.4 years		1.4 years

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

INCOME TAXES - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Deferred tax assets:
Inventories, net	$ 4,236	$ 5,979
Stock-based compensation	4,996	3,158
Loss carryforwards	50,831	42,199
Credit carryforwards	176	176
Interest carryforward	534	134
Lease liabilities	2,103	615
Other	1,360	507
Total deferred tax assets	64,236	52,768
Valuation allowance	(53,742)	(41,927)
Net deferred tax assets	10,494	10,841
Deferred tax liabilities:
Intangibles	(8,726)	(14,426)
Property and equipment	(2,933)	(1,898)
Right-of-use assets	(2,216)	0
Total deferred tax liabilities	(13,875)	(16,324)
Deferred tax liabilities, net	$ (3,381)	$ (5,483)

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
OPERATING ACTIVITIES
Net (loss) income	$ (37,822)	$ (20,974)	$ 1,258
Adjustments to reconcile net income (loss) to net cash used in operating activities:
Impairment	1,836	985	3,609
Depreciation and amortization	19,080	17,385	13,099
Loss on early extinguishment of debt	3,230	0	0
Stock-based compensation	13,548	10,526	6,679
Fair value adjustment of contingent consideration	0	(2,980)	(25,930)
Accretion of acquisition installment payable	661	1,372	2,307
Deferred income taxes	(4,736)	(1,163)	(5,032)
Non-cash other	90	0	0
Accounts receivable - trade	(4,749)	(9,724)	(3,983)
Inventories	(13,197)	(26,279)	(16,938)
Prepaid expenses and other current assets	(1,561)	94	(506)
Accounts payable - trade	(4,280)	1,491	(209)
Accrued expenses and other liabilities	537	6,852	3,344
Other	315	(4,631)	536
Net cash used in operating activities	(27,048)	(27,046)	(21,766)
INVESTING ACTIVITIES
Acquisition of Boston O&P, net of cash acquired	(20,225)	0	0
Clinic acquisitions, net of cash acquired	(2,882)	0	0
Acquisition of MedTech, net of cash acquired	0	(3,097)	0
Acquisition of Rhino assets	0	(546)	0
Acquisition of MDO, net of cash acquired	0	0	(8,360)
Acquisition of Pega, net of cash acquired	0	0	(31,730)
Sale of short-term marketable securities	49,855	112,904	46,872
Purchase of short-term marketable securities	(25,000)	(48,600)	(110,122)
Investment in private companies and purchases of licenses	(647)	(2,106)	0
Purchases of property and equipment	(14,263)	(16,878)	(10,031)
Net cash provided by (used in) investing activities	(13,162)	41,677	(113,371)
FINANCING ACTIVITIES
Payment of debt issuance costs	(3,407)	0	0
Proceeds from issuance of common stock, net of issuance costs	0	0	139,282
Proceeds from exercise of stock options	0	21	63
Payments on mortgage notes	(152)	(144)	(137)
Net cash provided by financing activities	53,135	7,301	135,974
Effect of exchange rate changes on cash	(175)	633	619
NET INCREASE IN CASH AND RESTRICTED CASH	12,750	22,565	1,456
Cash and restricted cash, beginning of period	33,027	10,462	9,006
Cash and restricted cash, end of period	45,777	33,027	10,462
SUPPLEMENTAL DISCLOSURES
Cash paid for interest	2,752	42	700
Transfer of instruments between property and equipment and inventory	420	57	(234)
Right-of-use assets obtained in exchange for lease liabilities	8,957	706	213
Debt issuance costs not yet paid	0	127	0
Related Party
FINANCING ACTIVITIES
Payments on debt with affiliate	0	0	(31,000)
Proceeds from issuance of debt	0	0	31,000
Nonrelated Party
FINANCING ACTIVITIES
Payments on debt with affiliate	(12,231)	0	0
Proceeds from issuance of debt	73,533	9,424	0
ApiFix
FINANCING ACTIVITIES
Installment payments	(2,250)	(2,000)	(3,234)
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	6,929	6,178	10,410
Medtech
FINANCING ACTIVITIES
Installment payments	(1,250)	0	0
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	133	2,274	0
Clinic Acquisitions
FINANCING ACTIVITIES
Installment payments	(1,108)	0	0
Rhino
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	0	478	0
MD Orthopaedics
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition	$ 0	$ 0	$ 9,707

INCOME TAXES - Components of Income from Continuing Operations Before Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Domestic	$ (27,327)	$ (12,582)	$ 6,451
Foreign	(14,602)	(8,730)	(10,140)
Net loss before income taxes	$ (41,929)	$ (21,312)	$ (3,689)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org/1943274/2147482785/280-10-55-48

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
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-Section 50
-Paragraph 30
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-30

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 7: http://fasb.org/us-gaap/role/ref/otherTransitionRef
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
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-Name Accounting Standards Codification
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-Paragraph 1
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Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-31

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477314/942-235-S99-1

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
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-Paragraph 1
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

+ Details

RESTRUCTURING (Tables)

12 Months Ended

Dec. 31, 2024

Restructuring and Related Activities [Abstract]

Schedule of Restructuring and Related Costs

The Company's restructuring expenses are comprised of the following:


	Year Ended December 31, 2024
Severance and employee costs	$	1,196
Write-down of inventory and property and equipment	1,771
Other exit costs	686
Balance at December 31, 2024	$	3,653

Schedule of Restructuring Reserve by Type of Cost


	Accrued Restructuring Balance
Balance at December 31, 2023	$	—
Restructuring charges	1,306
Payments	(234)
Balance at December 31, 2024	$	1,072

DEBT AND CREDIT ARRANGEMENTS

12 Months Ended

Dec. 31, 2024

Debt Disclosure [Abstract]

DEBT AND CREDIT ARRANGEMENTS

Long-term debt consisted of the following:


	December 31,
	2024		2023
Term loan and Final Payment	$	25,500	$	10,300
Convertible note	50,000		—
Mortgage payable to affiliate	611		763
Acquisition note payable	1,372		—
Total debt	77,483		11,063
Less: debt discount and issuance costs	3,630		1,003
Less: current maturities	897		152
Long-term debt, net of current maturities	$	72,956	$	9,908

Braidwell Term Loan

On August 5, 2024, the Company and its wholly owned domestic subsidiaries, as borrowers (collectively, the “Credit Parties”), entered into that certain Credit Agreement and Guaranty (the “Term Loan Agreement”), by and among the Credit Parties, any additional borrowers from time to time party thereto, any guarantors from time to time party thereto, one or more funds managed by Braidwell LP (“Braidwell”), as lenders, the other lenders from time to time party thereto (together with Braidwell, the “Term Lenders”), and Wilmington Trust, National Association, as agent (the “Term Agent”). The Term Loan Agreement provides for (i) an initial term loan facility in the initial principal amount of $25,000, which was funded in its entirety on August 12, 2024 and (ii) a delayed draw term loan facility (the “DDTL”) in an aggregate principal amount not to exceed $25,000, which, subject to certain conditions set forth in the Term Loan Agreement, may be drawn until August 5, 2025.

Loans borrowed pursuant to the Term Loan Agreement (the “Term Loans”) bear interest at a rate per annum equal to SOFR Interest Rate (as defined in the Term Loan Agreement and with a floor of 3.25%) plus 6.50%. The Company has the option to make a payment-in-kind interest payment equal to 1.00% per annum of the interest rate. The Term Loans do not amortize and will be interest-only until the August 5, 2029 maturity date, at which time all unpaid principal and accrued and unpaid interest, fees and expenses due under the Term Loan Agreement will become due and payable. The Company is obligated to pay certain upfront fees and agency fees in connection with the Term Loan Agreement.

The Company may pay all or a portion of the outstanding principal and accrued and unpaid interest under the Term Loan Agreement at any time upon prior notice to the Term Lenders subject to (i) a repayment fee schedule of, depending on when the repayment is made, 3.00% of the principal amount of any such repayment during the first 12 months of the Term Loan Agreement or applicable DDTL funding date, 2.00% of the principal amount of any such repayment during months 13 through 24 of the Term Loan Agreement or applicable DDTL funding date, 1.00% of the principal amount of any such repayment during months 25 through 36 of the Term Loan Agreement or applicable DDTL funding date, and —% thereafter and (ii) an exit fee equal to 2.00% of the principal amount of any such repayment ("Final Payment"). The Term Loan Agreement contains customary mandatory prepayment provisions. Once repaid or prepaid, the Term Loans may not be reborrowed.

The Term Loan Agreement includes customary conditions to borrowing, representations and warranties and covenants, including affirmative covenants and negative covenants that restrict the Credit Parties’ and their subsidiaries’ ability to, among other things, incur indebtedness, grant liens, merge or consolidate, make investments, dispose of assets, make acquisitions, pay dividends or make distributions, repurchase stock and enter into certain transactions with affiliates, in each case subject to certain exceptions. The Term Loan Agreement also has financial covenants requiring the Credit Parties to (i) maintain at all times unrestricted cash held in US accounts subject to Lenders’ first priority lien equal to at least 25% of the aggregate principal amount of any outstanding Term Loans and (ii) maintain certain minimum net product sales over a trailing twelve-month period as set forth therein.

The Term Loan Agreement also contains customary events of default, including among other things, the Credit Parties’ failure to make any principal or interest payments when due, the occurrence of certain bankruptcy or insolvency events, or the Credit Parties’ breach of the covenants under the Term Loan Agreement. Upon the

occurrence of an event of default, the Term Lenders may, among other things, accelerate the Credit Parties’ obligations under the Term Loan Agreement.

As security for their obligations under the Term Loan Agreement, the Credit Parties granted the Term Agent a continuing first priority security interest in substantially all of their assets (including intellectual property), subject to certain customary exceptions.

Braidwell Convertible Note

In addition to the Term Loans, on August 5, 2024, the Company entered into a Purchase Agreement (the “Purchase Agreement”) with Braidwell Transaction Holdings LLC – Series 10 (the “Purchaser”), whereby the Purchaser agreed to purchase $50,000 in aggregate principal amount of the Company’s 4.75% Convertible Senior Notes due February 15, 2030 (the “Notes”) for an aggregate purchase price of $49,500. The Notes were issued pursuant to, and are governed by, an indenture (the “Indenture”), dated as of August 12, 2024, between the Company and U.S. Bank Trust Company, National Association, as trustee (the “Trustee”).

The Notes represent the Company’s senior, unsecured obligations and are (i) equal in right of payment with the Company’s existing and future senior, unsecured indebtedness; (ii) senior in right of payment to the Company’s existing and future indebtedness that is expressly subordinated to the Notes; and (iii) effectively subordinated to the Company’s existing and future secured indebtedness, to the extent of the value of the collateral securing that indebtedness.

The Notes accrue interest at a rate of 4.75% per annum, payable quarterly in arrears on February 15, May 15, August 15, and November 15 of each year, beginning on November 15, 2024. The Notes will mature on February 15, 2030, unless earlier repurchased, redeemed, or converted. Before November 15, 2029, noteholders will have the right to convert their Notes only upon the occurrence of certain events, including, but not limited to, the Company’s common stock trading above 130% of the conversion price for a specified period, the Notes per $1 in principal amount trading below 98% of the product of the trading price of the Company’s common stock and the conversion rate, and certain fundamental changes to corporate structure. From and after November 15, 2029, noteholders may convert their Notes at any time at their election until the close of business on the second scheduled trading day immediately before the maturity date. The Company will settle conversions by paying or delivering, as applicable, cash, shares of its common stock, or a combination of cash and shares of its common stock, at the Company’s election. The initial conversion rate is 24.4021 shares of common stock per $1 principal amount of Notes, which represents an initial conversion price of approximately $40.98 per share of common stock. The conversion rate and conversion price are subject to customary adjustments upon the occurrence of certain events. In addition, if certain corporate events that constitute a “Make-Whole Fundamental Change” (as defined in the Indenture) occur, then the conversion rate will, in certain circumstances, be increased for a specified period of time.

The Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after February 21, 2028 and on or before the 30th scheduled trading day immediately before the maturity date, at a cash redemption price equal to the principal amount of the Notes to be redeemed, plus accrued and unpaid interest, if any, to, but excluding, the redemption date, but only if (i) the Notes are Freely Tradable (as defined in the Indenture) and any accrued and unpaid additional interest pursuant to the Notes has been paid as of the redemption date, and (ii) the last reported sale price per share of the Company’s common stock exceeds 140% of the conversion price on (1) each of at least 20 trading days, whether or not consecutive, during the 30 consecutive trading days ending on, and including, the trading day immediately before the date the Company sends the related redemption notice; and (2) the trading day immediately before the date the Company sends such notice. In addition, calling any Note for redemption will constitute a Make-Whole Fundamental Change with respect to that Note, in which case the conversion rate applicable to the conversion of that Note will be increased in certain circumstances if it is converted after it is called for redemption.

If certain corporate events that constitute a “Fundamental Change” (as defined in the Indenture) occur, then, subject to a limited exception for certain cash mergers, noteholders may require the Company to repurchase their Notes at a cash repurchase price equal to the principal amount of the Notes to be repurchased, plus accrued and unpaid interest, if any, to, but excluding, the fundamental change repurchase date. The definition of Fundamental Change includes certain business combination transactions involving the Company and certain de-listing events with respect to the Company’s common stock.

The Notes have customary provisions relating to the occurrence of “Events of Default” (as defined in the Indenture), which include the following: (i) certain payment defaults on the Notes (which, in the case of a default in the payment of interest on the Notes, will be subject to a 30-day cure period); (ii) the Company’s failure to send certain notices under the Indenture within specified periods of time; (iii) the Company’s failure to comply with certain covenants in the Indenture relating to the Company’s ability to consolidate with or merge with or into, or sell, lease, or otherwise transfer, in one transaction or a series of transactions, all or substantially all of the assets of the Company and its subsidiaries, taken as a whole, to another person; (iv) a default by the Company in its obligation to convert a note in accordance with the Indenture upon the exercise of the conversion right with respect thereto, if not cured within two business days after its occurrence; (v) a default by the Company in its other obligations or agreements under the Indenture or the Notes if such default is not cured or waived within 60 days after notice is given in accordance with the Indenture; (vi) certain defaults by the Company or any of its significant subsidiaries with respect to indebtedness for borrowed money of at least $25,000; (vii) the rendering of certain judgments against the Company or any of its significant subsidiaries for the payment of at least $25,000 where such judgments are not discharged or stayed within 60 days after the date on which the right to appeal has expired or on which all rights to appeal have been extinguished; and (viii) certain events of bankruptcy, insolvency, and reorganization involving the Company or any of the Company’s significant subsidiaries.

If an Event of Default involving bankruptcy, insolvency, or reorganization events with respect to the Company (and not solely with respect to a significant subsidiary of the Company) occurs, then the principal amount of, and all accrued and unpaid interest on, all of the Notes then outstanding will immediately become due and payable without any further action or notice by any person. If any other Event of Default occurs and is continuing, then, the Trustee, by notice to the Company, or noteholders of at least 25% of the aggregate principal amount of Notes then outstanding, by notice to the Company and the Trustee, may declare the principal amount of, and all accrued and unpaid interest on, all of the Notes then outstanding to become due and payable immediately. However, notwithstanding the foregoing, the Company may elect, at its option, that the sole remedy for an Event of Default relating to certain failures by the Company to comply with certain reporting covenants in the Indenture consists exclusively of the right of the noteholders to receive special interest on the Notes for up to 180 days at a specified rate per annum not exceeding 0.50% on the principal amount of the Notes.

The debt facilities replaced the $80,000 Credit, Security, and Guaranty Agreement with MidCap Funding IV Trust and MidCap Financial Trust and other parties named therein, dated December 29, 2023 (the "MidCap Credit Agreement"). There was approximately $10,000 outstanding under the MidCap Credit Agreement and it was terminated in connection with the Term Loan Agreement.

MidCap Credit Agreement

Borrowings under the MidCap Credit Agreement accrued interest at an annual rate equal to the greater of (a) One Month Term SOFR plus 6.50% or (b) 9.0% and interest on the Revolving Loan would have accrued at the greater of (a) One Month Term SOFR plus 4.0% or (b) 6.50% (the “Applicable Rate”). The Company paid MidCap 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 was payable quarterly in arrears.

Borrowings under the MidCap Credit Agreement were made under a term loan (the "MidCap Term Loan") of $10,000 and a Revolving Loan of $50,000, payable, jointly and severally, by the Company and each of its subsidiaries party thereto. The MidCap Term Loan and Revolving Loan matured at the earlier of (i) December 1, 2028; (ii) the occurrence of any transaction or series of transactions pursuant to which any person or entity in the aggregate acquire(s) 35% or more of the voting capital stock of the Company; (iii) a change in the majority of the Company’s Board of Directors over a 12-month period; (iv) the Company ceases to own directly or indirectly, 100% of the capital stock of any of its subsidiaries (with the exception of any subsidiaries permitted to be dissolved, merged or otherwise disposed of by the MidCap Credit Agreement), or (v) the occurrence of a change in control, fundamental change, deemed liquidation event or terms of similar import under any document or instrument governing or relating to debt of or equity interests of the Company. No amounts were drawn under the Revolving Loan as of December 31, 2023 or at any time during 2024.

Borrowings under the MidCap Credit Agreement were secured by a security interest in the Company’s and other Borrowers' assets. The MidCap Credit Agreement provided for customary events of default. If an event of default is not cured within the time periods specified (if any), the Lenders and Agent would have had the right to accelerate the Company’s payment of principal and interest in addition to other rights and remedies. The

MidCap Credit Agreement included certain customary non-financial covenants, and also include certain financial covenants related to the Company achieving minimum revenue targets over a trailing twelve month period and maintaining minimum liquidity of $10,000. The MidCap Credit Agreement was amended on May 3, 2024 to clarify the inputs into the financial covenant calculations.

As a result of the termination of the MidCap Credit Agreement, the Company recorded a loss on the extinguishment of debt in the amount of $3,230 on the consolidated statement of operations for the year ended December 31, 2024.

Squadron Revolver

The MidCap Credit Agreement replaced the Fourth Amended and Restated Loan and Security Agreement with Squadron Capital, LLC ("Squadron"), (as amended, the "Squadron Loan Agreement"), which provided the Company with a $50,000 revolving credit facility. There was no indebtedness outstanding under the Squadron Loan Agreement when it was terminated in connection with the MidCap Credit Agreement on December 31, 2023.

Borrowings under the Squadron Loan Agreement accrued interest at an annual rate equal to the greater of (a) six month SOFR plus 8.69% and (b) 10.0%, and the Company was 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 paid 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 was payable quarterly in arrears.

Borrowings under the Squadron Loan Agreement were 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 matured 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 Squadron Loan Agreement were secured by substantially all of the Company's assets and were unconditionally guaranteed by each of its subsidiaries with the exception of Vilex in Tennessee, Inc. ("Vilex"). There were no traditional financial covenants associated with the Squadron Loan Agreement. However, there were negative covenants that prohibited 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.

Other Debt

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., an affiliate of Squadron. Pursuant to the terms of the mortgage note, we pay Tawani Enterprises Inc. 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. As of December 31, 2024 and 2023, the mortgage balance was $611 and $763, respectively, of which current principal due of $160 and $152, respectively, was included in current portion of long-term debt.

Interest expense relating to notes payable to Squadron and mortgage note payable with Tawani was $35, $42 and $525 for the years ended December 31, 2024, 2023 and 2022, respectively.

At December 31, 2024, the aggregate future principal payments on our debt arrangements, including the Final Payment, are as follows:


Year Ending December 31:
2025	$	898
2026	527
2027	451
2028	107
2029	25,500
Thereafter	50,000
Total	$	77,483

- 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
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-Paragraph 6
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

INCOME TAXES

12 Months Ended

Dec. 31, 2024

Income Tax Disclosure [Abstract]

INCOME TAXES

Total income tax benefit for the years ended December 31, 2024, 2023 and 2022 was allocated as follows:


	2024		2023		2022
Total income tax benefit	$	(4,107)	$	(338)	$	(4,947)

For the years ended December 31, 2024, 2023 and 2022 loss before taxes of the Company consists of the following:


	2024		2023		2022
Domestic	$	(27,327)	$	(12,582)	$	6,451
Foreign	(14,602)		(8,730)		(10,140)
Total	$	(41,929)	$	(21,312)	$	(3,689)

The components of income tax benefit for the years ended December 31, 2024, 2023 and 2022 are as follows:


	2024		2023		2022
Current:
Federal	$	—	$	—	$	—
State	104		85		68
Foreign	525		740		17
	629		825		85

Deferred:
Federal	$	—	$	—	$	—
State	—		—		—
Foreign	(2,107)		(1,163)		(2,018)


Decrease in valuation allowance	(2,629)		—		(3,014)
Total income tax benefit	$	(4,107)	$	(338)	$	(4,947)

The reconciliation between the effective tax rate and the statutory tax rate is as follows:


	December 31,
	2024		2023		2022
Federal statutory rate	21.0	%	21.0	%	21.0	%
State statutory rate, net of federal benefit	1.8	%	1.2	%	(6.3)	%
Effect of foreign rates different from statutory	0.5	%	0.2	%	6.4	%
Change in state rate	0.4	%	(0.3)	%	0.9	%
Excess tax benefits from stock plans	(1.2)	%	(0.2)	%	9.6	%
Nondeductible/nontaxable or other items	9.3	%	(3.3)	%	(22.1)	%
Unborn foreign tax deduction	(1.7)	%	(0.5)	%	6.8	%
US benefit of foreign branches	8.0	%	8.6	%	64.4	%
Nondeductible executive compensation	(0.1)	%	(1.0)	%	(4.4)	%
Change in valuation allowance	(28.2)	%	(24.1)	%	57.8	%
Income tax benefit	9.8	%	1.6	%	134.1	%

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. The primary temporary differences that give rise to the deferred tax assets and liabilities are certain inventory adjustments, depreciation and amortization, interest expense, stock-based compensation and net operating loss carryforwards.

The deferred tax assets and liabilities consisted of the following at December 31, 2024 and 2023:


	2024		2023
Deferred tax assets:
Inventories, net	$	4,236	$	5,979
Stock-based compensation	4,996		3,158
Loss carryforwards	50,831		42,199
Credit carryforwards	176		176
Interest carryforward	534		134

Lease liabilities	2,103		615
Other	1,360		507
Total deferred tax assets	64,236		52,768
Valuation allowance	(53,742)		(41,927)
Net deferred tax assets	10,494		10,841
Deferred tax liabilities:
Intangibles	(8,726)		(14,426)
Property and equipment	(2,933)		(1,898)
Right-of-use assets	(2,216)		—
Total deferred tax liabilities	(13,875)		(16,324)
Deferred tax liabilities, net	$	(3,381)	$	(5,483)

The deferred tax assets were fully offset by a valuation allowance at December 31, 2024 and 2023, with the exception of certain deferred tax liabilities in Canada in 2024 and Canada and Israel in 2023. The Company has recorded a tax benefit during the years ended December 31, 2024 and 2023, for losses generated in certain foreign jurisdictions.

As of December 31, 2024, we had available federal, state and foreign tax loss carryforwards of $136,597, $85,383 and $35,172, respectively. We had available federal tax credits of $176. Net operating losses ("NOLs") generated prior to December 31, 2017 will begin to expire in 2028. Federal net operating losses generated after January 1, 2018 will have an indefinite carryforward period. An ownership change under Section 382 of the Internal Revenue Code was deemed to occur on May 30, 2014. Given the limitation calculation, we anticipate approximately $23,920 in losses generated prior to the ownership change date will be available to be utilized after applying the limitation. The estimated annual limitation is $1,062. A second ownership change under Section 382 was deemed to occur on December 11, 2018. The estimated annual limitation is $9,736, which is increased by $22,430 over the first five years as a result of an unrealized built in gain. NOLs sustained prior to May 30, 2014 will still be constricted by the lower limitation.

Management assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets. A significant piece of objective negative evidence evaluated was the cumulative loss incurred over the three-year period ended December 31, 2024. Such objective evidence limits the ability to consider other subjective evidence, such as our projections for future growth. As a result, a full valuation continues to be recorded against the Company's net deferred tax assets, with the exception of Canada and Israel.

We are subject to taxation in the United States, Indiana and various other state and international jurisdictions. As of December 31, 2024, all tax years from 2008 remain open to examination by the major taxing jurisdictions to which we are subject due to our net operating loss and credit carryforwards from those years. We believe that the income tax filing positions will be sustained on audit and do not anticipate any adjustments that will result in a material change. Therefore, no reserve for uncertain income tax positions has been recorded. Interest and penalties, if any, associated with income tax examinations will be recorded as a component of income taxes.

At December 31, 2024, our foreign operations held cash totaling $3,166. We have not provided for foreign withholding tax on the undistributed earnings from our non-U.S. subsidiaries that are considered to be indefinitely reinvested. If such earnings were to be distributed, any foreign withholding tax would not be significant.

- Definition

The entire disclosure for income tax.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Publisher FASB
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+ Details

FAIR VALUE OF FINANCIAL INSTRUMENTS - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Fair value adjustment of contingent consideration	$ 0	$ (2,980)	$ (25,930)

GOODWILL AND INTANGIBLE ASSETS - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets
Gross Intangible Assets	$ 93,651	$ 91,267
Accumulated Amortization	(29,224)	(21,992)
Impairment	0	0
Net Intangible Assets	$ 64,427	$ 69,275
Patents [Member]
Finite-Lived Intangible Assets
Weighted-Average Amortization Period	10 years 2 months 12 days	11 years 2 months 12 days
Gross Intangible Assets	$ 45,064	$ 45,646
Accumulated Amortization	(13,984)	(11,008)
Impairment	0	0
Net Intangible Assets	$ 31,080	$ 34,638
Intellectual Property
Finite-Lived Intangible Assets
Weighted-Average Amortization Period	8 years 2 months 12 days
Gross Intangible Assets	$ 16,027
Accumulated Amortization	(4,065)
Impairment	0
Net Intangible Assets	$ 11,962
Intellectual Property
Finite-Lived Intangible Assets
Weighted-Average Amortization Period		9 years 1 month 6 days
Gross Intangible Assets		$ 16,026
Accumulated Amortization		(2,524)
Impairment		0
Net Intangible Assets		$ 13,502
Customer Relationships & Other
Finite-Lived Intangible Assets
Weighted-Average Amortization Period	11 years 6 months	12 years 4 months 24 days
Gross Intangible Assets	$ 21,850	$ 18,862
Accumulated Amortization	(4,783)	(3,270)
Impairment	0	0
Net Intangible Assets	$ 17,067	$ 15,592
License agreements
Finite-Lived Intangible Assets
Weighted-Average Amortization Period	2 years 8 months 12 days	3 years 9 months 18 days
Gross Intangible Assets	$ 10,710	$ 10,733
Accumulated Amortization	(6,392)	(5,190)
Impairment	0	0
Net Intangible Assets	$ 4,318	$ 5,543

FAIR VALUE OF FINANCIAL INSTRUMENTS - Schedule of Assets and Liabilities Measured at Fair Value (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Corporate Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	$ 10,598
Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	9,274	$ 18,235
Asset-Backed Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	4,889
Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	252	5,015
Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		25,792
Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		207
Level 1 \| Corporate Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	10,598
Level 1 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	9,274	18,235
Level 1 \| Asset-Backed Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	4,889
Level 1 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	252	5,015
Level 1 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		0
Level 1 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		207
Level 2 \| Corporate Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0
Level 2 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0	0
Level 2 \| Asset-Backed Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0
Level 2 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0	0
Level 2 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		25,792
Level 2 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		0
Level 3 \| Corporate Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0
Level 3 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	0	0
Level 3 \| Asset-Backed Securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments	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 \| Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		0
Level 3 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short term Investments		$ 0

BUSINESS SEGMENT

12 Months Ended

Dec. 31, 2024

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, OrthoPediatrics, which designs, develops and markets anatomically appropriate specialized braces, 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. The Chief Executive Officer is regularly provided with consolidated expenses consistent with those presented in the consolidated statements of operations. 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 individual customer accounted for more than 10% of total product sales for any of the periods presented. No customer accounted for more than 10% of consolidated accounts receivable as of December 31, 2024 or 2023.

Disaggregated revenue - product sales by source were as follows:


	Year Ended December 31,
Product sales by geographic location:	2024		2023		2022
U.S.	$	161,163	$	111,010	$	92,419
International	43,564		37,722		29,870
Total	$	204,727	$	148,732	$	122,289


	Year Ended December 31,
Product sales by category:	2024		2023		2022
Trauma and deformity	$	145,126	$	106,781	$	85,055
Scoliosis	55,153		37,933		33,428
Sports medicine/other	4,448		4,018		3,806
Total	$	204,727	$	148,732	$	122,289

No individual country with sales originating outside of the United States accounted for more than 10% of consolidated revenue for the years ended December 31, 2024, 2023 and 2022.

No individual country outside of the United States held long-lived assets in excess of 10% of consolidated long-lived assets as of December 31, 2024 or 2023.

- 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.

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+ Details

FAIR VALUE OF FINANCIAL INSTRUMENTS

12 Months Ended

Dec. 31, 2024

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.

The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of December 31, 2024 and 2023, respectively.


	December 31, 2024
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term Investments
Corporate Bonds	$	10,598	$	—	$	—	$	10,598
Treasury Bonds	$	9,274	$	—	$	—	$	9,274
Asset-Backed Securities	$	4,889	$	—	$	—	$	4,889
Exchange Trade Mutual Funds	$	252	$	—	$	—	$	252


	December 31, 2023
	Level 1		Level 2		Level 3		Total
Financial Assets

Short term Investments
Certificates of Deposit	$	—	$	25,792	$	—	$	25,792
Exchange Trade Mutual Funds	$	5,015	$	—	$	—	$	5,015
Treasury Bonds	$	18,235	$	—	$	—	$	18,235

Other	$	207	$	—	$	—	$	207

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 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 resulted in income of $0, $2,980 and $25,930 for the years ended December 31, 2024, 2023 and 2022, respectively.

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


	Total

Balance at December 31, 2022	$	2,980
Change in fair value of contingent consideration	(2,980)
Balance at December 31, 2023	—
Change in fair value of contingent consideration	—
Balance at December 31, 2024	$	—


	December 31, 2023		December 31, 2022
Valuation techniques
Present value discount rate(1)	—	%	16.6	%
Volatility factor	—	%	48.0	%
Expected Years	0.4 years		1.4 years

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

- 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

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+ Details

DEBT AND CREDIT ARRANGEMENTS - Future Principal Payments (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Maturities of Long-term Debt
2025	$ 898
2026	527
2027	451
2028	107
2029	25,500
Thereafter	50,000
Total debt	$ 77,483	$ 11,063

- Definition

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

+ References + Details

SIGNIFICANT ACCOUNTING POLICIES - Property and Equipment, net (Details)	Dec. 31, 2024
Building and building improvements \| Minimum
Property, Plant and Equipment
Depreciable lives (in years)	25 years
Building and building improvements \| Maximum
Property, Plant and Equipment
Depreciable lives (in years)	30 years
Furniture and fixtures \| Minimum
Property, Plant and Equipment
Depreciable lives (in years)	5 years
Furniture and fixtures \| Maximum
Property, Plant and Equipment
Depreciable lives (in years)	7 years
Computer equipment \| Minimum
Property, Plant and Equipment
Depreciable lives (in years)	3 years
Computer equipment \| Maximum
Property, Plant and Equipment
Depreciable lives (in years)	5 years
Business software
Property, Plant and Equipment
Depreciable lives (in years)	3 years
Office and other equipment \| Minimum
Property, Plant and Equipment
Depreciable lives (in years)	5 years
Office and other equipment \| Maximum
Property, Plant and Equipment
Depreciable lives (in years)	7 years
Instruments
Property, Plant and Equipment
Depreciable lives (in years)	5 years
Sample inventory
Property, Plant and Equipment
Depreciable lives (in years)	2 years

DEBT AND CREDIT ARRANGEMENTS - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Debt Instrument
Mortgage balance	$ 77,483	$ 11,063
Less: debt discount and issuance costs	3,630	1,003
Less: current maturities	897	152
Long-term debt, net of current maturities	72,956	9,908
Revolving Credit Facility \| Term Loan
Debt Instrument
Mortgage balance	25,500	10,300
Mortgage payable to affiliate
Debt Instrument
Mortgage balance	611	763
Less: current maturities	160	152
Convertible note
Debt Instrument
Mortgage balance	50,000	0
Acquisition note payable \| Acquisition note payable
Debt Instrument
Mortgage balance	$ 1,372	$ 0

SIGNIFICANT ACCOUNTING POLICIES - Acquisition Payable and Contingent Consideration (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
New Accounting Pronouncements or Change in Accounting Principle
Contingent consideration, accretion expense	$ 661	$ 1,372	$ 2,307
Fair value adjustment of contingent consideration	$ 0	$ (2,980)	$ (25,930)

- 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

+ Details

GOODWILL AND INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND INTANGIBLE ASSETS

Goodwill

The Company tests goodwill for impairment by either performing a qualitative evaluation or a quantitative test.

The qualitative evaluation is an assessment of factors including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass the qualitative assessment for its two reporting units, a legacy surgical implants unit and a bracing reporting unit

established with the acquisition of MD Ortho, and perform a quantitative test on each. The assumptions used in evaluating goodwill for impairment are subject to change and are tracked against historical results by management.

The Company elected to perform a qualitative analysis for its reporting units as of October 1, 2024. The Company determined, after performing the qualitative analysis that there was no evidence that it is more likely than not that the fair value of its reporting units were less than the carrying amount, therefore, it was not necessary to perform a quantitative impairment test.

Changes in the carrying amount of goodwill were as follows:


	Total



Goodwill at January 1, 2024	$	83,699
Boston O&P acquisition	8,357
Other clinic acquisitions	3,367
Foreign currency translation impact	(1,579)
Goodwill at December 31, 2024	$	93,844

Intangible Assets

As of December 31, 2024, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Impairment		Net Intangible Assets
Patents	10.2 years	$	45,064	$	(13,984)	$	—	$	31,080
Intellectual Property	8.2 years	16,027		(4,065)		—		11,962
Customer Relationships & Other	11.5 years	21,850		(4,783)		—		17,067
License agreements	2.7 years	10,710		(6,392)		—		4,318
Total amortizable assets		$	93,651	$	(29,224)	$	—	$	64,427

As of December 31, 2023, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Impairment		Net Intangible Assets
Patents	11.2 years	$	45,646	$	(11,008)	$	—	$	34,638
Intellectual Property	9.1 years	16,026		(2,524)		—		13,502
Customer Relationships & Other	12.4 years	18,862		(3,270)		—		15,592
License agreements	3.8 years	10,733		(5,190)		—		5,543
Total amortizable assets		$	91,267	$	(21,992)	$	—	$	69,275

Amortization expense was $7,812, $7,149 and $5,977 for the years ended December 31, 2024, 2023 and 2022, respectively. Future amortization expenses are expected as follows:


Year Ending December 31:
2025	$	7,676
2026	7,669
2027	7,264
2028	6,319
2029	6,186
Thereafter	29,313
Total	$	64,427

Licenses are tied to product launches and do not begin amortizing until the product is launched to the market. Anticipated market launches are expected to occur through 2026 for products for which we previously obtained licensing rights.

Trademarks are recorded as indefinite-lived intangible assets in the amounts of $16,752 and $15,287 as of December 31, 2024 and 2023, respectively. In 2022, we acquired trademarks associated with MD Ortho and Pega Medical for approximately $2,410 and $3,878, respectively. In 2023, we acquired trademarks associated with MedTech and Rhino for approximately $520 and $140, respectively. In 2024, we acquired trademarks associated with Boston O&P for approximately $3,610. Trademarks are recorded in other intangible assets on the consolidated balance sheets.

During 2024, 2023 and 2022, management determined that a triggering event occurred for our ApiFix trademark, indicating that it was more likely than not the fair value of the trademark assets is less than the carrying value. As such, we completed a quantitative analysis whereby we determined the fair value of the trademark asset associated with our ApiFix acquisition was below the carrying value. We recorded impairment charges of $1,836, $985 and $3,609 for the years ended December 31, 2024, 2023 and 2022, respectively, to reduce the carrying amount of the intangible asset to its estimated fair value.

RESTRUCTURING - Schedule of Restructuring and Related Costs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Restructuring Cost and Reserve
Restructuring	$ 3,653	$ 0	$ 0
2024 Restructuring Plan
Restructuring Cost and Reserve
Restructuring	3,653
Severance and employee costs \| 2024 Restructuring Plan
Restructuring Cost and Reserve
Restructuring	1,196
Write-down of inventory and property and equipment \| 2024 Restructuring Plan
Restructuring Cost and Reserve
Restructuring	1,771
Other exit costs \| 2024 Restructuring Plan
Restructuring Cost and Reserve
Restructuring	$ 686

- 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 + Details

LEASES - Schedule of Future Minimum Lease Payments for Operating Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Leases [Abstract]
2025	$ 2,913
2026	2,397
2027	1,844
2028	1,468
2029	1,054
Thereafter	973
Total	10,649
Less imputed interest	2,868
Total	$ 7,781	$ 1,000
Operating Lease, Liability, Statement of Financial Position [Extensible Enumeration]	Other current liabilities, Other long-term liabilities	Other current liabilities, Other long-term liabilities

COMMITMENTS AND CONTINGENCIES	12 Months Ended
COMMITMENTS AND CONTINGENCIES	Dec. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES 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, and certain other defendants, were named in a lawsuit filed by IMED Surgical, LLC, a New Jersey company ("IMED"), in Broward County, Florida Circuit Court. In the lawsuit, IMED 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 IMED. IMED, among other things, requests that the defendants be ordered to convey and assign to IMED 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 IMED desires to further pursue the matter, it must first do so through a separate arbitration proceeding. In mid-November 2021, IMED initiated an arbitration proceeding; however, IMED 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 IMED 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. On February 3, 2023, the Court partially lifted the stay in this case for the sole purpose of, as clarified by the Court's order on March 7, 2023, "permitting any party to argue any motion challenging the events that occurred which led to the arbitration panel's termination order." No filing was made in response to that order. No further filings were made in this case until October 30, 2023, when defendants filed a motion to dismiss. On December 12, 2023, the Court ordered IMED has until March 13, 2024, to appear before the Court and show cause why this case should not be dismissed for failure to pursue arbitration consistent with the Court’s orders. On March 13, 2024, a hearing took place to discuss the status of IMED’s effort to re-initiate arbitration. Thereafter, on March 25, 2024, the Court ordered, if, by April 27, 2024, IMED has not begun arbitration, resolved this case, or substantiated (in the form of an attorney and client declaration) that it has executed an agreement with a litigation funder to pay for arbitration proceedings, to pay the balance due to the subject arbitration association and to re-instate the arbitration, the Court will dismiss this case without prejudice. On April 26, 2024, IMED informed the Court it has executed an agreement with a litigation funder to pay for arbitration proceedings, to pay the balance due to the subject arbitration association, and to reinstate the arbitration, and is in the final stages of resolving the balance due to the subject arbitration association. On September 20, 2024, the Court dismissed IMED’s lawsuit, without prejudice, for failure to prosecute. However, contemporaneously, IMED re-initiated arbitration. Although we believe the Company has strong defenses to the IMED arbitration and we intend to vigorously defend the claims asserted against us, arbitration 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. Boston O&P Litigation This lawsuit arises from the alleged wrongful death of a patient following his January 2016, tracheal and laryngeal resection procedure at Boston Children’s Hospital, which was performed by two physicians named as defendants in the suit. The Plaintiffs allege that as a result of the patient’s post-operative care, which included placing his neck in a position of flexion in a modified brace provided by Boston O&P, the patient was paralyzed, and years later, he died due to complications caused by his paralysis. The Company acquired all of the outstanding shares of Boston O&P on January 5, 2024 as described more fully under Note 3 - Business Combinations and Asset Acquisitions. The lawsuit commenced in December 2018, in Suffolk Superior Court in Boston, Massachusetts. The Plaintiffs assert counts of negligence against each individual defendant, lack of informed consent against the physician defendants, failure to warn, breach of warranty and alleged improper use against Boston O&P, and loss of consortium against all defendants. Trial is currently scheduled to begin in December 2025. Although we believe Boston O&P has strong defenses to this lawsuit and we intend to vigorously defend the claims asserted against us, 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. As part of the Company's purchase of Boston O&P, the selling equityholders of Boston O&P expressly agreed to indemnify the Company for any claims related to this lawsuit pursuant to the Stock Purchase Agreement. 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. As of December 31, 2021 the remaining balance of the commitment was $1,900. During the year ended December 31, 2022, 2023, and 2024, the Company met the minimum purchase commitment as required for the first twelve months of the agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of December 31, 2024, the Company has a minimum purchase commitment for approximately $1,456 for the year ending December 31, 2025. 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. During the years ended December 31, 2024, 2023 and 2022, the Company did not reach the minimum performance metrics. As such, the Company recorded $1,760, $2,000 and $1,104 as a component of cost of revenue for the shortfall which occurred during 2024, 2023 and 2022, respectively. Clinic acquisition promissory notes As of result of multiple O&P clinic acquisitions in 2024, as part of the consideration transferred, the Company is contracted to pay promissory notes to the previous owners. As of December 31, 2024, we had $1,372 remaining in present value, of which $737 is classified as short-term on the consolidated balance sheet. The payments are paid in installments with an interest rate of 5.0% per annum. Royalties As of December 31, 2024, 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. Currently, we have no minimum royalty commitments. 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 December 31, 2024, 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.

DEBT AND CREDIT ARRANGEMENTS - Braidwell Term Loan and Convertible Note (Details)	Aug. 05, 2024 USD ($) $ / shares	Dec. 31, 2024 USD ($)
Term Loan Agreement \| Scenario, Plan
Debt Instrument
Long term debt face amount	$ 25,000,000
Interest rate	6.50%
Payment in kind interest rate per annum (percent)	1.00%
Debt instrument, exit fee (percent)	2.00%
Debt covenant, required cash on hand as a percentage of outstanding debt (percent)	25.00%
Term Loan Agreement \| Period One \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	3.00%
Term Loan Agreement \| Period Two \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	2.00%
Term Loan Agreement \| Period Three \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	1.00%
Term Loan Agreement \| Minimum \| Scenario, Plan
Debt Instrument
Debt instrument, basis spread on variable rate (as a percent)	3.25%
Delayed Draw Term Loan Facility \| Scenario, Plan
Debt Instrument
Revolving credit facility	$ 25,000,000
4.75% Convertible Senior Notes \| Scenario, Plan
Debt Instrument
Long term debt face amount	$ 50,000,000
Interest rate	4.75%
Proceeds from the issuance of convertible debt	$ 49,500,000
Debt conversion price (percent)	130.00%
Debt covenant, percentage trigger for conversion, as a percentage of principal (percent)	98.00%
Debt instrument, convertible, conversion ratio	0.0244021
Debt instrument, convertible, conversion price (in dollars per share) \| $ / shares	$ 40.98
Threshold cured period	60 days
Debt covenant, default trigger	$ 25,000,000
Debt covenant, percentage of debt in default that would trigger recall (percent)	25.00%
Debt covenant, special interest rate upon debt default (percent)	0.50%
MidCap Credit Agreement \| Revolving Credit Facility
Debt Instrument
Revolving credit facility		$ 80,000,000
Line of credit		$ 10,000,000

STOCKHOLDERS' EQUITY - Schedule of Share Based Payment Arrangement Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation expense	$ 13,548	$ 10,526	$ 6,679
Sales and marketing
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation expense	1,774	1,422	1,041
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation expense	10,502	8,405	5,200
Research and development
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation expense	1,170	699	438
Restructuring
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation expense	$ 102	$ 0	$ 0

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 35
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Section 35
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
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-URI https://asc.fasb.org/1943274/2147480429/718-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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-Subparagraph (a)(3)
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 2
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (c)(2)(i)
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+ Details

GOODWILL AND INTANGIBLE ASSETS - Narrative (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) reporting_unit	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Indefinite-lived Intangible Assets
Number of reporting units \| reporting_unit	2
Amortization of expense	$ 7,812	$ 7,149	$ 5,977
Net Intangible Assets	16,752	15,287
Impairment of indefinitely-lived assets	1,836	985	3,609
Trademarks
Indefinite-lived Intangible Assets
Net Intangible Assets	16,752	15,287
Trademarks \| MD Orthopaedics
Indefinite-lived Intangible Assets
Indefinite-lived intangible assets acquired			2,410
Trademarks \| Pega Medical
Indefinite-lived Intangible Assets
Indefinite-lived intangible assets acquired			3,878
Trademarks \| Medtech
Indefinite-lived Intangible Assets
Indefinite-lived intangible assets acquired		520
Trademarks \| Rhino
Indefinite-lived Intangible Assets
Indefinite-lived intangible assets acquired		140
Trademarks \| Boston O&P acquisition
Indefinite-lived Intangible Assets
Indefinite-lived intangible assets acquired	3,610
Trademarks \| ApiFix
Indefinite-lived Intangible Assets
Impairment of indefinitely-lived assets	$ 1,836	$ 985	$ 3,609

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Pay vs Performance Disclosure
Net (loss) income	$ (37,822)	$ (20,974)	$ 1,258

- Definition

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

+ References

+ Details

BUSINESS SEGMENT (Tables)

12 Months Ended

Dec. 31, 2024

Segment Reporting [Abstract]

Schedule of Product Sales by Geographic Location

Disaggregated revenue - product sales by source were as follows:


	Year Ended December 31,
Product sales by geographic location:	2024		2023		2022
U.S.	$	161,163	$	111,010	$	92,419
International	43,564		37,722		29,870
Total	$	204,727	$	148,732	$	122,289

Schedule of Segment Reporting Information, by Segment


	Year Ended December 31,
Product sales by category:	2024		2023		2022
Trauma and deformity	$	145,126	$	106,781	$	85,055
Scoliosis	55,153		37,933		33,428
Sports medicine/other	4,448		4,018		3,806
Total	$	204,727	$	148,732	$	122,289

NET (LOSS) EARNINGS PER SHARE (Tables)

12 Months Ended

Dec. 31, 2024

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) earnings per share attributable to common stockholders:


	Year Ended December 31,
	2024		2023		2022
Net (loss) income	$	(37,822)	$	(20,974)	$	1,258
Less: Earnings allocated to participating securities	—		—		23
Net (loss) income available to common shareholders	$	(37,822)	$	(20,974)	$	1,235

Denominator for basic and diluted net (loss) income per share
Weighted average shares outstanding for basic	23,077,704		22,675,477		20,704,556
Weighted average shares outstanding for diluted	23,077,704		22,675,477		20,947,727

(Loss) earnings per share:
Basic	$	(1.64)	$	(0.92)	$	0.06
Diluted	$	(1.64)	$	(0.92)	$	0.06

Schedule of Antidilutive Shares Excluded from the Calculation of Diluted Net Loss Per Share


	Year Ended December 31,
	2024	2023	2022


Restricted stock	1,065,744	606,304	413,404
Stock options	—	—	3,556

	1,065,744	606,304	416,960

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2024
Audit Information [Abstract]
Auditor Name	Deloitte & Touche LLP
Auditor Location	Indianapolis, Indiana
Auditor Firm ID	34

SIGNIFICANT ACCOUNTING POLICIES - Advertising Costs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Accounting Policies [Abstract]
Advertising costs	$ 2,395	$ 2,409	$ 1,906

STOCKHOLDERS' EQUITY - Restricted Stock (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Aug. 02, 2024
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized
Stock-based compensation expense	$ 13,548	$ 10,526	$ 6,679
Term Loan Agreement
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized
Share repurchase program, authorized, amount	$ 250				$ 5,000
Restricted stock
Restricted Stock Awards
Outstanding at period start (in shares)	592,453	403,324	368,446
Granted (in shares)	560,252	311,689	216,881
Forfeited (in shares)	(12,503)	(6,800)	(28,344)
Vested (in shares)	(96,009)	(115,760)	(153,659)
Outstanding at period end (in shares)	1,044,193	592,453	403,324	368,446
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)	1 year 6 months	1 year 7 months 6 days	1 year 4 months 24 days	1 year 1 month 6 days
Employee Service Share-based Compensation, Nonvested Awards, Compensation Cost Not yet Recognized
Unrecognized compensation expense	$ 18,753
Unrecognized compensation expense, weighted average period of recognition	1 year 6 months
Stock-based compensation expense	$ 13,548	$ 10,526	$ 6,679
Restricted Stock Units
Restricted Stock Awards
Outstanding at period start (in shares)	13,851	10,080	0
Granted (in shares)	7,900	4,005	11,634
Forfeited (in shares)	(200)	(234)	(1,554)
Outstanding at period end (in shares)	21,551	13,851	10,080	0
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)	1 year 2 months 12 days	1 year 8 months 12 days	2 years 6 months

LEASES - Schedule of Lease Cost (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Leases [Abstract]
Right-of-use assets recognized in Other non-current assets	$ 8,237	$ 1,084
Operating Lease, Right-of-Use Asset, Statement of Financial Position	Other non-current assets	Other non-current assets
Lease liabilities recognized in Other current liabilities	$ 2,120	$ 340
Operating Lease, Liability, Current, Statement of Financial Position	Other current liabilities	Other current liabilities
Lease liabilities recognized in Other long-term liabilities	$ 5,661	$ 660
Operating Lease, Liability, Current, Statement of Financial Position	Other long-term liabilities	Other long-term liabilities
Weighted-average remaining lease term	4 years 6 months	3 years 3 months 18 days
Weighted-average discount rate	11.20%	11.70%

FAIR VALUE OF FINANCIAL INSTRUMENTS - Change in Fair Value of Level 3 Instruments (Details) - Contingent Consideration Liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Fair Value, Liabilities Measured on Recurring Basis
Loss on early extinguishment of debt	$ 0	$ (2,980)
Fair Value, Recurring
Fair Value, Liabilities Measured on Recurring Basis
Contingent consideration, beginning balance	0	2,980
Contingent consideration, ending balance	$ 0	$ 0

Insider Trading Arrangements	12 Months Ended
Insider Trading Arrangements	Dec. 31, 2024
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

PROPERTY AND EQUIPMENT, NET

12 Months Ended

Dec. 31, 2024

Property, Plant and Equipment [Abstract]

PROPERTY AND EQUIPMENT, NET

Property and equipment, net consisted of the following:


	December 31,
	2024		2023
Land	$	2,350	$	1,725
Building and building improvements	11,318		5,870
Computer equipment and software	5,029		5,828
Office and other equipment	6,377		5,821
Instruments	60,878		53,093
Sample inventory	3,419		2,780
Construction in progress	7,342		5,519
	96,713		80,636
Less: accumulated depreciation	(46,117)		(39,588)
Total property and equipment, net	$	50,596	$	41,048

Depreciation expense is primarily included in general and administrative expenses and was $10,948, $10,236 and $7,121 for the years ended December 31, 2024, 2023 and 2022, respectively.

INCOME TAXES - Narrative (Details) - USD ($)	Dec. 31, 2024	Dec. 11, 2018	May 30, 2014
Income Tax Disclosure [Abstract]
Loss carryforwards, federal	$ 136,597,000
Loss carryforwards, state	85,383,000
Loss carryforwards, foreign	35,172,000
Tax credit carryforward	176,000
Estimated limitation on losses generated prior to ownership change date			$ 23,920,000
Estimated annual limitation of losses		$ 9,736,000	$ 1,062,000
Increase of estimated annual limitation of first five years		$ 22,430,000
Reserve for uncertain income tax positions	0
Cash held by foreign operations	$ 3,166,000

INCOME TAXES - Income Taxes from Continuing and Discontinued Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Total income tax benefit	$ (4,107)	$ (338)	$ (4,947)

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

12 Months Ended

Dec. 31, 2024

Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]

BUSINESS COMBINATION AND ASSET ACQUISITIONS

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

Boston Brace International, Inc.

On January 5, 2024, the Company purchased all of the issued and outstanding share capital of Boston Brace International, Inc., a Massachusetts corporation ("Boston O&P"). Boston O&P has developed and manufactures pediatric orthotic and prosthetic devices, including non-surgical scoliosis treatment options, and provides related clinical services.

Under the terms of the stock purchase agreement, the Company paid to the shareholders of Boston O&P consideration of $21,535 in cash, after adjusting for closing net working capital, transaction expenses, and funded indebtedness. Additionally, certain employees and executives of Boston O&P also received awards of restricted stock of the Company which will vest in three years subject to continuous service. The Restricted Stock Award Agreements were to approximately 170 individuals for an aggregate of approximately 83,000 shares representing approximately $2,500 (based on a share price of $30.12, which was the average closing price during the four-month period ending on January 4, 2024) and were granted pursuant to the Company’s 2017 Incentive Award Plan. The restricted stock is not considered part of the purchase consideration.

The following table summarizes the total consideration paid for Boston O&P and the 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	$	21,535
Assets:
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities:
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,617
Other non-current liabilities	1,803
Total liabilities	8,222
Less: total net assets	13,178
Goodwill	$	8,357

The fair value of identifiable intangible assets and certain long-lived assets were 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	$	3,610	Indefinite

Customer Relationships & Other	2,963		12 years
	$	6,573

The following table represents the unaudited pro forma net revenue and net loss assuming the acquisition of Boston O&P occurred on January 1, 2023.


	Year Ended December 31,
	2024		2023
Net revenue	$	205,158	$	176,154
Net loss	$	(37,849)	$	(20,510)

In 2024, Boston O&P purchased all the issued and outstanding share capital or acquired the assets of multiple domestic orthotic and prosthetic device clinics. Total consideration for all O&P clinics acquired during 2024 was approximately $4,818 in total consideration, which comprised of cash of $3,388 and promissory notes in the original principal amount of $1,430 payable in installments with an interest rate of 5.0% per annum. We allocated $680 to customer relationship intangible assets and $3,367 to goodwill, and the rest to net working capital and other assets acquired and liabilities assumed. The allocation of the purchase price is considered preliminary.

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 CruiserTM, KickerTM, and Rhino StomperTM. 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. No revenue was recorded from this platform in 2023 or 2024.

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 (as amended, the "Purchase Agreement") 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 is being amortized over a useful life of ten years.

During the year ended December 31, 2024, the Company paid the first anniversary payment consisting of $1,250 in cash and issued 4,288 of the Company's common stock approximating $133 which reduced the amount of the acquisition installment payable on our consolidated balance sheet. The present value of the remaining acquisition installment payable is $3,799 as of December 31, 2024, of which $1,347 is recorded as a current liability. In addition, we issued 38,594 shares of our common stock to one individual on the first anniversary date in exchange for their continued service through the vesting date which had been accounted for as stock-based compensation expense in the post-combination consolidated financial statements.

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).

RELATED PARTY TRANSACTIONS	12 Months Ended
RELATED PARTY TRANSACTIONS	Dec. 31, 2024
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS In addition to the expired debt and credit agreements and mortgage with Squadron and its affiliate (refer to Note 9), 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. Our aggregate payments to Structure Medical for inventory purchases were $1,006, $1,060 and $956 for the years ended December 31, 2024, 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

GOODWILL AND INTANGIBLE ASSETS (Tables)

12 Months Ended

Dec. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill

Changes in the carrying amount of goodwill were as follows:


	Total



Goodwill at January 1, 2024	$	83,699
Boston O&P acquisition	8,357
Other clinic acquisitions	3,367
Foreign currency translation impact	(1,579)
Goodwill at December 31, 2024	$	93,844

Schedule of the Balances of Amortizable Intangible Assets

As of December 31, 2024, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Impairment		Net Intangible Assets
Patents	10.2 years	$	45,064	$	(13,984)	$	—	$	31,080
Intellectual Property	8.2 years	16,027		(4,065)		—		11,962
Customer Relationships & Other	11.5 years	21,850		(4,783)		—		17,067
License agreements	2.7 years	10,710		(6,392)		—		4,318
Total amortizable assets		$	93,651	$	(29,224)	$	—	$	64,427

As of December 31, 2023, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Impairment		Net Intangible Assets
Patents	11.2 years	$	45,646	$	(11,008)	$	—	$	34,638
Intellectual Property	9.1 years	16,026		(2,524)		—		13,502
Customer Relationships & Other	12.4 years	18,862		(3,270)		—		15,592
License agreements	3.8 years	10,733		(5,190)		—		5,543
Total amortizable assets		$	91,267	$	(21,992)	$	—	$	69,275

Schedule of Amortization Expense of Amortizable Intangible Assets

Future amortization expenses are expected as follows:


Year Ending December 31:
2025	$	7,676
2026	7,669
2027	7,264
2028	6,319
2029	6,186
Thereafter	29,313
Total	$	64,427

- Definition

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

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-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

RELATED PARTY TRANSACTIONS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Affiliated Entity \| Structure Medical, LLC \| Supplier
Related Party Transaction
Payments to related party	$ 1,006	$ 1,060	$ 956

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Finite-Lived Intangible Assets Acquired as Part of Business Combination (Details) - Boston O&P acquisition $ in Thousands	Jan. 05, 2024 USD ($)
Business Acquisition
Other intangible assets	$ 3,610
Amortizable intangible assets	2,963
Fair value of identifiable intangible assets	6,573
Customer Relationships & Other
Business Acquisition
Amortizable intangible assets	$ 2,963
Remaining economic useful life (in years)	12 years
Trademarks / Names
Business Acquisition
Other intangible assets	$ 3,610

SIGNIFICANT ACCOUNTING POLICIES - Goodwill and Intangible Assets (Details)	12 Months Ended
	Dec. 31, 2024 USD ($) reporting_unit	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Finite-Lived Intangible Assets
Impairment of finite lived intangible assets	$ 0	$ 0	$ 0
Goodwill impairment	$ 0
Number of reporting units \| reporting_unit	2
Impairment	$ 1,836,000	$ 985,000	$ 3,609,000
Minimum
Finite-Lived Intangible Assets
Intangible asset, useful life (in years)	3 years
Maximum
Finite-Lived Intangible Assets
Intangible asset, useful life (in years)	20 years

- 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 + Details

COMMITMENTS AND CONTINGENCIES (Details) - USD ($) $ in Thousands			1 Months Ended	12 Months Ended
	Jul. 20, 2021	Dec. 31, 2019	Jun. 30, 2019	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Long-term Purchase Commitment
Purchase commitment, remaining minimum amount committed							$ 1,900
Purchase obligation, year one				$ 1,456
Cost of revenue				56,129	$ 37,479	$ 31,629
Mortgage balance				$ 77,483	11,063
Minimum
Long-term Purchase Commitment
Royalty agreement percentage				0.50%
Maximum
Long-term Purchase Commitment
Royalty agreement percentage				20.00%
License agreements \| FIREFLY Technology
Long-term Purchase Commitment
Finite lived intangible asset useful life extension period	5 years
Cost of revenue				$ 1,760	2,000	$ 1,104
Acquisition note payable \| Acquisition note payable
Long-term Purchase Commitment
Mortgage balance				1,372	$ 0
Short-term debt				$ 737
Interest rate				5.00%
Squadron \| Team Note B \| Affiliated Entity
Long-term Purchase Commitment
Payments on debt with affiliate		$ 25,000
Vilex and Orthex
Long-term Purchase Commitment
Consideration transferred			$ 60,000

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS (Tables)

12 Months Ended

Dec. 31, 2024

Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed


Fair value of estimated total acquisition consideration	$	21,535
Assets:
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities:
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,617
Other non-current liabilities	1,803
Total liabilities	8,222
Less: total net assets	13,178
Goodwill	$	8,357

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


	Amount		Remaining Economic Useful Life
Trademarks / Names	$	3,610	Indefinite

Customer Relationships & Other	2,963		12 years
	$	6,573

Schedule of Business Acquisition, Pro Forma Information

The following table represents the unaudited pro forma net revenue and net loss assuming the acquisition of Boston O&P occurred on January 1, 2023.


	Year Ended December 31,
	2024		2023
Net revenue	$	205,158	$	176,154
Net loss	$	(37,849)	$	(20,510)

Schedule of Asset Acquisition

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

ACCRUED COMPENSATION AND BENEFITS (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Compensation Related Costs [Abstract]
Accrued compensation and related costs	$ 6,368	$ 4,279
Accrued commissions	7,520	7,046
Total accrued compensation and benefits	$ 13,888	$ 11,325

BUSINESS SEGMENT - Schedule of Revenue by Geographical Location (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Revenues from External Customers and Long-Lived Assets
Total	$ 204,727	$ 148,732	$ 122,289
U.S.
Revenues from External Customers and Long-Lived Assets
Total	161,163	111,010	92,419
International
Revenues from External Customers and Long-Lived Assets
Total	$ 43,564	$ 37,722	$ 29,870

- Definition

+ References

+ Details

BUSINESS	12 Months Ended
BUSINESS	Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS	BUSINESS OrthoPediatrics Corp., a Delaware corporation, is a medical device company committed to designing, developing and marketing anatomically appropriate implants, instruments and specialized braces for children with orthopedic conditions, giving pediatric orthopedic surgeons and caregivers the ability to treat children with technologies specifically designed to meet their needs, including PediLoc®, PediPlates®, Cannulated Screws, PediFlexTM nail, PediNailTM, PediLoc® Tibia, ACL Reconstruction System, Locking Cannulated Blade, Locking Proximal Femur, Spica Tables, RESPONSETM Spine, BandLocTM, Pediatric Nailing Platform \| Femur, Devise Rail, Orthex®, The Fassier-Duval Telescopic Intramedullary System®, SLIMTM Nail, The GAP NailTM, The Free Gliding SCFE Screw SystemTM, GIROTM Growth Modulation System, PNP Tibia System, ApiFix® Mid-C System and Mitchell Ponseti® and Boston Brace 3D 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 while our orthopedic bracing products are manufactured in-house. We also operate multiple O&P clinics delivering leading pediatric non-surgical O&P treatment. 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 braces as well as provide O&P clinic services to meet the specialized needs of pediatric surgeons 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.

INCOME TAXES - Reconciliation Between the Effective Tax Rate and the Statutory Tax Rate (Details)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	21.00%
State statutory rate, net of federal benefit	1.80%	1.20%	(6.30%)
Effect of foreign rates different from statutory	0.50%	0.20%	6.40%
Change in state rate	0.40%	(0.30%)	0.90%
Excess tax benefits from stock plans	(1.20%)	(0.20%)	9.60%
Nondeductible/nontaxable or other items	9.30%	(3.30%)	(22.10%)
Unborn foreign tax deduction	(1.70%)	(0.50%)	6.80%
US benefit of foreign branches	8.00%	8.60%	64.40%
Nondeductible executive compensation	(0.10%)	(1.00%)	(4.40%)
Change in valuation allowance	(28.20%)	(24.10%)	57.80%
Income tax benefit	9.80%	1.60%	134.10%

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,145	$ 1,373
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)	24,217,508	23,378,408
Common stock, shares outstanding (in shares)	24,217,508	23,378,408

STOCKHOLDERS' EQUITY (Tables)

12 Months Ended

Dec. 31, 2024

Share-Based Payment Arrangement [Abstract]

Schedule of Stock Option Activity

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


	Options	Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Terms (in Years)
Outstanding at January 1, 2022	6,638	$	30.97	1.3
Forfeited or expired	(1,072)	$	30.97
Exercised	(2,010)	$	30.97
Outstanding at December 31, 2022	3,556	$	30.97	0.7
Forfeited or expired	(2,886)	$	30.97
Exercised	(670)	$	30.97
Outstanding at December 31, 2023	—	$	—	—
Outstanding at December 31, 2024	—	$	—	—

Schedule of Restricted Stock Activity

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


	Restricted Stock Awards	Weighted-Average Remaining Contractual Terms (in Years)	Restricted Stock Units	Weighted-Average Remaining Contractual Terms (in Years)
Outstanding at January 1, 2022	368,446	1.1	—	—
Granted	216,881		11,634
Forfeited	(28,344)		(1,554)
Outstanding at Vested	(153,659)		—
Outstanding at December 31, 2022	403,324	1.4	10,080	2.5
Granted	311,689		4,005
Forfeited	(6,800)		(234)
Outstanding at Vested	(115,760)		—
Outstanding at December 31, 2023	592,453	1.6	13,851	1.7
Granted	560,252		7,900
Forfeited	(12,503)		(200)
Vested	(96,009)		—
Outstanding at December 31, 2024	1,044,193	1.5	21,551	1.2

Schedule of Share Based Payment Arrangement Expense

Stock-based compensation expense on restricted stock amounted to $13,548, $10,526 and $6,679 for the years ended December 31, 2024, 2023 and 2022, respectively, and is classified as follows:


	Year Ended December 31,
	2024		2023		2022
Sales and marketing	$	1,774	$	1,422	$	1,041
General and administrative	10,502		8,405		5,200
Research and development	1,170		699		438
Restructuring	102		—		—
Total	$	13,548	$	10,526	$	6,679

DEBT AND CREDIT ARRANGEMENTS (Tables)

12 Months Ended

Dec. 31, 2024

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

Long-term debt consisted of the following:


	December 31,
	2024		2023
Term loan and Final Payment	$	25,500	$	10,300
Convertible note	50,000		—
Mortgage payable to affiliate	611		763
Acquisition note payable	1,372		—
Total debt	77,483		11,063
Less: debt discount and issuance costs	3,630		1,003
Less: current maturities	897		152
Long-term debt, net of current maturities	$	72,956	$	9,908

Schedule of Aggregate Future Principal Payments

At December 31, 2024, the aggregate future principal payments on our debt arrangements, including the Final Payment, are as follows:


Year Ending December 31:
2025	$	898
2026	527
2027	451
2028	107
2029	25,500
Thereafter	50,000
Total	$	77,483

- 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.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(22))
-SubTopic 10
-Topic 210
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 69B
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481568/470-20-55-69B

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 69E
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481568/470-20-55-69E

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.12-04(a))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-3

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 835
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482925/835-30-45-2

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-3

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
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-URI https://asc.fasb.org/1943274/2147477734/942-470-50-3

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
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-Topic 505
-SubTopic 10
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Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-6

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-7

+ Details

LEASES - Narrative (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Leases [Abstract]
Operating lease liability	$ 7,781	$ 1,000
Right-of-use assets recognized in Other non-current assets	$ 8,237	$ 1,084

SIGNIFICANT ACCOUNTING POLICIES - Inventories, net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
New Accounting Pronouncements or Change in Accounting Principle
Charges for obsolete inventory	$ 914	$ 995	$ 1,011
2024 Restructuring Plan
New Accounting Pronouncements or Change in Accounting Principle
Charges for obsolete inventory	$ 1,756

- 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

+ Details

STOCKHOLDERS' EQUITY - Stock Options (Details) - USD ($)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award
Options, granted (in shares)	0	0	0
Options
Outstanding at period start (in shares)	0	3,556	6,638
Forfeited or expired (in shares)		(2,886)	(1,072)
Exercised (in shares)		(670)	(2,010)
Outstanding at period end (in shares)	0	0	3,556	6,638
Weighted-Average Exercise Price
Outstanding at period start, weighted-average exercise price (in dollars per share)	$ 0	$ 30.97	$ 30.97
Forfeited or expired, weighted-average exercise price (in dollars per share)		30.97	30.97
Exercised (in dollars per share)		30.97	30.97
Outstanding at period end, weighted-average exercise price (in dollars per share)	$ 0	$ 0	$ 30.97	$ 30.97
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)			8 months 12 days	1 year 3 months 18 days
Stock-based compensation expense	$ 13,548,000	$ 10,526,000	$ 6,679,000
Stock options
Share-based Compensation Arrangement by Share-based Payment Award
Options, granted (in shares)	0	0	0
Weighted-Average Remaining Contractual Terms (in Years)
Vesting period (in years)	3 years	3 years
Stock-based compensation expense	$ 0	$ 0	$ 0

PROPERTY AND EQUIPMENT, NET (Tables)

12 Months Ended

Dec. 31, 2024

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

Sample inventory is carried at cost less accumulated depreciation.

Depreciable lives are generally as follows:


Building and building improvements			25 to 30 years
Furniture and fixtures			5 to 7 years
Computer equipment			3 to 5 years
Business software			3 years
Office and other equipment			5 to 7 years
Instruments			5 years
Sample inventory			2 years

Property and equipment, net consisted of the following:


	December 31,
	2024		2023
Land	$	2,350	$	1,725
Building and building improvements	11,318		5,870
Computer equipment and software	5,029		5,828
Office and other equipment	6,377		5,821
Instruments	60,878		53,093
Sample inventory	3,419		2,780
Construction in progress	7,342		5,519
	96,713		80,636
Less: accumulated depreciation	(46,117)		(39,588)
Total property and equipment, net	$	50,596	$	41,048

PROPERTY AND EQUIPMENT, NET - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Property, Plant and Equipment
Property and equipment, gross	$ 96,713	$ 80,636
Less: accumulated depreciation	(46,117)	(39,588)
Total property and equipment, net	50,596	41,048
Land
Property, Plant and Equipment
Property and equipment, gross	2,350	1,725
Building and building improvements
Property, Plant and Equipment
Property and equipment, gross	11,318	5,870
Computer equipment and software
Property, Plant and Equipment
Property and equipment, gross	5,029	5,828
Office and other equipment
Property, Plant and Equipment
Property and equipment, gross	6,377	5,821
Instruments
Property, Plant and Equipment
Property and equipment, gross	60,878	53,093
Sample inventory
Property, Plant and Equipment
Property and equipment, gross	3,419	2,780
Construction in progress
Property, Plant and Equipment
Property and equipment, gross	$ 7,342	$ 5,519

STOCKHOLDERS' EQUITY - Warrants (Details) - Squadron shares in Thousands	Aug. 15, 2022 $ / shares shares
Class of Warrant or Right
Warrants and rights outstanding (shares) \| shares	1,525
Warrants exercise price (in dollars per share) \| $ / shares	$ 0.00025

ACCRUED COMPENSATION AND BENEFITS (Tables)

12 Months Ended

Dec. 31, 2024

Schedule of Accrued Compensation and Benefits

Accrued compensation and benefits consisted of the following:


	December 31,
	2024		2023
Accrued compensation and related costs	$	6,368	$	4,279
Accrued commissions	7,520		7,046
Total accrued compensation and benefits	$	13,888	$	11,325

SIGNIFICANT ACCOUNTING POLICIES - Investments in Privately Held Companies (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Accounting Policies [Abstract]
Debt securities	$ 2,180	$ 1,855