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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-Q
(Mark One)

☒    QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2024

OR

☐    TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from _______ to _______

Commission file number: 001-38242
OrthoPediatrics Corp.
(Exact name of registrant as specified in its charter)
Delaware
26-1761833
(State or other jurisdiction of incorporation or organization)
(I.R.S. Employer Identification Number)
2850 Frontier Drive
Warsaw, IN 46582
(574) 268-6379
(Address of principal executive offices, including zip code)
(Registrant’s telephone number, including area code)
Title of Each ClassTrading Symbol(s)Name of each exchange on which registered
Common Stock, $0.00025 par value per shareKIDSNasdaq Global Market
________________________________________________________________________________________
Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes ☒ No ¨
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).    Yes ☒ No ¨
Indicate by check mark whether t he registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and "emerging growth company" in Rule 12b-2 of the Exchange Act.
Large accelerated filer
☐
Accelerated filer
☒
Non-accelerated filer
☐
Smaller reporting company
☐
Emerging growth company
☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.   ☐ 
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).  Yes ☐    No ☒

As of May 3, 2024, the registrant had 23,828,882 outstanding shares of common stock, $0.00025 par value per share.




OrthoPediatrics Corp.
Form 10-Q
For the Quarterly Period Ended March 31, 2024

TABLE OF CONTENTS
Page No.
PART I. FINANCIAL INFORMATION
Item 1
Item 2
Item 3
Item 4
PART II. OTHER INFORMATION
Item 1
Item 1A
Item 2
Item 3
Item 4
Item 5
Item 6







NOTE REGARDING FORWARD-LOOKING STATEMENTS

All statements, other than statements of historical facts, contained in this quarterly report, including statements regarding our business, operations and financial performance and condition, as well as our plans, objectives and expectations for our business, operations and financial performance and condition, are forward-looking statements. You can often identify forward-looking statements by words such as "anticipate," "believe," "continue," "could," "estimate," "expect," "intend," "may," "might," "target," "ongoing," "plan," "potential," "predict," "project," "should," "will" or "would," or the negative of these terms or other terms. Forward-looking statements involve known and unknown risks, uncertainties and other factors, such as the impact of widespread health emergencies, such as COVID-19 and respiratory syncytial virus, that may cause our results, activity levels, performance or achievements to be materially different from the information expressed or implied by the forward-looking statements. Forward-looking statements may include, among other things, statements relating to:

•our ability to achieve or sustain profitability in the future;

•our ability to raise additional capital to fund our existing commercial operations, develop and commercialize new products and expand our operations;

•our ability to commercialize our products in development and to develop and commercialize additional products through our research and development efforts, and if we fail to do so we may be unable to compete effectively;

•our ability to generate sufficient revenue from the commercialization of our products to achieve and sustain profitability;

•our ability to comply with extensive government regulation and oversight both in the United States and abroad;

•our ability to maintain and expand our network of third-party independent sales agencies and distributors to market and distribute our products; and

•our ability to protect our intellectual property rights or if we are accused of infringing on the intellectual property rights of others.

We cannot assure you that forward-looking statements will prove to be accurate, and you are encouraged not to place undue reliance on forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations expressed or implied by the forward-looking statements. You are urged to carefully review and consider the various disclosures made by us in this quarterly report, in our Annual Report on Form 10-K filed with the Securities and Exchange Commission (the "SEC") on March 8, 2024 and in other reports filed with the SEC that discuss the risks and factors that may affect our business. Other than as required by law, we undertake no obligation to update or revise any forward-looking statements to reflect new information, events or circumstances occurring after the date of this quarterly report.
3

PART I. FINANCIAL INFORMATION

ITEM 1.        FINANCIAL STATEMENTS
ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)
(In Thousands, Except Share Data)
March 31, 2024December 31, 2023
ASSETS
Current assets:
Cash and cash equivalents$21,602 $31,055 
Restricted cash1,962 1,972 
Short-term investments26,141 49,251 
Accounts receivable - trade, net of allowances of $1,195 and $1,373, respectively
36,275 34,617 
Inventories, net112,689 105,851 
Prepaid expenses and other current assets5,056 3,750 
Total current assets203,725 226,496 
Property and equipment, net48,721 41,048 
Other assets:
Amortizable intangible assets, net70,382 69,275 
Goodwill91,481 83,699 
Other intangible assets18,792 15,287 
Other non-current assets4,084 2,940 
Total other assets184,739 171,201 
Total assets$437,185 $438,745 
LIABILITIES AND STOCKHOLDERS' EQUITY
Current liabilities:
Accounts payable - trade$19,736 $12,649 
Accrued compensation and benefits9,772 11,325 
Current portion of long-term debt with affiliate154 152 
Current portion of acquisition installment payable10,368 10,149 
Other current liabilities5,790 7,391 
Total current liabilities45,820 41,666 
Long-term liabilities:
Long-term debt, net of current portion9,579 9,297 
Long-term debt with affiliate, net of current portion572 611 
Acquisition installment payable, net of current portion3,613 3,551 
Deferred income taxes5,202 5,483 
Other long-term liabilities1,815 1,112 
Total long-term liabilities20,781 20,054 
Total liabilities66,601 61,720 
Stockholders' equity:
Common stock, $0.00025 par value; 50,000,000 shares authorized; 23,540,411 shares and 23,378,408 shares issued as of March 31, 2024 and December 31, 2023, respectively
6 6 
Additional paid-in capital583,086 580,287 
Accumulated deficit(205,547)(197,742)
Accumulated other comprehensive loss(6,961)(5,526)
Total stockholders' equity370,584 377,025 
Total liabilities and stockholders' equity$437,185 $438,745 

See notes to condensed consolidated financial statements.
4

ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(Unaudited)
(In Thousands, Except Share and Per Share Data)
Three Months Ended March 31,
20242023
Net revenue$44,685 $31,588 
Cost of revenue12,511 8,027 
Gross profit32,174 23,561 
Operating expenses:
Sales and marketing14,169 12,549 
General and administrative24,730 17,157 
Research and development2,998 2,446 
Total operating expenses41,897 32,152 
Operating loss(9,723)(8,591)
Other expense (income):
Interest expense (income), net637 (210)
Fair value adjustment of contingent consideration— (670)
Other income, net(24)(331)
Total other expense (income), net613 (1,211)
Loss before income taxes$(10,336)$(7,380)
Provision for income taxes (benefit)(2,531)(574)
Net loss$(7,805)$(6,806)
Weighted average shares outstanding
Basic and diluted22,820,779 22,506,024 
Net loss per share
Basic and diluted$(0.34)$(0.30)

See notes to condensed consolidated financial statements.
5

ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS
(Unaudited) (In Thousands)

Three Months Ended March 31,
20242023
Net loss$(7,805)$(6,806)
Other comprehensive loss:
Foreign currency translation adjustment(1,426)(962)
Unrealized gain (loss) on short-term investments109 617 
Adjustment for realized (gain) loss on securities(118)(301)
Other comprehensive loss, net of tax(1,435)(646)
Comprehensive loss$(9,240)$(7,452)

See notes to condensed consolidated financial statements.
6

ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
(Unaudited)
(In Thousands, Except Share Data)
Three Months Ended March 31, 2024
Accumulated
AdditionalOtherTotal
Common StockPaid-inAccumulatedComprehensiveStockholders'
SharesValueCapitalDeficitLossEquity
Balance at January 1, 202423,378,408 $6 $580,287 $(197,742)$(5,526)$377,025 
Net loss— — — (7,805)— (7,805)
Other comprehensive loss— — — — (1,435)(1,435)
Restricted stock162,003 — 2,799 — — 2,799 
Balance at March 31, 202423,540,411 $6 $583,086 $(205,547)$(6,961)$370,584 

See notes to condensed consolidated financial statements.
7

ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY
(Unaudited)
(In Thousands, Except Share Data)
Three Months Ended March 31, 2023
Accumulated
AdditionalOtherTotal
Common StockPaid-inAccumulatedComprehensiveStockholders'
SharesValueCapitalDeficitLossEquity
Balance at January 1, 202322,877,962 $6 $560,810 $(176,768)$(5,400)$378,648 
Net loss— — — (6,806)— (6,806)
Other comprehensive loss— — — — (646)(646)
Restricted stock264,156 — 1,959 — — 1,959 
Balance at March 31, 202323,142,118 $6 $562,769 $(183,574)$(6,046)$373,155 

See notes to condensed consolidated financial statements.
8

ORTHOPEDIATRICS CORP.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
(In Thousands)
Three Months Ended
March 31,
20242023
OPERATING ACTIVITIES
Net loss$(7,805)$(6,806)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization5,028 3,848 
Stock-based compensation2,799 2,113 
Fair value adjustment of contingent consideration— (670)
Accretion of acquisition installment payable281 381 
Deferred income taxes(2,445)(574)
Changes in certain operating assets and liabilities:
Accounts receivable - trade1,155 (2,002)
Inventories, net(6,631)(5,979)
Prepaid expenses and other current assets(953)(33)
Accounts payable - trade6,562 5,541 
Accrued expenses and other liabilities(5,049)(1,571)
Other368 (709)
Net cash used in operating activities(6,690)(6,461)
INVESTING ACTIVITIES
Acquisition of Boston O&P, net of cash acquired(20,693)— 
Sale of short-term marketable securities23,474 37,250 
Purchases of property and equipment(6,460)(4,940)
Net cash (used in) provided by investing activities(3,679)32,310 
FINANCING ACTIVITIES
Payments on acquisition note(538)— 
Payments on mortgage notes(35)(36)
Net cash used in financing activities(573)(36)
Effect of exchange rate changes on cash, cash equivalents and restricted cash1,479 (138)
NET (DECREASE) INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH(9,463)25,675 
Cash, cash equivalents and restricted cash, beginning of year$33,027 $10,462 
Cash, cash equivalents and restricted cash, end of period$23,564 $36,137 
SUPPLEMENTAL DISCLOSURES
Cash paid for interest$223 $11 
Transfer of instruments between property and equipment and inventory$117 $332 
See notes to condensed consolidated financial statements.
9

ORTHOPEDIATRICS CORP.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
(Dollars In Thousands, Except Share and Per Share data)
NOTE 1 – 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. We sell our specialized products, including PediLoc®, PediPlates®, Cannulated Screws, PediFlexTM nail, PediNailTM, PediLoc® Tibia, ACL Reconstruction System, Locking Cannulated Blade, Locking Proximal Femur, Spica Tables, RESPONSETM Spine, BandLoc Duo®, Pediatric Nailing Platform | Femur, Devise Rail, Orthex®, The Fassier-Duval Telescopic Intramedullary System®, SLIMTM Nail, The GAP NailTM, The Free Gliding SCFE Screw SystemTM, GIRO® Growth Modulation System, PNP Tibia System, ApiFix® Mid-C System and Mitchell Ponseti® specialized bracing products to various hospitals and medical facilities throughout the United States and various international markets. We currently use a contract manufacturing model for the manufacturing of implants and related surgical instrumentation while our clubfoot orthopedic products are manufactured in-house.

We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis and sports medicine product offering to the pediatric orthopedic market in order to improve the lives of children with orthopedic conditions. We design, develop and commercialize innovative orthopedic implants, instruments and specialized braces to meet the needs of pediatric surgeons or orthotists and their patients, who we believe have been largely neglected by the orthopedic industry. We currently serve three of the largest categories in this market.

NOTE 2 – SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation

The accompanying condensed consolidated financial statements include the accounts of OrthoPediatrics Corp. and its wholly-owned subsidiaries (collectively, the “Company,” “we,” “our” or “us”). All intercompany balances and transactions have been eliminated.

Unaudited Interim Condensed Consolidated Financial Statements

We have prepared the accompanying condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying condensed consolidated financial statements are unaudited and should be read in conjunction with the annual consolidated financial statements as of and for the year ended December 31, 2023 and related notes thereto contained in our Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC") on March 8, 2024. The financial data and other financial information disclosed in the notes to the accompanying condensed consolidated financial statements are also unaudited. As such, certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to applicable rules and regulations thereunder.

The unaudited condensed consolidated financial statements have been prepared on the same basis as the audited consolidated financial statements as of and for the year ended December 31, 2023 and, in management’s opinion, include all adjustments, consisting of only normal recurring adjustments, necessary for the fair presentation of the financial statements for the interim periods. The results of
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operations for the three months ended March 31, 2024 are not necessarily indicative of the results to be expected for the full fiscal year or for any other period.

The accompanying condensed consolidated financial statements have been prepared assuming our Company will continue as a going concern. We have experienced recurring losses from operations since our inception and had an accumulated deficit of $205,547 and $197,742 as of March 31, 2024 and December 31, 2023, respectively. Management continues to monitor cash flows and liquidity on a regular basis. We believe that our cash balance, including short-term investments, at March 31, 2024 and expected cash flows from operations for the next twelve months subsequent to the issuance of the accompanying condensed consolidated financial statements, are sufficient to enable us to maintain current and essential planned operations for more than the next twelve months.

Use of Estimates

Preparation of our condensed consolidated financial statements requires the use of estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, as of the date of the condensed consolidated financial statements. By their nature, these judgments are subject to an inherent degree of uncertainty. We use historical experience and other assumptions as the basis for our judgments and estimates. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in our consolidated financial statements.

Significant Accounting Policies

There have been no changes in the Company's significant accounting polices as disclosed in Note 2 to the audited consolidated financial statements included in the 2023 Annual Report on Form 10-K.

Reclassification

In the condensed 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 condensed consolidated statements of operations.

The following tables present the impact of the reclassification on our condensed consolidated statements of operations:
Three Months Ended March 31, 2023
Sales and marketing (prior presentation)$12,216 
Reclassification333 
Sales and marketing (new presentation)$12,549 
Three Months Ended March 31, 2023
General and administrative (prior presentation)$17,666 
Reclassification(509)
General and administrative (new presentation)$17,157 
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Three Months Ended March 31, 2023
Research and development (prior presentation)$2,270 
Reclassification176 
Research and development (new presentation)$2,446 

Financial Instruments and Concentration of Credit Risk

Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.

Recent Accounting Pronouncements

In October 2023, the FASB issued ASU No. 2023-06 "Disclosure Improvements - Codification Amendments in Response to SEC's Disclosure Update and Simplification Initiative". This amendment modifies the disclosure or presentation requirements of a variety of Topics in the Codification. Certain of the amendments represent clarifications to or technical corrections of the current requirements. For entities subject to the SEC's existing disclosure requirements and entities required to file or furnish financial statements with or to the SEC in preparation for the sale of or for purposes of issuing securities that are not subject to contractual restrictions on transfer, the effective date for each amendment will be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. For all other entities, the amendments will be effective two years later. Amendments in this Update should be applied prospectively. The Company continues to analyze this ASU. The update is specific to disclosures and, therefore, is not expected to have a material impact to the condensed consolidated financial statements.

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. This authoritative guidance will be effective for us in fiscal 2024 for annual periods and in the first quarter of fiscal 2025 for interim periods, with early adoption permitted. We are currently evaluating the effect of this new guidance on our consolidated financial statements and disclosures.

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 new guidance on our consolidated financial statements and disclosures.





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NOTE 3 - 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 $22,000 in cash, subject to customary adjustments related to 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 Plan. The restricted stock units are not considered part of the purchase consideration.

The following table summarizes the total consideration paid for Boston O&P and the preliminary 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$22,000 
Assets
Cash1,307 
Accounts receivable - trade2,876 
Inventories1,093 
Prepaid expenses and other current assets378 
Property and equipment4,360 
Amortizable intangible assets3,720 
Other intangible assets3,650 
Other non-current assets2,208 
Total assets19,592 
Liabilities
Accounts payable-trade581 
Other current liabilities2,063 
Long-term debt724 
Deferred tax liability2,268 
Other non-current liabilities1,003 
Total liabilities6,639 
Less: total net assets12,953 
Goodwill$9,047 

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:
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AmountRemaining Economic Useful Life
Trademarks / Names$3,650 Indefinite
Customer Relationships & Other 3,720 12 years
$7,370 

The following table represents the pro forma net revenue and net loss assuming the acquisition of Boston O&P occurred on January 1, 2023.
Three Months Ended March 31,
20242023
Net revenue$45,116 $38,435 
Net loss$(7,786)$(6,690)

Rhino Pediatric Orthopedic Designs, Inc.

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

Medtech Concepts LLC

On May 1, 2023, the Company purchased all of the issued and outstanding membership interest of Medtech Concepts LLC, a Delaware limited liability company (“MedTech”). MedTech has developed an early-stage, pre-commercial enabling technology platform designed to increase efficiency in the perioperative environment. The solution combines hardware, software, and data analytics to help streamline operative care and support better decision making in the operating room. In the future, the Company believes this enabling technology platform will provide valuable intraoperative resources for surgeons that will improve decision making, drive operating room efficiency, and ultimately improve healthcare for children. The Company also expects that the acquisition will further support future market share gains for its implant systems, similar to what the Company has experienced with the FIREFLY® Technology and the 7D Surgical FLASHTM Navigation platform. No revenue was recorded from this platform in 2023, and the Company does not anticipate material revenue contributions from the platform in 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 (the "Purchase Agreement"), as amended, relating to the transaction.

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

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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 is being 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.
ConsiderationPresent Value
Cash consideration$3,000 $3,000 
Issuance of common stock2,274 2,274 
Anniversary payments5,500 4,672 
Transaction costs97 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.

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).

NOTE 4 - GOODWILL AND INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the three months ended March 31, 2024 were as follows:
Total
Goodwill at January 1, 2024$83,699 
Boston O&P acquisition9,047 
Foreign currency translation impact(1,265)
Goodwill at March 31, 2024
$91,481 

Intangible Assets

As of March 31, 2024, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.0 years$44,969 $(11,619)$33,350 
Intellectual Property & Capitalized Software8.9 years16,027 (2,911)13,116 
Customer Relationships & Other12.1 years22,417 (3,675)18,742 
License Agreements3.6 years10,733 (5,559)5,174 
Total amortizable assets$94,146 $(23,764)$70,382 
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As of December 31, 2023, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.2 years$45,646 $(11,008)$34,638 
Intellectual Property & Capitalized Software9.1 years16,026 (2,524)13,502 
Customer Relationships & Other12.4 years18,862 (3,270)15,592 
License Agreements3.8 years10,733 (5,190)5,543 
Total amortizable assets$91,267 $(21,992)$69,275 

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

Trademarks are non-amortizing intangible assets which were $18,792 and $15,287 as of March 31, 2024 and December 31, 2023, respectively. Trademarks are recorded in Other intangible assets on the condensed consolidated balance sheets. The change in balance during the three months ended March 31, 2024 was driven by foreign currency translation adjustments and the Boston O&P acquisition.

During 2023, management determined that a triggering event occurred, indicating that it was more likely than not the fair value of the ApiFix trademark asset was less than the carrying value. As such, the Company completed a quantitative analysis whereby we determined the fair value of the ApiFix trademark asset was below the carrying value. We recorded an impairment charge of $985 for the year ended December 31, 2023 to reduce the carrying amount of the intangible asset to its estimated fair value.

NOTE 5 - FAIR VALUE OF FINANCIAL INSTRUMENTS

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

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

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

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

The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of March 31, 2024 and December 31, 2023.
March 31, 2024
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $26,141 $— $26,141 
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December 31, 2023
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $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 certain asset-backed securities, collateralized by non-mortgage-related consumer debt, or certificates of deposit. These securities are predominately priced by third parties, either by a pricing vendor or dealer with significant inputs observable in active markets.

The Company's Level 3 instruments consist of contingent consideration. The fair value of the contingent consideration liability assumed in business combinations is recorded as part of the purchase price consideration of the acquisition and is determined using a discounted cash flow model or probability simulation model. The significant inputs of such models are not always observable in the market, such as forecasted annual revenues, expected volatility and discount rates. The contingent consideration was zero as of both March 31, 2024 and December 31, 2023.

NOTE 6 - DEBT AND CREDIT ARRANGEMENTS

Long-term debt consisted of the following as of the dates indicated:
March 31, 2024December 31, 2023
Term loan and final payment$10,300 $10,300 
Mortgage payable to affiliate726 763 
Acquisition note payable261 — 
Total debt11,287 11,063 
Less: debt discount and issuance costs982 1,003 
Less: current maturities154 152 
Long-term debt, net of current maturities$10,151 $9,908 

On December 29, 2023, the Company entered into an $80 million Credit, Security and Guaranty Agreement (the “Credit Agreement”) by and among (i) the Company and other borrowers party to the Credit Agreement (collectively, the “Borrowers”), (ii) MidCap Funding IV Trust, as Agent (“Agent”), (iii) MidCap Financial Trust, as Term Loan Servicer (“Servicer”), and (iv) the financial institutions or other entities from time to time party thereto as Lenders (collectively, “Lenders”). Under the terms of the Credit Agreement, the Lenders have provided to Borrowers a term loan in an aggregate principal amount that will not exceed $30 million available in three tranches of $10 million each subject to certain draw conditions (the “Term Loan”) and a revolving loan in an aggregate principal amount that will not exceed $50 million (the “Revolving Loan”). Borrowings are available subject to certain levels of working capital for the Revolving Loan. The second tranche of the Term Loan is eligible to be drawn between July 1, 2024 through June 30, 2025. The third tranche of the Term Loan is eligible to be drawn between January 1, 2025 through June 30, 2025. The Company must meet certain cash usage requirements at the time of each draw to be eligible to access these term loans. Interest on the Term Loan will accrue at the greater of (a) One Month Term SOFR plus 6.50% or (b) 9.0% and interest on the Revolving Loan will accrue at the greater of (a) One Month Term SOFR plus 4.0% or (b) 6.50% (the “Applicable Rate”) and
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will be payable monthly by the Borrowers. The Term Loans may be prepaid in full through December 29, 2024 with payment of a 3.00% prepayment premium, after which they may be prepaid in full through December 29, 2025 with payment of a 2.00% prepayment premium, after which they may be prepaid in full through December 29, 2026 with payment of a 1.00% prepayment premium, after which they may be prepaid in full with no prepayment premium. An additional final payment of 3.00% ("Final Payment") of the amount of the Terms Loans advanced by the Lenders will be due upon prepayment or repayment of the Terms Loans in full, and is accounted for as debt discount. The first tranche of $10 million was issued under the Term Loan upon execution. Payments of principal and all accrued but unpaid interest will be due and payable upon 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 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. The loans under the Credit Agreement are secured by a security interest in the Company’s and other Borrowers' assets. The Credit Agreement provides for customary events of default. If an event of default is not cured within the time periods specified (if any), the Lenders and Agent have the right to accelerate the Company’s payment of principal and interest in addition to other rights and remedies.

The Credit Agreement includes 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. The Credit Agreement was amended on May 3, 2024 to clarify the inputs into the financial covenant calculations. No other changes were made to the Credit Agreement. The Company was in compliance with all covenants under the Credit Agreement, as amended, as of March 31, 2024 and December 31, 2023.

The debt facilities available under the Credit Agreement replace 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 million revolving credit facility. During the year ended December 31, 2023, there was no indebtedness outstanding under the Squadron Loan Agreement and it was terminated in connection with the Credit Agreement.

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,
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transferring any of our material assets, merging with or acquiring another entity, entering into a transaction that would result in a change of control, incurring additional indebtedness, creating any lien on our property, making investments in third parties and redeeming stock or paying dividends, in each case subject to certain exceptions.

In connection with the purchase of our office and warehouse space in Warsaw, Indiana in August 2013, we entered into a mortgage note payable to Tawani Enterprises Inc., 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. At March 31, 2024, the mortgage balance was $726 of which current principal of $154 was included in the current portion of long-term debt. As of December 31, 2023, the mortgage balance was $763 of which current principal due of $152 was included in the current portion of long-term debt.

The aggregate interest expense relating to the notes payable to Squadron, the mortgage note payable to Tawani Enterprises Inc. and the term loan with MidCap was $339 and $11 for the three months ended March 31, 2024 and 2023, respectively.

NOTE 7 - INCOME TAXES

The Company utilizes an estimated annual effective tax rate to determine its provision or benefit for income taxes for interim periods. The income tax provision or benefit is computed by multiplying the estimated annual effective tax rate by the year-to-date pre-tax book income (loss).

For the three months ended March 31, 2024, the income tax benefit was $2,531 compared to $574 for the three months ended March 31, 2023. Our effective income tax rate was (24.5)% and (7.8)% for the three months ended March 31, 2024 and 2023, respectively. The higher effective rate compared to the prior period is from the remeasurement of the valuation allowance subsequent to recording the deferred tax liability as a result of the purchase accounting from the Boston O&P acquisition.

The deferred tax assets were fully offset by a valuation allowance at March 31, 2024 and December 31, 2023, with the exception of certain deferred tax liabilities recognized in a foreign jurisdiction as a result of fair value adjustments recorded upon the acquisition of ApiFix, Ltd. ("ApiFix") and Pega Medical. See Note 3 under Item 8 in the Company's Annual Report on Form 10-K for additional information regarding the ApiFix business combination. The Company has recorded a tax benefit during the period ended March 31, 2024 for losses generated in Canada and Israel, respectively.

NOTE 8 - STOCKHOLDERS’ EQUITY

Restricted Stock

Our restricted stock activity and related information are summarized as follows:
Weighted-AverageWeighted-Average
RestrictedRemainingRestrictedRemaining
StockContractual TermsStockContractual Terms
Awards(in Years)Units(in Years)
Outstanding at January 1, 2024592,453 1.613,851 1.7
Granted165,473 7,900 
Forfeited(3,470)(100)
Vested(82,659)— 
Outstanding at March 31, 2024
671,797 1.921,651 1.9

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At March 31, 2024, there was $16,757 of unrecognized compensation expense remaining related to our service-based restricted stock awards and restricted stock units. The unrecognized compensation cost is expected to be recognized over a weighted-average period of 1.9 years or earlier upon an elimination of the restriction period as a result of a change in control event.

Stock-based compensation expense on restricted stock amounted to $2,799 and $1,959 for the three months ended March 31, 2024 and 2023, respectively.

NOTE 9 – NET LOSS PER SHARE

The following is a reconciliation of basic and diluted net loss per share:
Three Months Ended
March 31,
20242023
Net loss$(7,805)$(6,806)
Weighted average shares outstanding for basic and diluted22,820,779 22,506,024 
Net loss per share - basic and diluted$(0.34)$(0.30)

Our basic and diluted net loss per share is computed using the two-class method.  For purposes of our equity disclosures and calculation of weighted average shares for basic earnings per share calculations, the two-class method is an earnings allocation that determines net income per share for each class of common stock and participating securities according to their participation rights in dividends and undistributed earnings or losses.  Non-vested restricted stock that includes non-forfeitable rights to dividends are considered participating securities. 

The contingently issuable shares in the paragraph above do not include shares of our common stock associated with our obligation to issue a variable number of our common shares as a result of our recent acquisitions of Pega Medical, ApiFix or MedTech. See Note 3 for additional information regarding our commitment to issue future equity under the MedTech acquisition. Additionally, as a component of the acquisition of ApiFix, the Company is obligated to make anniversary installment payments on the second, third and fourth anniversary of the acquisition date. These payments included a minimum cash component with the remaining settled in common stock. See Note 3 under Item 8 in the Company's Annual Report on Form 10-K for additional information regarding this business combination.

NOTE 10 – BUSINESS SEGMENT

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

Product sales attributed to a country or region includes product sales to hospitals, physicians and distributors and is based on the final destination where the products are sold. No individual customer accounted for more than 10% of total product sales for the three months ended March 31, 2024 or 2023.
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No individual customer accounted for more than 10% of consolidated accounts receivable as of March 31, 2024 and December 31, 2023.

Product sales by source were as follows:
Three Months Ended March 31,
Product sales by geographic location:20242023
U.S.$34,305 $23,800 
International10,380 7,788 
Total$44,685 $31,588 
Three Months Ended March 31,
Product sales by category:20242023
Trauma and deformity$33,302 $23,395 
Scoliosis10,203 7,072 
Sports medicine/other1,180 1,121 
Total$44,685 $31,588 

NOTE 11 - RELATED PARTY TRANSACTIONS

In addition to the expired debt and credit agreements and mortgage with Squadron (the Company's largest investor) and its affiliate (see Note 6), we currently use Structure Medical, LLC (“Structure Medical”) as one of our suppliers. Structure Medical is affiliated with Squadron and a supplier with which we maintain certain long-term agreements. We made aggregate payments to Structure Medical for inventory purchases of $382 and $246 for the three months ended March 31, 2024 and 2023, respectively.

NOTE 12 - EMPLOYEE BENEFIT PLAN

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

NOTE 13 – COMMITMENTS AND CONTINGENCIES

Leases

As of March 31, 2024, the Company has recorded a lease liability of $2,235 and corresponding right-of-use asset of $2,529 on its condensed consolidated balance sheet. We assumed $1,749 of operating right-of-use assets and $1,582 of total lease liabilities in connection with our acquisition of Boston O&P.

Legal Proceedings

From time to time, we are involved in various legal proceedings arising in the ordinary course of our business.



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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.
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Although we believe the Company has strong defenses to the IMED lawsuit and we intend to vigorously defend the claims asserted against us, arbitration and litigation can involve complex factual and legal questions, and an adverse resolution of such proceedings could have a material adverse effect on our business, operating results and financial condition.

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.

We are not presently a party to any other legal proceedings the outcome of which, if determined adversely to us, would individually or in the aggregate materially affect our financial position or results of operations or cash flows.

Purchase Obligations and Performance Requirements

As a result of entering into a license agreement for the exclusive distribution of the 7D Surgical FLASHTM Navigation platform during 2021, the Company agreed to a minimum purchase commitment for the first twelve months of that agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of March 31, 2024, the remaining purchase commitment under the agreement was $1,820 for the year ended December 31, 2024 and $1,456 for the year ended 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. The Company analyzes its projected achievement of these performance metrics and accrues for any estimated shortfall. During the three months ended March 31, 2024, the Company recorded an expense of $542 based on current estimates. The Company recorded $300 of expense for the three months ended March 31, 2023.

Royalties

As of March 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.
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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 March 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.

NOTE 14 – SUBSEQUENT EVENT

ApiFix Acquisition Installment Payment

On April 1, 2024, the fourth-year anniversary of the acquisition of ApiFix, the Company paid $2,250 in cash and issued 245,812 shares of the Company's common stock, representing $6,929 of fair value (based on the April 1, 2024 closing share price of $28.19), to fulfill its installment obligation to ApiFix. This was the third and final installment payment paid since the acquisition.

MedTech Anniversary Payment

On May 1, 2024, the first-year anniversary of the acquisition of MedTech, the Company paid $1,250 in cash and issued 42,882 shares of the Company's common stock, representing $1,331 of fair value (based on the May 1, 2024 closing share price of $31.04), to fulfill its installment obligation to MedTech. This was the first installment payment paid since the acquisition.


ITEM 2.    MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

This Management's Discussion and Analysis of Financial Condition and Results of Operations should be read in conjunction with the condensed consolidated financial statements and related notes thereto contained elsewhere in this quarterly report, as well as the information under "Note Regarding Forward-Looking Statements."

The description of our business included in this quarterly report is summary in nature and only includes material developments that have occurred since the latest full description. The full description of the history and general development of our business is included in "Item 1. Description of Business" section of the Company's Annual Report on Form 10-K filed with the SEC on March 8, 2024, which section is incorporated herein by reference.

Overview

We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis and sports medicine product offering to the pediatric orthopedic market in order to improve the lives of children with orthopedic conditions. We design, develop and commercialize innovative orthopedic implants, instruments and specialized braces to meet the needs of pediatric surgeons or orthotists and their patients, who we believe have been largely neglected by the orthopedic industry. We currently serve three of the largest categories in this market. We estimate that the portion of this market that we currently serve represents a $3.9 billion opportunity globally, including over $1.7 billion in the United States.

We sell implants, instruments and specialized braces to our customers for use by pediatric orthopedic surgeons, orthotists or physical therapists to treat orthopedic conditions in children. We provide our implants in sets that consist of a range of implant sizes and include the instruments necessary to perform the surgical procedure. In the United States and a few selected international markets, our customers typically expect us to have full sets of implants and instruments on site at each hospital but do not purchase the implants until they are used in surgery. Accordingly, we must make an up-front
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investment in inventory of consigned implants and instruments before we can generate revenue from a particular hospital and we maintain substantial levels of inventory at any given time. In the international markets where we sell to stocking distributors or in the case of our braces, we transfer control of our products to the distributor or customer when title passes upon shipment.

We currently market 71 surgical and specialized bracing systems that serve three of the largest categories within the pediatric orthopedic market: (i) trauma and deformity correction, (ii) scoliosis and (iii) sports medicine/other. We rely on a broad network of third parties to manufacture the components of our products, which we then inspect and package. We believe our innovative products promote improved surgical accuracy, increase consistency of outcomes and enhance surgeon confidence in achieving high standards of care. In the future, we expect to expand our product offering within these categories, as well as to address additional categories of the pediatric orthopedic market.

The majority of our revenue has been generated in the United States, where we sell our products through a network of multiple direct sales representatives as well as 38 independent sales agencies employing more than 210 sales representatives specifically focused on pediatrics. These independent sales agents are trained by us, distribute our products and are compensated through sales-based commissions and performance bonuses. We do not sell our products through or participate in physician-owned distributorships, or PODs.

We market and sell our products internationally in over 70 countries, through independent stocking distributors and sales agencies. Our independent distributors manage the billing relationship with each hospital in their respective territories and are responsible for servicing the product needs of their surgeon customers. In 2017, we began to supplement our international stocking distributors with sales agencies using direct sales programs in the United Kingdom, Ireland, Australia and New Zealand where we sell directly to the hospitals. We began selling direct to Canada in September 2018, Belgium and the Netherlands in January 2019, Italy in March 2020 and Germany, Switzerland and Austria in January 2021. 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 January 2023, we established a direct sales organization in Germany, the Company's first direct selling organization serving an international market. In our international markets, excluding Germany, we work through sales agencies that are paid a commission, similar to our U.S. sales model. These arrangements have generated an increase in revenue and gross margin.

We believe there are significant opportunities for us to strengthen our position in U.S. and international markets by increasing investments in consigned implant and instrument sets, strengthening our global sales and distribution infrastructure and expanding our product offering.

Environmental, Social and Governance ("ESG") Activities

OrthoPediatrics was founded on the cause of impacting the lives of children with orthopedic conditions. Since inception we have impacted the lives of over 1,000,000 children, when including those served by our acquired companies. We believe we should continue to expand our social efforts while minimizing our impact to the environment and ensuring corporate governance. In 2021, we created an internal ESG team, which reports directly to our Board’s Governance Committee, to identify ESG topics for disclosure by assessing both the impact on our business and the importance to our stakeholders.

We encourage you to review our ESG page and summary report which can be found under the "About" section of our corporate website for more detailed information regarding our ESG efforts and current initiatives. On our website, among other information, are the following highlights:

•OrthoPediatrics cares about our environmental impact while working in a highly regulated industry and we are certified according to ISO 13485. Our team in Warsaw, Indiana recently implemented
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an enhanced recycling program and our team in the United Kingdom created a carbon reduction plan.

•The Company and its associates regularly participate in philanthropic causes important to our local communities. We also partner with charitable organizations that provide pediatric orthopedic care around the world. In 2020, we were named as "Corporate Partner of the Year" by World Pediatrics - with whom we work to provide access to medical care for children in developing countries.

•We are committed to fostering an environment that is respectful, compassionate, and inclusive of everyone in our community which is communicated in our diversity and inclusion policy. For eight years we have been recognized by the Indiana Chamber of Commerce - Best Companies to Work in Indiana.

•The Company and its Board of Directors understand the value of diversity. In 2022 and again in 2023, the Company added diverse Directors to our Board and will continue its Board diversity initiative in the future.

We believe effectively managing our priorities, as well as increasing our transparency related to ESG programs, will help create long-term value for our stakeholders. We expect to increase our disclosures and communicate our ESG efforts in future SEC filings.

Nothing on our website shall be deemed part of or incorporated by reference into this Quarterly Report on Form 10-Q.

Trends and Uncertainties

From time to time we acquire, make investments in or license other technologies, products and business that may enhance our capabilities, complement our current products or expand the breadth of our markets or customer base. As a result of these transactions, we may record certain intangible assets, including goodwill and trademarks, which are subject to annual impairment testing. Fair value is based on our current assessment of the expected future cash flows based on recent results and other specific market factors. During 2023 and 2022, we determined that a triggering event had occurred indicating it was more likely than not the fair value of the ApiFix trademark was less than the associated carrying value. Subsequently, the Company completed a quantitative analysis and concluded that the fair value was in fact less than the carrying value and a partial impairment losses of $1.0 million and $3.6 million were recorded in 2023 and 2022, respectively. We believe that the expected future cash flows in the most recent calculations represent management’s best estimate; however, if actual results differ materially from these estimates, we could record an additional impairment charge which could be material to our consolidated financial statements and have an adverse impact on our results of operations.

In 2022 and 2023, there was a significant and unprecedented increase in cases of respiratory syncytial virus, or RSV, and other respiratory illnesses. RSV is a common respiratory virus that follows a seasonal pattern. The typical season shows an increase in mid-September, peaks in late December and drops around mid-April. In 2023 the United States experienced a significant increase in RSV activity outside of the typical peak season as well as a heightened impact during the winter months. The volume of elective procedures utilizing our products were negatively impacted as a significant percent of hospital capacity was absorbed to cover the increase in RSV-related hospitalizations. This had a negative impact on our sales volume in 2022 and 2023 and may continue to do so into the future. We are unable to accurately determine exactly how this will impact us in the future.

As a result of the COVID-19 pandemic, we experienced significant business disruption throughout the last several years. Elective procedures were delayed in some cases as hospitals continue to struggle with adequate staffing levels. As a majority of our products are utilized in elective surgeries or procedures, the
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deferrals of such surgeries and procedures have had, and may continue to have, a significant negative impact on our business and results of operations. Throughout the pandemic, we took a variety of steps to address the impact. We continue to monitor the impact of the pandemic on our employees and customers and the markets in which we operate and will take further actions that are considered prudent to address the pandemic. We cannot accurately predict with certainty the full extent to which the pandemic will impact demand for our products in the future.

We encourage the readers of this document to read our risk factors in their entirety contained in Item 1A “Risk Factors” in our Annual Report on Form 10-K filed with the Securities and Exchange Commission (the "SEC") on March 8, 2024 and in other reports filed with the SEC that discuss the risks and factors that may affect our business.

Summary of Statements of Operations for the Three Months Ended March 31, 2024 and 2023

The following table sets forth our results of operations for the three months ended March 31, 2024 and 2023:
Three Months Ended March 31,
20242023Increase
(Decrease)		%
Net revenue$44,685 $31,588 $13,097 41 %
Cost of revenue12,511 8,027 4,484 56 %
Sales and marketing expenses14,169 12,549 1,620 13 %
General and administrative expenses24,730 17,157 7,573 44 %
Research and development expenses2,998 2,446 552 23 %
Other expense (income), net613 (1,211)1,824 (151)%
Provision for income taxes (benefit)(2,531)(574)(1,957)(341)%
Net loss$(7,805)$(6,806)$999 15 %

Net Revenue

The following tables set forth our net revenue by geography and product category for the three months ended March 31, 2024 and 2023:
Three Months Ended March 31,
Product sales by geographic location:20242023
U.S.$34,305 $23,800 
International10,380 7,788 
Total$44,685 $31,588 
Three Months Ended March 31,
Product sales by category:20242023
Trauma and deformity$33,302 $23,395 
Scoliosis10,203 7,072 
Sports medicine/other1,180 1,121 
Total$44,685 $31,588 

Net revenue increased $13.1 million, or 41%, from $31.6 million for the three months ended March 31, 2023 to $44.7 million for the three months ended March 31, 2024. The increase during the three months ended March 31, 2024 was primarily driven by the addition of Boston O&P sales, as well as strong performance across global Trauma and Deformity, International Scoliosis and OP Specialty Bracing.

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Trauma and deformity sales increased $9.9 million, or 42%, from $23.4 million during the three months ended March 31, 2023, to $33.3 million for the three months ended March 31, 2024. The increase for the three months ended March 31, 2024 was primarily driven by strong growth across numerous product lines, specifically our Cannulated Screws, PNP Femur, PediPlate, external fixation and Pega systems, as well as the addition of Boston O&P. Scoliosis sales increased $3.1 million, or 44%, during the three months ended March 31, 2024. The increase for the three months ended March 31, 2024 was primarily driven by increased sales of our RESPONSE 5.5/6.0 and ApiFix systems and revenue generated from 7D Technology, as well as the addition of Boston O&P. Sports medicine / other increased $0.1 million, or 5%, during the three months ended March 31, 2024. The change in sports medicine / other was primarily driven by sales from our Telos operations. Nearly all the change in each category was due to an increase or decrease in the unit volume sold and not a result of price changes.

Cost of Revenue and Gross Margin

Cost of revenue increased $4.5 million, or 56%, from $8.0 million for the three months ended March 31, 2023 to $12.5 million for the three months ended March 31, 2024. The increase is due primarily to sales volume, including the added cost of revenue associated with the revenue generated by acquisitions and mix related to additional international sales. Gross margin was 72% and 75% for the three months ended March 31, 2024 and March 31, 2023, respectively.

Sales and Marketing Expenses

Sales and marketing expenses increased $1.6 million, or 13%, to $14.2 million for the three months ended March 31, 2024 from $12.5 million for the three months ended March 31, 2023. The changes in the three month periods ended March 31, 2024 was due primarily to increased sales commission expenses, as well as the addition of Boston O&P.

General and Administrative Expenses

General and administrative expenses increased $7.6 million, or 44%, from $17.2 million for the three months ended March 31, 2023 to $24.7 million for the three months ended March 31, 2024. The increases for the three month period ended March 31, 2024 was due primarily to the addition of Boston O&P. Stock compensation increased by $0.5 million with the increase in personnel and also as a result of restricted stock issued as part of the Boston O&P acquisition.

Depreciation and amortization expenses increased $1.2 million, or 31%, from $3.8 million for the three months ended March 31, 2023 to $5.0 million for the three months ended March 31, 2024. The increase in depreciation for the three month period ended March 31, 2024 was primarily due to higher set deployments and increased amortization associated with acquisitions, as well as the addition of Boston O&P.

Research and Development Expenses

Research and development expenses increased $0.6 million, or 23%, from $2.4 million for the three months ended March 31, 2023 to $3.0 million for the three months ended March 31, 2024. The increase for the three month period ended March 31, 2024 was primarily due to incremental product development and the addition of personnel to support the future growth of the business, including $0.4 million of additional non-cash stock based compensation expense.

Total Other (Income) Expenses

Other expense was $0.6 million for the three months ended March 31, 2024 compared to other income of $1.2 million for the three months ended March 31, 2023, a change of $1.8 million or 151%. The change for the three months ended March 31, 2024 was primarily due to the fair value adjustment of contingent
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consideration associated with our ApiFix acquisition, as well as an increase to net interest expense related to the new Term Loan with MidCap.

Liquidity and Capital Resources

We have incurred operating losses since inception which resulted in negative cash flows used in operating activities of $6.7 million and $6.5 million for the three months ended March 31, 2024 and 2023, respectively. As of March 31, 2024, we had an accumulated deficit of $205.5 million. We anticipate that our losses will continue in the near term as we continue to expand our product portfolio and invest in additional consigned implant and instrument sets to support our expansion into existing and new markets. Since inception, we have funded our operations primarily with proceeds from the sales of our common and preferred stock, convertible securities and debt, as well as through sales of our products. At March 31, 2024, we had cash and cash equivalents, restricted cash and short-term investments of $49.7 million.

Cash Flows

The following table sets forth our cash flows from operating, investing and financing activities for the periods indicated:
Three Months Ended March 31,
20242023
Net cash used in operating activities$(6,690)$(6,461)
Net cash (used in) provided by investing activities(3,679)32,310 
Net cash used in financing activities(573)(36)
Effect of exchange rate changes on cash, cash equivalents and restricted cash1,479 (138)
Net (decrease) increase in cash, cash equivalents and restricted cash$(9,463)$25,675 

Cash Used in Operating Activities

Net cash used in operating activities was $6.7 million and $6.5 million for the three months ended March 31, 2024 and 2023, respectively. The primary use of this cash was to fund our operations related to the development and commercialization of our products in each of these periods. Net cash used for working capital was $4.5 million for the three months ended March 31, 2024 compared to $4.8 million for the three months ended March 31, 2023. The increase in cash used in operating activities was primarily driven by additional inventory purchased to support sales growth as well as accounts receivable from the increased sales which was offset by cash provided by accounts payable associated with the acquired inventory.

Cash (Used in) Provided by Investing Activities

Net cash used in investing activities for the three months ended March 31, 2024 was $3.7 million compared to cash provided of $32.3 million for the three months ended March 31, 2023. Net cash used in investing activities for the three months ended March 31, 2024 consisted primarily of the sale of short-term marketable securities, when netted against the purchase of similar securities, offset by purchases of property, plant and equipment of $6.5 million, the majority of which is instrument sets. The change in cash related to investing activities is primarily driven by business combinations and the purchase of short term marketable securities which decreased from the prior year.

Cash Used in Financing Activities

Net cash used in financing activities for the three months ended March 31, 2024 was $0.6 million consisting primarily of $0.5 million payments on acquisition note payable that was assumed with the
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Boston O&P acquisition. Net cash used in financing activities for the three months ended March 31, 2023 was not material to the results of our operations.

Indebtedness

The Company is party to a $80 million Credit, Security and Guaranty Agreement with Midcap Funding IV Trust and Midcap Financial Trust and other parties named therein. As of March 31, 2024, there was $10 million outstanding indebtedness under the Credit Agreement.

In August 2013, pursuant to the purchase of our office and warehouse space, we entered into a mortgage note payable to Tawani Enterprises Inc., the owner of which is a member of Squadron’s management committee. Pursuant to the terms of the mortgage note, we pay Tawani Enterprises Inc. monthly principal and interest installments of $15,543, with interest compounded at 5% until maturity in August 2028, at which time a final payment of remaining principal and interest will become due.

See Note 6 - Debt and Credit Arrangements in Item 1 for further detail regarding our debt.
Pediatric Orthopedic Business Seasonality

Our revenue is typically higher in the summer months and holiday periods, driven by higher sales of our trauma and deformity and scoliosis products, which is influenced by the higher incidence of pediatric surgeries during these periods due to recovery time provided by breaks in the school year. Additionally, our scoliosis patients tend to have additional health challenges that make scheduling their procedures variable in nature.

Critical Accounting Policies and Significant Judgments and Estimates

There were no material changes to our critical accounting policies that are disclosed in our audited consolidated financial statements for the year ended December 31, 2023 filed with the SEC on March 8, 2024.

Recent Accounting Pronouncements

See Note 2 - Significant Accounting Policies in Item 1 Financial Statements of Part 1 of this Quarterly report on Form 10-Q for a description of recent accounting pronouncements applicable to our condensed consolidated financial statements.

ITEM 3.        QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

We consider our greatest potential area of market risk exposure to be interest rate risk related to our indebtedness and foreign currency exchange rate risk on our operating results. Quantitative and qualitative disclosures about exchange rate risk are included in Item 7A "Quantitative and Qualitative Disclosures About Market Risk" of our Annual Report on Form 10-K for 2023. There were no material changes from the information provided therein.

ITEM 4.        CONTROLS AND PROCEDURES

a.Evaluation of Disclosure Controls and Procedures

Our management, with the participation of our Chief Executive Officer and Chief Financial Officer, evaluated the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the "Exchange Act")) at the end of the period covered by this quarterly report.
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Based on this evaluation, we concluded that, as of such date, our disclosure controls and procedures were effective to provide reasonable assurance that the information required to be disclosed by us in the reports we file or submit under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms, and that such information is accumulated and communicated to management, including our Chief Executive Officer and Chief Financial Officer, as appropriate to allow timely decisions regarding required disclosure.

We recognize that any controls system, no matter how well designed and operated, can provide only reasonable assurance of achieving its objectives, and our management necessarily applies its judgment in evaluating the benefits of possible controls and procedures relative to their costs.

b. Changes in Internal Control over Financial Reporting

On January 5, 2024, the Company completed the acquisition of Boston O&P. The company continues to evaluate Boston O&P's systems and controls and to integrate them into the Company's existing control structure. Except as it relates to the integration of the Boston O&P business, there were no changes in our internal control over financial reporting during the period covered by this quarterly report that materially affected, or are reasonably likely to materially affect, our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act).



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PART II. OTHER INFORMATION

ITEM 1.        LEGAL PROCEEDINGS

From time to time, we are involved in various legal proceedings arising in the ordinary course of our business.

A discussion of certain of those legal proceedings is contained in Note 13 – Commitments and Contingencies (under the heading “Legal Proceedings”) of the notes to the condensed consolidated financial statements included in Item 1. Financial Statements of Part I of this quarterly report on Form 10-Q, which discussion is incorporated herein by reference.

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, results of operations or cash flows.

ITEM 1A.    RISK FACTORS

In addition to the other information set forth in this quarterly report, you should carefully consider the factors discussed in “Risk Factors” in our Annual Report on Form 10-K filed with the SEC on March 8, 2024. There have been no material changes to these Risk Factors since the filing of our Annual Report on Form 10-K.

ITEM 2.        UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

a. Sale of Unregistered Securities.

None.

b. Use of Proceeds.

None.

c. Issuer Purchases of Equity Securities.

None.

ITEM 3.        DEFAULTS UPON SENIOR SECURITIES

None.

ITEM 4.        MINE SAFETY DISCLOSURES

None.

ITEM 5.        OTHER INFORMATION

a. Information required under Form 8-K.

None.
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b. Modifications to nomination process.

None.

c. Insider trading arrangements.

During the three months ended March 31, 2024, no director or officer of the Company adopted or terminated a "Rule 10b5-1 trading arrangement" or "non-Rule 10b5-1 trading arrangement," as each term is defined in Item 408(a) of Regulation S-K.

ITEM 6.        EXHIBITS

The following exhibits are included within this Report or incorporated herein by reference.




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Exhibit
Number
Description
*
34

+
+
++
++
101.INS+Inline XBRL Instance Document (The instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.)
101.SCH+Inline XBRL Taxonomy Extension Schema Document
101.CAL+Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF+Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB+Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE+Inline XBRL Taxonomy Extension Presentation Linkbase Document
104Cover Page Interactive Data File (formatted as Inline XBRL and included in Exhibit 101)

w The exhibits and schedules to the applicable agreement have been omitted pursuant to Item 601(a)(5) of Regulation S-K. The Company agrees to furnish a copy of any schedule omitted from such agreement to the SEC upon request.

*    Exhibits that describe or evidence management contracts or compensatory plans or arrangements required to be filed as Exhibits to this Report.

+ Filed herewith.

++ Furnished herewith.

35

SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, as amended, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

May 7, 2024By:/s/ David R. Bailey
David R. Bailey
President and Chief Executive Officer
(Principal Executive Officer)


May 7, 2024
By:
/s/ Fred L. Hite
Fred L. Hite
Chief Financial Officer and Chief Operating Officer
(Principal Financial and Accounting Officer)

36

CERTIFICATION PURSUANT TO RULE 13a-14(a)/15d-14(a)
OF THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, David R. Bailey, certify that:

1.I have reviewed this Quarterly Report on Form 10-Q of OrthoPediatrics Corp.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a.    Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b.    Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with general accepted accounting principles;

c.    Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d.    Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is likely to materially affect, the registrant’s internal control over financial reporting; and

5.The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a.    All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b.    Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

/s/ David R. Bailey
David R. Bailey
President and Chief Executive Officer
(Principal Executive Officer)

Date:     May 7, 2024



CERTIFICATION PURSUANT TO RULE 13a-14(a)/15d-14(a)
OF THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Fred L. Hite, certify that:

1.I have reviewed this Quarterly Report on Form 10-Q of OrthoPediatrics Corp.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a.    Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b.    Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with general accepted accounting principles;

c.    Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d.    Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is likely to materially affect, the registrant’s internal control over financial reporting; and

5.The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a.    All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b.    Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

/s/ Fred L. Hite
Fred L. Hite
Chief Financial Officer and Chief Operating Officer
(Principal Financial and Accounting Officer)

Date:     May 7, 2024



CERTIFICATION PURSUANT TO 18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report on Form 10-Q of OrthoPediatrics Corp. (the “Company”) for the quarterly period ended March 31 2024, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), the undersigned, David R. Bailey, Chief Executive Officer of the Company, hereby certifies, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to his knowledge:

1.the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2.the information contained in the Report fairly presents, in all material aspects, the financial condition and results of operations of the Company.

This certificate is being furnished solely for purposes of Section 906 and is not being filed as part of the Report.
/s/ David R. Bailey
David R. Bailey
President and Chief Executive Officer
(Principal Executive Officer)

Date:     May 7, 2024



CERTIFICATION PURSUANT TO 18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report on Form 10-Q of OrthoPediatrics Corp. (the “Company”) for the quarterly period ended March 31, 2024, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), the undersigned, Fred L. Hite, Chief Financial Officer and Chief Operating Officer of the Company, hereby certifies, pursuant to 18 Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to his knowledge:

1.the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2.the information contained in the Report fairly presents, in all material aspects, the financial condition and results of operations of the Company.

This certificate is being furnished solely for purposes of Section 906 and is not being filed as part of the Report.
/s/ Fred L. Hite
Fred L. Hite
Chief Financial Officer and Chief Operating Officer
(Principal Financial and Accounting Officer)

Date:     May 7, 2024


v3.24.1.u1
COVER - shares
 3 Months Ended
Mar. 31, 2024
May 03, 2024
Cover [Abstract]    
Document Type 10-Q  
Document Quarterly Report true  
Document Period End Date Mar. 31, 2024  
Document Transition Report false  
Entity File Number 001-38242  
Entity Registrant Name OrthoPediatrics Corp  
Entity Incorporation, State or Country Code DE  
Entity Tax Identification Number 26-1761833  
Entity Address, Address Line One 2850 Frontier Drive  
Entity Address, City or Town Warsaw  
Entity Address, State or Province IN  
Entity Address, Postal Zip Code 46582  
City Area Code 574  
Local Phone Number 268-6379  
Title of Each Class Common Stock, $0.00025 par value per share  
Trading Symbol(s) KIDS  
Name of each exchange on which registered NASDAQ  
Entity Current Reporting Status Yes  
Entity Interactive Data Current Yes  
Entity Filer Category Accelerated Filer  
Entity Small Business false  
Entity Emerging Growth Company false  
Entity Shell Company false  
Entity Common Stock, Shares Outstanding   23,828,882
Document Fiscal Year Focus 2024  
Document Fiscal Period Focus Q1  
Amendment Flag false  
Entity Central Index Key 0001425450  
Current Fiscal Year End Date --12-31  
v3.24.1.u1
CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Current assets:    
Cash and cash equivalents $ 21,602 $ 31,055
Restricted cash 1,962 1,972
Short-term investments 26,141 49,251
Accounts receivable - trade, net of allowances of $1,195 and $1,373, respectively 36,275 34,617
Inventories, net 112,689 105,851
Prepaid expenses and other current assets 5,056 3,750
Total current assets 203,725 226,496
Property and equipment, net 48,721 41,048
Other assets:    
Amortizable intangible assets, net 70,382 69,275
Goodwill 91,481 83,699
Other intangible assets 18,792 15,287
Other non-current assets 4,084 2,940
Total other assets 184,739 171,201
Total assets 437,185 438,745
Current liabilities:    
Accounts payable - trade 19,736 12,649
Accrued compensation and benefits 9,772 11,325
Current portion of long-term debt with affiliate 154 152
Current portion of acquisition installment payable 10,368 10,149
Other current liabilities 5,790 7,391
Total current liabilities 45,820 41,666
Long-term liabilities:    
Acquisition installment payable, net of current portion 3,613 3,551
Deferred income taxes 5,202 5,483
Other long-term liabilities 1,815 1,112
Total long-term liabilities 20,781 20,054
Total liabilities 66,601 61,720
Stockholders' equity:    
Common stock, $0.00025 par value; 50,000,000 shares authorized; 23,540,411 shares and 23,378,408 shares issued as of March 31, 2024 and December 31, 2023, respectively 6 6
Additional paid-in capital 583,086 580,287
Accumulated deficit (205,547) (197,742)
Accumulated other comprehensive loss (6,961) (5,526)
Total stockholders' equity 370,584 377,025
Total liabilities and stockholders' equity 437,185 438,745
Nonrelated Party    
Long-term liabilities:    
Long-term debt, net of current portion 9,579 9,297
Long-term debt with affiliate, net of current portion 9,579 9,297
Related Party    
Long-term liabilities:    
Long-term debt, net of current portion 572 611
Long-term debt with affiliate, net of current portion $ 572 $ 611
v3.24.1.u1
CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Statement of Financial Position [Abstract]    
Allowance for doubtful accounts $ 1,195 $ 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) 23,540,411 23,378,408
v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Income Statement [Abstract]    
Net revenue $ 44,685 $ 31,588
Cost of revenue 12,511 8,027
Gross profit 32,174 23,561
Operating expenses:    
Sales and marketing 14,169 12,549
General and administrative 24,730 17,157
Research and development 2,998 2,446
Total operating expenses 41,897 32,152
Operating loss (9,723) (8,591)
Other expense (income):    
Interest expense (income), net 637 (210)
Fair value adjustment of contingent consideration 0 (670)
Other income, net (24) (331)
Total other expense (income), net 613 (1,211)
Loss before income taxes (10,336) (7,380)
Provision for income taxes (benefit) (2,531) (574)
Net loss $ (7,805) $ (6,806)
Weighted average shares outstanding - basic (in shares) 22,820,779 22,506,024
Weighted average common stock - diluted (in shares) 22,820,779 22,506,024
Net loss per share - basic (in dollars per share) $ (0.34) $ (0.30)
Net loss per share - diluted (in dollars per share) $ (0.34) $ (0.30)
v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Statement of Comprehensive Income [Abstract]    
Net loss $ (7,805) $ (6,806)
Other comprehensive loss:    
Foreign currency translation adjustment (1,426) (962)
Unrealized gain (loss) on short-term investments 109 617
Adjustment for realized (gain) loss on securities (118) (301)
Other comprehensive loss, net of tax (1,435) (646)
Comprehensive loss $ (9,240) $ (7,452)
v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (Unaudited) - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid-in Capital
Accumulated Deficit
Accumulated Other Comprehensive Loss
Beginning balance at Dec. 31, 2022 $ 378,648 $ 6 $ 560,810 $ (176,768) $ (5,400)
Beginning balance (in shares) at Dec. 31, 2022   22,877,962      
Increase (Decrease) in Stockholders' Equity          
Net loss (6,806)     (6,806)  
Other comprehensive loss (646)       (646)
Restricted stock 1,959   1,959    
Restricted stock (in shares)   264,156      
Ending balance at Mar. 31, 2023 373,155 $ 6 562,769 (183,574) (6,046)
Ending balance (in shares) at Mar. 31, 2023   23,142,118      
Beginning balance at Dec. 31, 2023 377,025 $ 6 580,287 (197,742) (5,526)
Beginning balance (in shares) at Dec. 31, 2023   23,378,408      
Increase (Decrease) in Stockholders' Equity          
Net loss (7,805)     (7,805)  
Other comprehensive loss (1,435)       (1,435)
Restricted stock 2,799   2,799    
Restricted stock (in shares)   162,003      
Ending balance at Mar. 31, 2024 $ 370,584 $ 6 $ 583,086 $ (205,547) $ (6,961)
Ending balance (in shares) at Mar. 31, 2024   23,540,411      
v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
OPERATING ACTIVITIES    
Net loss $ (7,805) $ (6,806)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 5,028 3,848
Stock-based compensation 2,799 2,113
Fair value adjustment of contingent consideration 0 (670)
Accretion of acquisition installment payable 281 381
Deferred income taxes (2,445) (574)
Changes in certain operating assets and liabilities:    
Accounts receivable - trade 1,155 (2,002)
Inventories, net (6,631) (5,979)
Prepaid expenses and other current assets (953) (33)
Accounts payable - trade 6,562 5,541
Accrued expenses and other liabilities (5,049) (1,571)
Other 368 (709)
Net cash used in operating activities (6,690) (6,461)
INVESTING ACTIVITIES    
Acquisition of Boston O&P, net of cash acquired (20,693) 0
Sale of short-term marketable securities 23,474 37,250
Purchases of property and equipment (6,460) (4,940)
Net cash (used in) provided by investing activities (3,679) 32,310
FINANCING ACTIVITIES    
Payments on acquisition note (538) 0
Payments on mortgage notes (35) (36)
Net cash used in financing activities (573) (36)
Effect of exchange rate changes on cash, cash equivalents and restricted cash 1,479 (138)
NET (DECREASE) INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH (9,463) 25,675
Cash, cash equivalents and restricted cash, beginning of year 33,027 10,462
Cash, cash equivalents and restricted cash, end of period 23,564 36,137
SUPPLEMENTAL DISCLOSURES    
Cash paid for interest 223 11
Transfer of instruments between property and equipment and inventory $ 117 $ 332
v3.24.1.u1
BUSINESS
 3 Months Ended
Mar. 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. We sell our specialized products, including PediLoc®, PediPlates®, Cannulated Screws, PediFlexTM nail, PediNailTM, PediLoc® Tibia, ACL Reconstruction System, Locking Cannulated Blade, Locking Proximal Femur, Spica Tables, RESPONSETM Spine, BandLoc Duo®, Pediatric Nailing Platform | Femur, Devise Rail, Orthex®, The Fassier-Duval Telescopic Intramedullary System®, SLIMTM Nail, The GAP NailTM, The Free Gliding SCFE Screw SystemTM, GIRO® Growth Modulation System, PNP Tibia System, ApiFix® Mid-C System and Mitchell Ponseti® specialized bracing products to various hospitals and medical facilities throughout the United States and various international markets. We currently use a contract manufacturing model for the manufacturing of implants and related surgical instrumentation while our clubfoot orthopedic products are manufactured in-house.
We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis and sports medicine product offering to the pediatric orthopedic market in order to improve the lives of children with orthopedic conditions. We design, develop and commercialize innovative orthopedic implants, instruments and specialized braces to meet the needs of pediatric surgeons or orthotists and their patients, who we believe have been largely neglected by the orthopedic industry. We currently serve three of the largest categories in this market.
v3.24.1.u1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
 3 Months Ended
Mar. 31, 2024
Accounting Policies [Abstract]  
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Basis of Presentation

The accompanying condensed consolidated financial statements include the accounts of OrthoPediatrics Corp. and its wholly-owned subsidiaries (collectively, the “Company,” “we,” “our” or “us”). All intercompany balances and transactions have been eliminated.

Unaudited Interim Condensed Consolidated Financial Statements

We have prepared the accompanying condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying condensed consolidated financial statements are unaudited and should be read in conjunction with the annual consolidated financial statements as of and for the year ended December 31, 2023 and related notes thereto contained in our Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC") on March 8, 2024. The financial data and other financial information disclosed in the notes to the accompanying condensed consolidated financial statements are also unaudited. As such, certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to applicable rules and regulations thereunder.

The unaudited condensed consolidated financial statements have been prepared on the same basis as the audited consolidated financial statements as of and for the year ended December 31, 2023 and, in management’s opinion, include all adjustments, consisting of only normal recurring adjustments, necessary for the fair presentation of the financial statements for the interim periods. The results of
operations for the three months ended March 31, 2024 are not necessarily indicative of the results to be expected for the full fiscal year or for any other period.

The accompanying condensed consolidated financial statements have been prepared assuming our Company will continue as a going concern. We have experienced recurring losses from operations since our inception and had an accumulated deficit of $205,547 and $197,742 as of March 31, 2024 and December 31, 2023, respectively. Management continues to monitor cash flows and liquidity on a regular basis. We believe that our cash balance, including short-term investments, at March 31, 2024 and expected cash flows from operations for the next twelve months subsequent to the issuance of the accompanying condensed consolidated financial statements, are sufficient to enable us to maintain current and essential planned operations for more than the next twelve months.

Use of Estimates

Preparation of our condensed consolidated financial statements requires the use of estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, as of the date of the condensed consolidated financial statements. By their nature, these judgments are subject to an inherent degree of uncertainty. We use historical experience and other assumptions as the basis for our judgments and estimates. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in our consolidated financial statements.

Significant Accounting Policies

There have been no changes in the Company's significant accounting polices as disclosed in Note 2 to the audited consolidated financial statements included in the 2023 Annual Report on Form 10-K.

Reclassification

In the condensed 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 condensed consolidated statements of operations.

The following tables present the impact of the reclassification on our condensed consolidated statements of operations:
Three Months Ended March 31, 2023
Sales and marketing (prior presentation)$12,216 
Reclassification333 
Sales and marketing (new presentation)$12,549 
Three Months Ended March 31, 2023
General and administrative (prior presentation)$17,666 
Reclassification(509)
General and administrative (new presentation)$17,157 
Three Months Ended March 31, 2023
Research and development (prior presentation)$2,270 
Reclassification176 
Research and development (new presentation)$2,446 

Financial Instruments and Concentration of Credit Risk

Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.

Recent Accounting Pronouncements

In October 2023, the FASB issued ASU No. 2023-06 "Disclosure Improvements - Codification Amendments in Response to SEC's Disclosure Update and Simplification Initiative". This amendment modifies the disclosure or presentation requirements of a variety of Topics in the Codification. Certain of the amendments represent clarifications to or technical corrections of the current requirements. For entities subject to the SEC's existing disclosure requirements and entities required to file or furnish financial statements with or to the SEC in preparation for the sale of or for purposes of issuing securities that are not subject to contractual restrictions on transfer, the effective date for each amendment will be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. For all other entities, the amendments will be effective two years later. Amendments in this Update should be applied prospectively. The Company continues to analyze this ASU. The update is specific to disclosures and, therefore, is not expected to have a material impact to the condensed consolidated financial statements.

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. This authoritative guidance will be effective for us in fiscal 2024 for annual periods and in the first quarter of fiscal 2025 for interim periods, with early adoption permitted. We are currently evaluating the effect of this new guidance on our consolidated financial statements and disclosures.
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 new guidance on our consolidated financial statements and disclosures.
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS
 3 Months Ended
Mar. 31, 2024
Business Combination and Asset Acquisition [Abstract]  
BUSINESS COMBINATIONS 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 $22,000 in cash, subject to customary adjustments related to 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 Plan. The restricted stock units are not considered part of the purchase consideration.

The following table summarizes the total consideration paid for Boston O&P and the preliminary 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$22,000 
Assets
Cash1,307 
Accounts receivable - trade2,876 
Inventories1,093 
Prepaid expenses and other current assets378 
Property and equipment4,360 
Amortizable intangible assets3,720 
Other intangible assets3,650 
Other non-current assets2,208 
Total assets19,592 
Liabilities
Accounts payable-trade581 
Other current liabilities2,063 
Long-term debt724 
Deferred tax liability2,268 
Other non-current liabilities1,003 
Total liabilities6,639 
Less: total net assets12,953 
Goodwill$9,047 

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:
AmountRemaining Economic Useful Life
Trademarks / Names$3,650 Indefinite
Customer Relationships & Other 3,720 12 years
$7,370 

The following table represents the pro forma net revenue and net loss assuming the acquisition of Boston O&P occurred on January 1, 2023.
Three Months Ended March 31,
20242023
Net revenue$45,116 $38,435 
Net loss$(7,786)$(6,690)

Rhino Pediatric Orthopedic Designs, Inc.

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

Medtech Concepts LLC

On May 1, 2023, the Company purchased all of the issued and outstanding membership interest of Medtech Concepts LLC, a Delaware limited liability company (“MedTech”). MedTech has developed an early-stage, pre-commercial enabling technology platform designed to increase efficiency in the perioperative environment. The solution combines hardware, software, and data analytics to help streamline operative care and support better decision making in the operating room. In the future, the Company believes this enabling technology platform will provide valuable intraoperative resources for surgeons that will improve decision making, drive operating room efficiency, and ultimately improve healthcare for children. The Company also expects that the acquisition will further support future market share gains for its implant systems, similar to what the Company has experienced with the FIREFLY® Technology and the 7D Surgical FLASHTM Navigation platform. No revenue was recorded from this platform in 2023, and the Company does not anticipate material revenue contributions from the platform in 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 (the "Purchase Agreement"), as amended, relating to the transaction.

The Company concluded that the business acquired did not comprise an integrated set of activities that meet the definition of a business and therefore did not result in the acquisition of a business. Instead, the Company accounted for the transaction as an asset acquisition for accounting purposes.
Under the Purchase Agreement, a number of future payments in the form of common stock are contingent on continued service through each applicable payment anniversary date. As such, these amounts have been excluded from measuring the cost of the acquisition. The result is $4,500 of stock compensation which is being 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.
ConsiderationPresent Value
Cash consideration$3,000 $3,000 
Issuance of common stock2,274 2,274 
Anniversary payments5,500 4,672 
Transaction costs97 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.

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).
v3.24.1.u1
GOODWILL AND INTANGIBLE ASSETS
 3 Months Ended
Mar. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]  
GOODWILL AND INTANGIBLE ASSETS GOODWILL AND INTANGIBLE ASSETS
Goodwill

Changes in the carrying amount of goodwill for the three months ended March 31, 2024 were as follows:
Total
Goodwill at January 1, 2024$83,699 
Boston O&P acquisition9,047 
Foreign currency translation impact(1,265)
Goodwill at March 31, 2024
$91,481 

Intangible Assets

As of March 31, 2024, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.0 years$44,969 $(11,619)$33,350 
Intellectual Property & Capitalized Software8.9 years16,027 (2,911)13,116 
Customer Relationships & Other12.1 years22,417 (3,675)18,742 
License Agreements3.6 years10,733 (5,559)5,174 
Total amortizable assets$94,146 $(23,764)$70,382 
As of December 31, 2023, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.2 years$45,646 $(11,008)$34,638 
Intellectual Property & Capitalized Software9.1 years16,026 (2,524)13,502 
Customer Relationships & Other12.4 years18,862 (3,270)15,592 
License Agreements3.8 years10,733 (5,190)5,543 
Total amortizable assets$91,267 $(21,992)$69,275 

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

Trademarks are non-amortizing intangible assets which were $18,792 and $15,287 as of March 31, 2024 and December 31, 2023, respectively. Trademarks are recorded in Other intangible assets on the condensed consolidated balance sheets. The change in balance during the three months ended March 31, 2024 was driven by foreign currency translation adjustments and the Boston O&P acquisition.
During 2023, management determined that a triggering event occurred, indicating that it was more likely than not the fair value of the ApiFix trademark asset was less than the carrying value. As such, the Company completed a quantitative analysis whereby we determined the fair value of the ApiFix trademark asset was below the carrying value. We recorded an impairment charge of $985 for the year ended December 31, 2023 to reduce the carrying amount of the intangible asset to its estimated fair value.
v3.24.1.u1
FAIR VALUE OF FINANCIAL INSTRUMENTS
 3 Months Ended
Mar. 31, 2024
Fair Value Disclosures [Abstract]  
FAIR VALUE OF FINANCIAL INSTRUMENTS FAIR VALUE OF FINANCIAL INSTRUMENTS
The Company measures certain financial assets and liabilities at fair value. The accounting standards related to fair value measurements define fair value and provide a consistent framework for measuring fair value under the authoritative literature. A fair value hierarchy was established, which prioritizes the inputs used in measuring fair value into three broad levels.

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

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

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

The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of March 31, 2024 and December 31, 2023.
March 31, 2024
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $26,141 $— $26,141 
December 31, 2023
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $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 certain asset-backed securities, collateralized by non-mortgage-related consumer debt, or certificates of deposit. These securities are predominately priced by third parties, either by a pricing vendor or dealer with significant inputs observable in active markets.
The Company's Level 3 instruments consist of contingent consideration. The fair value of the contingent consideration liability assumed in business combinations is recorded as part of the purchase price consideration of the acquisition and is determined using a discounted cash flow model or probability simulation model. The significant inputs of such models are not always observable in the market, such as forecasted annual revenues, expected volatility and discount rates. The contingent consideration was zero as of both March 31, 2024 and December 31, 2023.
v3.24.1.u1
DEBT AND CREDIT ARRANGEMENTS
 3 Months Ended
Mar. 31, 2024
Debt Disclosure [Abstract]  
DEBT AND CREDIT ARRANGEMENTS DEBT AND CREDIT ARRANGEMENTS
Long-term debt consisted of the following as of the dates indicated:
March 31, 2024December 31, 2023
Term loan and final payment$10,300 $10,300 
Mortgage payable to affiliate726 763 
Acquisition note payable261 — 
Total debt11,287 11,063 
Less: debt discount and issuance costs982 1,003 
Less: current maturities154 152 
Long-term debt, net of current maturities$10,151 $9,908 

On December 29, 2023, the Company entered into an $80 million Credit, Security and Guaranty Agreement (the “Credit Agreement”) by and among (i) the Company and other borrowers party to the Credit Agreement (collectively, the “Borrowers”), (ii) MidCap Funding IV Trust, as Agent (“Agent”), (iii) MidCap Financial Trust, as Term Loan Servicer (“Servicer”), and (iv) the financial institutions or other entities from time to time party thereto as Lenders (collectively, “Lenders”). Under the terms of the Credit Agreement, the Lenders have provided to Borrowers a term loan in an aggregate principal amount that will not exceed $30 million available in three tranches of $10 million each subject to certain draw conditions (the “Term Loan”) and a revolving loan in an aggregate principal amount that will not exceed $50 million (the “Revolving Loan”). Borrowings are available subject to certain levels of working capital for the Revolving Loan. The second tranche of the Term Loan is eligible to be drawn between July 1, 2024 through June 30, 2025. The third tranche of the Term Loan is eligible to be drawn between January 1, 2025 through June 30, 2025. The Company must meet certain cash usage requirements at the time of each draw to be eligible to access these term loans. Interest on the Term Loan will accrue at the greater of (a) One Month Term SOFR plus 6.50% or (b) 9.0% and interest on the Revolving Loan will accrue at the greater of (a) One Month Term SOFR plus 4.0% or (b) 6.50% (the “Applicable Rate”) and
will be payable monthly by the Borrowers. The Term Loans may be prepaid in full through December 29, 2024 with payment of a 3.00% prepayment premium, after which they may be prepaid in full through December 29, 2025 with payment of a 2.00% prepayment premium, after which they may be prepaid in full through December 29, 2026 with payment of a 1.00% prepayment premium, after which they may be prepaid in full with no prepayment premium. An additional final payment of 3.00% ("Final Payment") of the amount of the Terms Loans advanced by the Lenders will be due upon prepayment or repayment of the Terms Loans in full, and is accounted for as debt discount. The first tranche of $10 million was issued under the Term Loan upon execution. Payments of principal and all accrued but unpaid interest will be due and payable upon 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 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. The loans under the Credit Agreement are secured by a security interest in the Company’s and other Borrowers' assets. The Credit Agreement provides for customary events of default. If an event of default is not cured within the time periods specified (if any), the Lenders and Agent have the right to accelerate the Company’s payment of principal and interest in addition to other rights and remedies.

The Credit Agreement includes 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. The Credit Agreement was amended on May 3, 2024 to clarify the inputs into the financial covenant calculations. No other changes were made to the Credit Agreement. The Company was in compliance with all covenants under the Credit Agreement, as amended, as of March 31, 2024 and December 31, 2023.

The debt facilities available under the Credit Agreement replace 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 million revolving credit facility. During the year ended December 31, 2023, there was no indebtedness outstanding under the Squadron Loan Agreement and it was terminated in connection with the Credit Agreement.

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.

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. At March 31, 2024, the mortgage balance was $726 of which current principal of $154 was included in the current portion of long-term debt. As of December 31, 2023, the mortgage balance was $763 of which current principal due of $152 was included in the current portion of long-term debt.

The aggregate interest expense relating to the notes payable to Squadron, the mortgage note payable to Tawani Enterprises Inc. and the term loan with MidCap was $339 and $11 for the three months ended March 31, 2024 and 2023, respectively.
v3.24.1.u1
INCOME TAXES
 3 Months Ended
Mar. 31, 2024
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXES
The Company utilizes an estimated annual effective tax rate to determine its provision or benefit for income taxes for interim periods. The income tax provision or benefit is computed by multiplying the estimated annual effective tax rate by the year-to-date pre-tax book income (loss).

For the three months ended March 31, 2024, the income tax benefit was $2,531 compared to $574 for the three months ended March 31, 2023. Our effective income tax rate was (24.5)% and (7.8)% for the three months ended March 31, 2024 and 2023, respectively. The higher effective rate compared to the prior period is from the remeasurement of the valuation allowance subsequent to recording the deferred tax liability as a result of the purchase accounting from the Boston O&P acquisition.

The deferred tax assets were fully offset by a valuation allowance at March 31, 2024 and December 31, 2023, with the exception of certain deferred tax liabilities recognized in a foreign jurisdiction as a result of fair value adjustments recorded upon the acquisition of ApiFix, Ltd. ("ApiFix") and Pega Medical. See Note 3 under Item 8 in the Company's Annual Report on Form 10-K for additional information regarding the ApiFix business combination. The Company has recorded a tax benefit during the period ended March 31, 2024 for losses generated in Canada and Israel, respectively.
v3.24.1.u1
STOCKHOLDERS' EQUITY
 3 Months Ended
Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]  
STOCKHOLDERS' EQUITY STOCKHOLDERS’ EQUITY
Restricted Stock

Our restricted stock activity and related information are summarized as follows:
Weighted-AverageWeighted-Average
RestrictedRemainingRestrictedRemaining
StockContractual TermsStockContractual Terms
Awards(in Years)Units(in Years)
Outstanding at January 1, 2024592,453 1.613,851 1.7
Granted165,473 7,900 
Forfeited(3,470)(100)
Vested(82,659)— 
Outstanding at March 31, 2024
671,797 1.921,651 1.9
At March 31, 2024, there was $16,757 of unrecognized compensation expense remaining related to our service-based restricted stock awards and restricted stock units. The unrecognized compensation cost is expected to be recognized over a weighted-average period of 1.9 years or earlier upon an elimination of the restriction period as a result of a change in control event.
Stock-based compensation expense on restricted stock amounted to $2,799 and $1,959 for the three months ended March 31, 2024 and 2023, respectively.
v3.24.1.u1
NET LOSS PER SHARE
 3 Months Ended
Mar. 31, 2024
Earnings Per Share [Abstract]  
NET LOSS PER SHARE NET LOSS PER SHARE
The following is a reconciliation of basic and diluted net loss per share:
Three Months Ended
March 31,
20242023
Net loss$(7,805)$(6,806)
Weighted average shares outstanding for basic and diluted22,820,779 22,506,024 
Net loss per share - basic and diluted$(0.34)$(0.30)

Our basic and diluted net loss per share is computed using the two-class method.  For purposes of our equity disclosures and calculation of weighted average shares for basic earnings per share calculations, the two-class method is an earnings allocation that determines net income per share for each class of common stock and participating securities according to their participation rights in dividends and undistributed earnings or losses.  Non-vested restricted stock that includes non-forfeitable rights to dividends are considered participating securities. 
The contingently issuable shares in the paragraph above do not include shares of our common stock associated with our obligation to issue a variable number of our common shares as a result of our recent acquisitions of Pega Medical, ApiFix or MedTech. See Note 3 for additional information regarding our commitment to issue future equity under the MedTech acquisition. Additionally, as a component of the acquisition of ApiFix, the Company is obligated to make anniversary installment payments on the second, third and fourth anniversary of the acquisition date. These payments included a minimum cash component with the remaining settled in common stock. See Note 3 under Item 8 in the Company's Annual Report on Form 10-K for additional information regarding this business combination.
v3.24.1.u1
BUSINESS SEGMENT
 3 Months Ended
Mar. 31, 2024
Segment Reporting [Abstract]  
BUSINESS SEGMENT BUSINESS SEGMENT
Operating segments are defined as components of an enterprise for which separate financial information is available that is evaluated regularly by the chief operating decision maker, or decision making group, in deciding how to allocate resources and in assessing performance. We have one operating and reportable segment, which designs, develops and markets anatomically appropriate implants and devices for children with orthopedic problems. Our chief operating decision-maker, our Chief Executive Officer, reviews financial information presented on a consolidated basis for purposes of making operating decisions and assessing financial performance, accompanied by disaggregated revenue information by product category. We determined that disaggregating revenue into these categories achieves the disclosure objective of illustrating the differences in the nature, timing and uncertainty of our revenue streams. We do not assess the performance of our individual product categories on measures of profit or loss, or other asset-based metrics. Therefore, the information below is presented only for revenue by category and geography.

Product sales attributed to a country or region includes product sales to hospitals, physicians and distributors and is based on the final destination where the products are sold. No individual customer accounted for more than 10% of total product sales for the three months ended March 31, 2024 or 2023.
No individual customer accounted for more than 10% of consolidated accounts receivable as of March 31, 2024 and December 31, 2023.

Product sales by source were as follows:
Three Months Ended March 31,
Product sales by geographic location:20242023
U.S.$34,305 $23,800 
International10,380 7,788 
Total$44,685 $31,588 
Three Months Ended March 31,
Product sales by category:20242023
Trauma and deformity$33,302 $23,395 
Scoliosis10,203 7,072 
Sports medicine/other1,180 1,121 
Total$44,685 $31,588 
v3.24.1.u1
RELATED PARTY TRANSACTIONS
 3 Months Ended
Mar. 31, 2024
Related Party Transactions [Abstract]  
RELATED PARTY TRANSACTIONS RELATED PARTY TRANSACTIONSIn addition to the expired debt and credit agreements and mortgage with Squadron (the Company's largest investor) and its affiliate (see Note 6), we currently use Structure Medical, LLC (“Structure Medical”) as one of our suppliers. Structure Medical is affiliated with Squadron and a supplier with which we maintain certain long-term agreements. We made aggregate payments to Structure Medical for inventory purchases of $382 and $246 for the three months ended March 31, 2024 and 2023, respectively
v3.24.1.u1
EMPLOYEE BENEFIT PLAN
 3 Months Ended
Mar. 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. We have elected to match our employees' 401(k) contributions up to 4% of employees' salary. Additionally, employees of MD Ortho receive contribution matches up to 3% of their salary.
v3.24.1.u1
COMMITMENTS AND CONTINGENCIES
 3 Months Ended
Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]  
COMMITMENTS AND CONTINGENCIES COMMITMENTS AND CONTINGENCIES
Leases

As of March 31, 2024, the Company has recorded a lease liability of $2,235 and corresponding right-of-use asset of $2,529 on its condensed consolidated balance sheet. We assumed $1,749 of operating right-of-use assets and $1,582 of total lease liabilities in connection with our acquisition of Boston O&P.

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.
Although we believe the Company has strong defenses to the IMED lawsuit and we intend to vigorously defend the claims asserted against us, arbitration and litigation can involve complex factual and legal questions, and an adverse resolution of such proceedings could have a material adverse effect on our business, operating results and financial condition.

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.

We are not presently a party to any other legal proceedings the outcome of which, if determined adversely to us, would individually or in the aggregate materially affect our financial position or results of operations or cash flows.

Purchase Obligations and Performance Requirements

As a result of entering into a license agreement for the exclusive distribution of the 7D Surgical FLASHTM Navigation platform during 2021, the Company agreed to a minimum purchase commitment for the first twelve months of that agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of March 31, 2024, the remaining purchase commitment under the agreement was $1,820 for the year ended December 31, 2024 and $1,456 for the year ended 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. The Company analyzes its projected achievement of these performance metrics and accrues for any estimated shortfall. During the three months ended March 31, 2024, the Company recorded an expense of $542 based on current estimates. The Company recorded $300 of expense for the three months ended March 31, 2023.

Royalties

As of March 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.
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 March 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.
v3.24.1.u1
SUBSEQUENT EVENT
 3 Months Ended
Mar. 31, 2024
Subsequent Events [Abstract]  
SUBSEQUENT EVENT SUBSEQUENT EVENT
ApiFix Acquisition Installment Payment

On April 1, 2024, the fourth-year anniversary of the acquisition of ApiFix, the Company paid $2,250 in cash and issued 245,812 shares of the Company's common stock, representing $6,929 of fair value (based on the April 1, 2024 closing share price of $28.19), to fulfill its installment obligation to ApiFix. This was the third and final installment payment paid since the acquisition.

MedTech Anniversary Payment
On May 1, 2024, the first-year anniversary of the acquisition of MedTech, the Company paid $1,250 in cash and issued 42,882 shares of the Company's common stock, representing $1,331 of fair value (based on the May 1, 2024 closing share price of $31.04), to fulfill its installment obligation to MedTech. This was the first installment payment paid since the acquisition.
v3.24.1.u1
Pay vs Performance Disclosure - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Pay vs Performance Disclosure    
Net loss $ (7,805) $ (6,806)
v3.24.1.u1
Insider Trading Arrangements
 3 Months Ended
Mar. 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
v3.24.1.u1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
 3 Months Ended
Mar. 31, 2024
Accounting Policies [Abstract]  
Basis of Presentation and Unaudited Interim Condensed Consolidated Financial Statements
Basis of Presentation

The accompanying condensed consolidated financial statements include the accounts of OrthoPediatrics Corp. and its wholly-owned subsidiaries (collectively, the “Company,” “we,” “our” or “us”). All intercompany balances and transactions have been eliminated.

Unaudited Interim Condensed Consolidated Financial Statements

We have prepared the accompanying condensed consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The accompanying condensed consolidated financial statements are unaudited and should be read in conjunction with the annual consolidated financial statements as of and for the year ended December 31, 2023 and related notes thereto contained in our Annual Report on Form 10-K filed with the Securities and Exchange Commission ("SEC") on March 8, 2024. The financial data and other financial information disclosed in the notes to the accompanying condensed consolidated financial statements are also unaudited. As such, certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to applicable rules and regulations thereunder.

The unaudited condensed consolidated financial statements have been prepared on the same basis as the audited consolidated financial statements as of and for the year ended December 31, 2023 and, in management’s opinion, include all adjustments, consisting of only normal recurring adjustments, necessary for the fair presentation of the financial statements for the interim periods. The results of
operations for the three months ended March 31, 2024 are not necessarily indicative of the results to be expected for the full fiscal year or for any other period.
The accompanying condensed consolidated financial statements have been prepared assuming our Company will continue as a going concern.
Use of Estimates
Use of Estimates
Preparation of our condensed consolidated financial statements requires the use of estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses, as of the date of the condensed consolidated financial statements. By their nature, these judgments are subject to an inherent degree of uncertainty. We use historical experience and other assumptions as the basis for our judgments and estimates. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in our consolidated financial statements.
Reclassification
Reclassification
In the condensed 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 condensed consolidated statements of operations.
Financial Instruments
Financial Instruments and Concentration of Credit Risk
Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.
Concentration of Credit Risk
Financial Instruments and Concentration of Credit Risk
Financial instruments that could subject the Company to credit risk consist primarily of cash, cash equivalents, short-term investments and accounts receivable. We consider all highly liquid investments with original maturity of three months or less at inception to be cash equivalents.The Company performs ongoing credit evaluations of customers and maintains a reserve for expected credit losses. The Company believes the risk of credit losses associated with accounts receivable is low given the history of collections and customer base. Additionally, the Company considers the risk for credit losses associated with short-term investments to be low given the types of investments which primarily include Certificates of Deposits and Treasury Bonds.
Recent Accounting Pronouncements
Recent Accounting Pronouncements

In October 2023, the FASB issued ASU No. 2023-06 "Disclosure Improvements - Codification Amendments in Response to SEC's Disclosure Update and Simplification Initiative". This amendment modifies the disclosure or presentation requirements of a variety of Topics in the Codification. Certain of the amendments represent clarifications to or technical corrections of the current requirements. For entities subject to the SEC's existing disclosure requirements and entities required to file or furnish financial statements with or to the SEC in preparation for the sale of or for purposes of issuing securities that are not subject to contractual restrictions on transfer, the effective date for each amendment will be the date on which the SEC's removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. For all other entities, the amendments will be effective two years later. Amendments in this Update should be applied prospectively. The Company continues to analyze this ASU. The update is specific to disclosures and, therefore, is not expected to have a material impact to the condensed consolidated financial statements.

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. This authoritative guidance will be effective for us in fiscal 2024 for annual periods and in the first quarter of fiscal 2025 for interim periods, with early adoption permitted. We are currently evaluating the effect of this new guidance on our consolidated financial statements and disclosures.
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 new guidance on our consolidated financial statements and disclosures.
v3.24.1.u1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)
 3 Months Ended
Mar. 31, 2024
Accounting Policies [Abstract]  
Schedule of Reclassifications
The following tables present the impact of the reclassification on our condensed consolidated statements of operations:
Three Months Ended March 31, 2023
Sales and marketing (prior presentation)$12,216 
Reclassification333 
Sales and marketing (new presentation)$12,549 
Three Months Ended March 31, 2023
General and administrative (prior presentation)$17,666 
Reclassification(509)
General and administrative (new presentation)$17,157 
Three Months Ended March 31, 2023
Research and development (prior presentation)$2,270 
Reclassification176 
Research and development (new presentation)$2,446 
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS (Tables)
 3 Months Ended
Mar. 31, 2024
Business Combination and Asset Acquisition [Abstract]  
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed
The following table summarizes the total consideration paid for Boston O&P and the preliminary 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$22,000 
Assets
Cash1,307 
Accounts receivable - trade2,876 
Inventories1,093 
Prepaid expenses and other current assets378 
Property and equipment4,360 
Amortizable intangible assets3,720 
Other intangible assets3,650 
Other non-current assets2,208 
Total assets19,592 
Liabilities
Accounts payable-trade581 
Other current liabilities2,063 
Long-term debt724 
Deferred tax liability2,268 
Other non-current liabilities1,003 
Total liabilities6,639 
Less: total net assets12,953 
Goodwill$9,047 
Schedule of Indefinite-Lived Intangible Assets Acquired as Part of Business Combination
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:
AmountRemaining Economic Useful Life
Trademarks / Names$3,650 Indefinite
Customer Relationships & Other 3,720 12 years
$7,370 
Schedule of Business Acquisition, Pro Forma Information
The following table represents the pro forma net revenue and net loss assuming the acquisition of Boston O&P occurred on January 1, 2023.
Three Months Ended March 31,
20242023
Net revenue$45,116 $38,435 
Net loss$(7,786)$(6,690)
Schedule of Total Consideration Transferred after Discounting Future Payments The table below reconciles the payments and issuances to total consideration transferred after discounting the future payments to present value.
ConsiderationPresent Value
Cash consideration$3,000 $3,000 
Issuance of common stock2,274 2,274 
Anniversary payments5,500 4,672 
Transaction costs97 97 
Total consideration transferred$10,871 $10,043 
v3.24.1.u1
GOODWILL AND INTANGIBLE ASSETS (Tables)
 3 Months Ended
Mar. 31, 2024
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Goodwill
Changes in the carrying amount of goodwill for the three months ended March 31, 2024 were as follows:
Total
Goodwill at January 1, 2024$83,699 
Boston O&P acquisition9,047 
Foreign currency translation impact(1,265)
Goodwill at March 31, 2024
$91,481 
Schedule of the Balances of Amortizable Intangible Assets
As of March 31, 2024, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.0 years$44,969 $(11,619)$33,350 
Intellectual Property & Capitalized Software8.9 years16,027 (2,911)13,116 
Customer Relationships & Other12.1 years22,417 (3,675)18,742 
License Agreements3.6 years10,733 (5,559)5,174 
Total amortizable assets$94,146 $(23,764)$70,382 
As of December 31, 2023, the balances of amortizable intangible assets were as follows:
Weighted-Average Amortization PeriodGross Intangible AssetsAccumulated AmortizationNet Intangible Assets
Patents11.2 years$45,646 $(11,008)$34,638 
Intellectual Property & Capitalized Software9.1 years16,026 (2,524)13,502 
Customer Relationships & Other12.4 years18,862 (3,270)15,592 
License Agreements3.8 years10,733 (5,190)5,543 
Total amortizable assets$91,267 $(21,992)$69,275 
v3.24.1.u1
FAIR VALUE OF FINANCIAL INSTRUMENTS (Tables)
 3 Months Ended
Mar. 31, 2024
Fair Value Disclosures [Abstract]  
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis
The following tables summarize the assets and liabilities measured at fair value on a recurring basis as of March 31, 2024 and December 31, 2023.
March 31, 2024
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $26,141 $— $26,141 
December 31, 2023
Level 1Level 2Level 3Total
Financial Assets
Short-term investments
Certificates of Deposit$— $25,792 $— $25,792 
Exchange Trade Mutual Funds$5,015 $— $— $5,015 
Treasury Bonds$18,235 $— $— $18,235 
Other$207 $— $— $207 
v3.24.1.u1
DEBT AND CREDIT ARRANGEMENTS (Tables)
 3 Months Ended
Mar. 31, 2024
Debt Disclosure [Abstract]  
Schedule of Long-Term Debt
Long-term debt consisted of the following as of the dates indicated:
March 31, 2024December 31, 2023
Term loan and final payment$10,300 $10,300 
Mortgage payable to affiliate726 763 
Acquisition note payable261 — 
Total debt11,287 11,063 
Less: debt discount and issuance costs982 1,003 
Less: current maturities154 152 
Long-term debt, net of current maturities$10,151 $9,908 
v3.24.1.u1
STOCKHOLDERS' EQUITY (Tables)
 3 Months Ended
Mar. 31, 2024
Share-Based Payment Arrangement [Abstract]  
Schedule of Restricted Stock Activity
Our restricted stock activity and related information are summarized as follows:
Weighted-AverageWeighted-Average
RestrictedRemainingRestrictedRemaining
StockContractual TermsStockContractual Terms
Awards(in Years)Units(in Years)
Outstanding at January 1, 2024592,453 1.613,851 1.7
Granted165,473 7,900 
Forfeited(3,470)(100)
Vested(82,659)— 
Outstanding at March 31, 2024
671,797 1.921,651 1.9
v3.24.1.u1
NET LOSS PER SHARE (Tables)
 3 Months Ended
Mar. 31, 2024
Earnings Per Share [Abstract]  
Schedule of Reconciliation of Basic and Diluted Net Loss Per Share Attributable to Common Stockholders
The following is a reconciliation of basic and diluted net loss per share:
Three Months Ended
March 31,
20242023
Net loss$(7,805)$(6,806)
Weighted average shares outstanding for basic and diluted22,820,779 22,506,024 
Net loss per share - basic and diluted$(0.34)$(0.30)
v3.24.1.u1
BUSINESS SEGMENT (Tables)
 3 Months Ended
Mar. 31, 2024
Segment Reporting [Abstract]  
Schedule of Product Sales by Geographic Location Product sales by source were as follows:
Three Months Ended March 31,
Product sales by geographic location:20242023
U.S.$34,305 $23,800 
International10,380 7,788 
Total$44,685 $31,588 
Schedule of Product Sales by Category
Three Months Ended March 31,
Product sales by category:20242023
Trauma and deformity$33,302 $23,395 
Scoliosis10,203 7,072 
Sports medicine/other1,180 1,121 
Total$44,685 $31,588 
v3.24.1.u1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Accounting Policies [Abstract]    
Accumulated deficit $ 205,547 $ 197,742
v3.24.1.u1
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Schedule of Reclassifications (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Reclassification [Line Items]    
Sales and marketing $ 14,169 $ 12,549
General and administrative 24,730 17,157
Research and development $ 2,998 2,446
Previously Reported    
Reclassification [Line Items]    
Sales and marketing   12,216
General and administrative   17,666
Research and development   2,270
Reclassification    
Reclassification [Line Items]    
Sales and marketing   333
General and administrative   (509)
Research and development   $ 176
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Narratives (Details)
$ / shares in Units, $ in Thousands
 3 Months Ended
Jan. 05, 2024
USD ($)
individual
$ / shares
shares
Jul. 01, 2023
USD ($)
$ / shares
shares
May 01, 2023
USD ($)
$ / shares
shares
Mar. 31, 2024
USD ($)
$ / shares
Mar. 31, 2023
USD ($)
Dec. 31, 2023
$ / shares
Business Acquisition            
Cash paid to acquire       $ 20,693 $ 0  
Common stock, par value (in dollars per share) | $ / shares       $ 0.00025   $ 0.00025
Rhino Pediatric Orthopedic Designs, Inc.            
Business Acquisition            
Total consideration transferred   $ 1,024        
Cash consideration   546        
Asset acquisition   46        
Issuance of common stock   $ 478        
Medtech Concepts LLC            
Business Acquisition            
Total consideration transferred     $ 15,274      
Cash consideration     3,000      
Asset acquisition     97      
Issuance of common stock     $ 2,274      
Business combination, consideration paid In cash (as a percent)     50.00%      
Stock based compensation capitalized     $ 4,500      
Stock based compensation service period (in years)     4 years      
Total consideration transferred     $ 10,871      
Present Value | Medtech Concepts LLC            
Business Acquisition            
Cash consideration     3,000      
Asset acquisition     97      
Issuance of common stock     2,274      
Total consideration transferred     10,043      
Intellectual Property & Capitalized Software | Medtech Concepts LLC            
Business Acquisition            
Finite-lived intangible assets acquired     $ 9,523      
Intangible asset, useful life (in years)     10 years      
Trademarks | Medtech Concepts LLC            
Business Acquisition            
Indefinite-lived intangible assets acquired     $ 520      
Common Stock | Rhino Pediatric Orthopedic Designs, Inc.            
Business Acquisition            
Asset acquisition, consideration (in shares) | shares   11,133        
Common stock, par value (in dollars per share) | $ / shares   $ 0.00025        
Asset Acquisition, acquisition price (per share) | $ / shares   $ 42.91        
Common Stock | Medtech Concepts LLC            
Business Acquisition            
Asset acquisition, consideration (in shares) | shares     43,751      
Common stock, par value (in dollars per share) | $ / shares     $ 0.00025      
Asset Acquisition, acquisition 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%      
Boston Brace International, Inc.            
Business Acquisition            
Cash paid to acquire $ 22,000          
Issuance of common stock $ 2,500          
Boston Brace International, Inc. | 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          
Share acquisition price (in dollars per share) | $ / shares $ 30.12          
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Assets Acquired and Liabilities Assumed (Details) - USD ($)
$ in Thousands
Jan. 05, 2024
Mar. 31, 2024
Dec. 31, 2023
Liabilities      
Goodwill   $ 91,481 $ 83,699
Boston Brace International, Inc.      
Business Acquisition      
Fair value of estimated total acquisition consideration $ 22,000    
Assets      
Cash 1,307    
Accounts receivable - trade 2,876    
Inventories 1,093    
Prepaid expenses and other current assets 378    
Property and equipment 4,360    
Amortizable intangible assets 3,720    
Other intangible assets 3,650    
Other non-current assets 2,208    
Total assets 19,592    
Liabilities      
Accounts payable-trade 581    
Other current liabilities 2,063    
Long-term debt 724    
Deferred tax liability 2,268    
Other non-current liabilities 1,003    
Total liabilities 6,639    
Less: total net assets 12,953    
Goodwill $ 9,047    
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Indefinite-Lived Intangible Assets Acquired as Part of Business Combination (Details) - Boston Brace International, Inc.
$ in Thousands
Jan. 05, 2024
USD ($)
Business Acquisition  
Other intangible assets $ 3,650
Amortizable intangible assets 3,720
Fair value of identifiable intangible assets 7,370
Customer Relationships & Other  
Business Acquisition  
Amortizable intangible assets $ 3,720
Remaining economic useful life (in years) 12 years
Trademarks / Names  
Business Acquisition  
Other intangible assets $ 3,650
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Business Acquisition, Pro Forma Information (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Business Combination and Asset Acquisition [Abstract]    
Net revenue $ 45,116 $ 38,435
Net loss $ (7,786) $ (6,690)
v3.24.1.u1
BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Discounting the Future Payments (Details) - Medtech Concepts LLC
$ in Thousands
May 01, 2023
USD ($)
Business Acquisition  
Cash consideration $ 3,000
Issuance of common stock 2,274
Anniversary payments 5,500
Transaction costs 97
Total consideration transferred 10,871
Present Value  
Business Acquisition  
Cash consideration 3,000
Issuance of common stock 2,274
Anniversary payments 4,672
Transaction costs 97
Total consideration transferred $ 10,043
v3.24.1.u1
GOODWILL AND INTANGIBLE ASSETS - Changes in Goodwill (Details)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
USD ($)
Goodwill  
Goodwill, beginning balance $ 83,699
Boston O&P acquisition 9,047
Foreign currency translation impact (1,265)
Goodwill, ending balance $ 91,481
v3.24.1.u1
GOODWILL AND INTANGIBLE ASSETS - Amortizable Intangible Assets (Details) - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Intangible Assets $ 94,146 $ 91,267
Accumulated Amortization (23,764) (21,992)
Net Intangible Assets $ 70,382 $ 69,275
Patents    
Finite-Lived Intangible Assets, Net [Abstract]    
Weighted-Average Amortization Period 11 years 11 years 2 months 12 days
Gross Intangible Assets $ 44,969 $ 45,646
Accumulated Amortization (11,619) (11,008)
Net Intangible Assets $ 33,350 $ 34,638
Intellectual Property & Capitalized Software    
Finite-Lived Intangible Assets, Net [Abstract]    
Weighted-Average Amortization Period 8 years 10 months 24 days 9 years 1 month 6 days
Gross Intangible Assets $ 16,027 $ 16,026
Accumulated Amortization (2,911) (2,524)
Net Intangible Assets $ 13,116 $ 13,502
Customer Relationships & Other    
Finite-Lived Intangible Assets, Net [Abstract]    
Weighted-Average Amortization Period 12 years 1 month 6 days 12 years 4 months 24 days
Gross Intangible Assets $ 22,417 $ 18,862
Accumulated Amortization (3,675) (3,270)
Net Intangible Assets $ 18,742 $ 15,592
License Agreements    
Finite-Lived Intangible Assets, Net [Abstract]    
Weighted-Average Amortization Period 3 years 7 months 6 days 3 years 9 months 18 days
Gross Intangible Assets $ 10,733 $ 10,733
Accumulated Amortization (5,559) (5,190)
Net Intangible Assets $ 5,174 $ 5,543
v3.24.1.u1
GOODWILL AND INTANGIBLE ASSETS - Narrative (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2023
Mar. 31, 2024
Business Acquisition    
Other intangible assets $ 15,287 $ 18,792
Trademarks    
Business Acquisition    
Other intangible assets 15,287 $ 18,792
Trademarks | ApiFix Ltd    
Business Acquisition    
Trademark impairment $ 985  
v3.24.1.u1
FAIR VALUE OF FINANCIAL INSTRUMENTS - Schedule of Assets and Liabilities Measured at Fair Value (Details) - Fair Value, Recurring - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Certificates of Deposit    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments $ 26,141 $ 25,792
Exchange Trade Mutual Funds    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   5,015
Treasury Bonds    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   18,235
Other    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   207
Level 1 | Certificates of Deposit    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments 0 0
Level 1 | Exchange Trade Mutual Funds    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   5,015
Level 1 | Treasury Bonds    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   18,235
Level 1 | Other    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   207
Level 2 | Certificates of Deposit    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments 26,141 25,792
Level 2 | Exchange Trade Mutual Funds    
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
Level 2 | Other    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   0
Level 3 | Certificates of Deposit    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments $ 0 0
Level 3 | Exchange Trade Mutual Funds    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis    
Short-term investments   0
Level 3 | Treasury Bonds    
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
v3.24.1.u1
DEBT AND CREDIT ARRANGEMENTS - Schedule of Long-term Debt (Details) - USD ($)
$ in Thousands
Mar. 31, 2024
Dec. 31, 2023
Debt Instrument    
Long term debt $ 11,287 $ 11,063
Less: debt discount and issuance costs 982 1,003
Less: current maturities 154 152
Long-term debt, net of current maturities 10,151 9,908
Revolving Credit Facility | Term Loan    
Debt Instrument    
Long term debt 10,300 10,300
Mortgage payable to affiliate    
Debt Instrument    
Long term debt 726 763
Less: current maturities 154 152
Acquisition note payable | Acquisition note payable    
Debt Instrument    
Long term debt $ 261 $ 0
v3.24.1.u1
DEBT AND CREDIT ARRANGEMENTS - Narrative (Details)
 3 Months Ended
Dec. 29, 2023
USD ($)
tranche
Jun. 13, 2022
Mar. 31, 2024
USD ($)
Mar. 31, 2023
USD ($)
Dec. 31, 2023
USD ($)
Debt Instrument          
Mortgage balance     $ 10,151,000   $ 9,908,000
Current portion of long-term debt with affiliate     154,000   152,000
Interest expense     339,000 $ 11,000  
Long term debt     $ 11,287,000   11,063,000
Mortgage payable to affiliate          
Debt Instrument          
Interest rate (as a percent)     5.00%    
Monthly interest and principal installments     $ 16,000    
Current portion of long-term debt with affiliate     154,000   152,000
Long term debt     726,000   763,000
Revolving Credit Facility | Security and Guaranty Agreement          
Debt Instrument          
Long term debt face amount $ 80,000,000        
Debt instrument, maximum distribution per tranche $ 30,000,000        
Debt instrument, number of tranches | tranche 3        
Revolving Credit Facility | Term Loan          
Debt Instrument          
Debt instrument, maximum distribution per tranche $ 10,000,000        
Proceeds from lines of credit $ 10,000,000        
Debt instrument, debt repayment trigger, as a basis of capital stock ownership (percent) 35.00%        
Long term debt     10,300,000   $ 10,300,000
Revolving Credit Facility | Revolving Loan          
Debt Instrument          
Debt instrument, maximum distribution per tranche $ 50,000,000        
Percentage of prepayment of facility (percent) 3.00%        
Revolving Credit Facility | Revolving Loan | Option One          
Debt Instrument          
Interest rate (as a percent) 9.00%        
Revolving Credit Facility | Revolving Loan | Option Two          
Debt Instrument          
Applicable debt rate (percent) 6.50%        
Revolving Credit Facility | Revolving Loan | Option Three          
Debt Instrument          
Debt prepayment premium (percent) 3.00%        
Revolving Credit Facility | Revolving Loan | Option Four          
Debt Instrument          
Debt prepayment premium (percent) 2.00%        
Revolving Credit Facility | Revolving Loan | Option Five          
Debt Instrument          
Debt prepayment premium (percent) 1.00%        
Revolving Credit Facility | Revolving Loan | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Option One          
Debt Instrument          
Debt instrument, basis spread on variable rate (as a percent) 6.50%        
Revolving Credit Facility | Revolving Loan | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | Option Two          
Debt Instrument          
Debt instrument, basis spread on variable rate (as a percent) 4.00%        
Revolving Credit Facility | Fourth Amended Loan Agreement          
Debt Instrument          
Interest rate (as a percent)   10.00%      
Revolving credit facility     $ 50,000,000    
Unused commitment fee percentage (as a percent)   0.50%      
Revolving Credit Facility | Fourth Amended Loan Agreement | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate          
Debt Instrument          
Debt instrument, basis spread on variable rate (as a percent)   8.69%      
Revolving Credit Facility | Fourth Amended Loan Agreement | Three Month LIBOR          
Debt Instrument          
Debt instrument, basis spread on variable rate (as a percent)   8.61%      
v3.24.1.u1
INCOME TAXES (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Income Tax Disclosure [Abstract]    
Income tax benefit $ 2,531 $ 574
Effective income tax rate (as a percent) (24.50%) (7.80%)
v3.24.1.u1
STOCKHOLDERS' EQUITY - Restricted Stock (Details) - shares
 3 Months Ended 12 Months Ended
Mar. 31, 2024
Dec. 31, 2023
Restricted Stock    
Restricted Stock    
Outstanding at period start (in shares) 592,453  
Granted (in shares) 165,473  
Forfeited (in shares) (3,470)  
Vested (in shares) (82,659)  
Outstanding at period end (in shares) 671,797 592,453
Weighted-Average Remaining Contractual Terms (in Years)    
Weighted-average remaining contractual terms (in years) 1 year 10 months 24 days 1 year 7 months 6 days
Restricted Stock Units (RSUs)    
Restricted Stock    
Outstanding at period start (in shares) 13,851  
Granted (in shares) 7,900  
Forfeited (in shares) (100)  
Vested (in shares) 0  
Outstanding at period end (in shares) 21,651 13,851
Weighted-Average Remaining Contractual Terms (in Years)    
Weighted-average remaining contractual terms (in years) 1 year 10 months 24 days 1 year 8 months 12 days
v3.24.1.u1
STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award    
Stock-based compensation $ 2,799 $ 2,113
Restricted Stock    
Share-based Compensation Arrangement by Share-based Payment Award    
Unrecognized compensation expense $ 16,757  
Unrecognized compensation expense, weighted average period of recognition (in years) 1 year 10 months 24 days  
Stock-based compensation $ 2,799 $ 1,959
v3.24.1.u1
NET LOSS PER SHARE - Reconciliation of Basic and Diluted Net Loss Per Share (Details) - USD ($)
$ / shares in Units, $ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Earnings Per Share [Abstract]    
Net loss $ (7,805) $ (6,806)
Weighted average shares outstanding for basic (in shares) 22,820,779 22,506,024
Weighted average common stock - diluted (in shares) 22,820,779 22,506,024
Net loss per share - basic (in dollars per share) $ (0.34) $ (0.30)
Net loss per share - diluted (in dollars per share) $ (0.34) $ (0.30)
v3.24.1.u1
BUSINESS SEGMENT - Narrative (Details)
 3 Months Ended
Mar. 31, 2024
segment
Segment Reporting [Abstract]  
Number of operating segments 1
Number of reportable segments 1
v3.24.1.u1
BUSINESS SEGMENT - Schedule of Revenue by Geographical Location (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Revenues from External Customers and Long-Lived Assets    
Total $ 44,685 $ 31,588
U.S.    
Revenues from External Customers and Long-Lived Assets    
Total 34,305 23,800
International    
Revenues from External Customers and Long-Lived Assets    
Total $ 10,380 $ 7,788
v3.24.1.u1
BUSINESS SEGMENT - Schedule of Revenue by Category (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Segment Reporting Information    
Total $ 44,685 $ 31,588
Trauma and deformity    
Segment Reporting Information    
Total 33,302 23,395
Scoliosis    
Segment Reporting Information    
Total 10,203 7,072
Sports medicine/other    
Segment Reporting Information    
Total $ 1,180 $ 1,121
v3.24.1.u1
RELATED PARTY TRANSACTIONS (Details)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
USD ($)
supplier
Mar. 31, 2023
USD ($)
Structure Medical, LLC | Supplier    
Related Party Transaction    
Payments to related party | $ $ 382 $ 246
Affiliated Entity    
Related Party Transaction    
Number of related party suppliers | supplier 1  
v3.24.1.u1
EMPLOYEE BENEFIT PLAN - Narrative (Details)
 3 Months Ended
Mar. 31, 2024
Business Acquisition  
Employer contribution as a percentage of employees' salary (as a percent) 4.00%
MD Orthopaedics  
Business Acquisition  
Employer contribution as a percentage of employees' salary (as a percent) 3.00%
v3.24.1.u1
COMMITMENTS AND CONTINGENCIES (Details) - USD ($)
$ in Thousands
 1 Months Ended 3 Months Ended
Jul. 20, 2021
Dec. 31, 2019
Jun. 30, 2019
Mar. 31, 2024
Mar. 31, 2023
Dec. 31, 2023
Long-term Purchase Commitment            
Operating lease liability       $ 2,235    
Operating lease, right-of-use asset       $ 2,529    
Operating Lease, Liability, Current, Statement of Financial Position       Other long-term liabilities   Other long-term liabilities
Operating Lease, Right-of-Use Asset, Statement of Financial Position       Assets, Noncurrent, Excluding Property, Plant And Equipment   Assets, Noncurrent, Excluding Property, Plant And Equipment
Purchase obligation, to be paid, remainder of fiscal year       $ 1,820    
Purchase obligation, to be paid, year one       1,456    
Cost of revenue       $ 12,511 $ 8,027  
Minimum            
Long-term Purchase Commitment            
Royalty agreement percentage (as a percent)       0.50%    
Maximum            
Long-term Purchase Commitment            
Royalty agreement percentage (as a percent)       20.00%    
Firefly Technology | License Agreements            
Long-term Purchase Commitment            
Finite lived intangible asset useful life extension period (in years) 5 years          
Cost of revenue       $ 542    
Trademark impairment         $ 300  
Squadron Capital LLC | Team Note B | Affiliated Entity            
Long-term Purchase Commitment            
Repayments of related party debt   $ 25,000        
Boston O&P            
Long-term Purchase Commitment            
Operating lease liability       1,582    
Operating lease, right-of-use asset       $ 1,749    
Vilex and Orthex            
Long-term Purchase Commitment            
Fair value of estimated total acquisition consideration     $ 60,000      
v3.24.1.u1
SUBSEQUENT EVENT (Details) - Subsequent Event
$ / shares in Units, $ in Thousands
Apr. 01, 2024
USD ($)
$ / shares
shares
ApiFix Ltd  
Subsequent Event  
Cash consideration $ 2,250
Consideration for acquisition (in shares) | shares 245,812
Issuance of common stock $ 6,929
Share acquisition price (in dollars per share) | $ / shares $ 28.19
Medtech  
Subsequent Event  
Cash consideration $ 1,250
Consideration for acquisition (in shares) | shares 42,882
Share acquisition price (in dollars per share) | $ / shares $ 31.04
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