Form 10-Q - Quarterly report [Sections 13 or 15(d)]

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 September 30, 2024

☐ 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 Class

Trading Symbol(s)

Name of each exchange on which registered

Common Stock, $0.00025 par value per share

KIDS

Nasdaq 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 the 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 November 4, 2024, the registrant had 24,215,936 outstanding shares of common stock, $0.00025 par value per share.

OrthoPediatrics Corp.

Form 10-Q

For the Quarterly Period Ended September 30, 2024

TABLE OF CONTENTS


		Page No.
Note Regarding Forward-Looking Statements		3

PART I. FINANCIAL INFORMATION
Item 1	Financial Statements (unaudited)	4
	Condensed Consolidated Balance Sheets - September 30, 2024 and December 31, 2023	4
	Condensed Consolidated Statements of Operations - Three and Nine Months Ended September 30, 2024 and 2023	5
	Condensed Consolidated Statements of Comprehensive Loss - Three and Nine Months Ended September 30, 2024 and 2023	6
	Condensed Consolidated Statements of Stockholders' Equity - Three and Nine Months Ended Sept ember 30, 2024 and 2023	7
	Condensed Consolidated Statements of Cash Flows - Nine Months Ended September 30, 2024 and 2023	9
	Notes to Condensed Consolidated Financial Statements	11
Item 2	Management’s Discussion and Analysis of Financial Condition and Results of Operations	29
Item 3	Quantitative and Qualitative Disclosures About Market Risk	36
Item 4	Controls and Procedures	36

PART II. OTHER INFORMATION
Item 1	Legal Proceedings	37
Item 1A	Risk Factors	37
Item 2	Unregistered Sales of Equity Securities and Use of Proceeds	37
Item 3	Defaults Upon Senior Securities	38
Item 4	Mine Safety Disclosures	38
Item 5	Other Information	38
Item 6	Exhibits	38
Exhibit Index		39
Signatures		41

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.

PART I. FINANCIAL INFORMATION

ITEM 1. FINANCIAL STATEMENTS

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

(In Thousands, Except Share Data)


	September 30, 2024		December 31, 2023
ASSETS
Current assets:
Cash and cash equivalents	$	51,047	$	31,055
Restricted cash	1,998		1,972
Short-term investments	25,017		49,251
Accounts receivable - trade, net of allowances of $1,025 and $1,373, respectively	42,827		34,617
Inventories, net	120,934		105,851


Prepaid expenses and other current assets	6,489		3,750

Total current assets	248,312		226,496

Property and equipment, net	54,765		41,048
Other assets:
Amortizable intangible assets, net	65,955		69,275
Goodwill	91,262		83,699
Other intangible assets	18,744		15,287
Other non-current assets	10,256		2,940
Total other assets	186,217		171,201

Total assets	$	489,294	$	438,745

LIABILITIES AND STOCKHOLDERS' EQUITY
Current liabilities:
Accounts payable - trade	$	11,647	$	12,649
Accrued compensation and benefits	13,221		11,325

Current portion of long-term debt with affiliate	158		152
Current portion of acquisition installment payable	1,325		10,149



Other current liabilities	8,274		7,391
Total current liabilities	34,625		41,666
Long-term liabilities:
Long-term term loan	23,948		9,297
Long-term convertible note	47,831		—
Long-term debt with affiliate, net of current portion	491		611
Other long-term debt, net of current portion	244		—
Acquisition installment payable, net of current portion	2,412		3,551
Deferred income taxes	4,025		5,483
Other long-term liabilities	4,799		1,112
Total long-term liabilities	83,750		20,054

Total liabilities	118,375		61,720








Stockholders' equity:
Common stock, $0.00025 par value; 50,000,000 shares authorized; 24,214,046 shares and 23,378,408 shares issued as of September 30, 2024 and December 31, 2023, respectively	6		6
Additional paid-in capital	597,009		580,287

Accumulated deficit	(219,495)		(197,742)
Accumulated other comprehensive loss	(6,601)		(5,526)
Total stockholders' equity	370,919		377,025
Total liabilities and stockholders' equity	$	489,294	$	438,745

See notes to condensed consolidated financial statements.

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(Unaudited)

(In Thousands, Except Share and Per Share Data)


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net revenue	$	54,573	$	39,972	$	152,060	$	111,119
Cost of revenue	14,513		9,019		39,027		26,580
Gross profit	40,060		30,953		113,033		84,539
Operating expenses:
Sales and marketing	16,750		13,942		47,512		40,024
General and administrative	26,299		17,973		78,358		54,242
Tradename impairment	—		985		—		985
Research and development	2,577		2,561		8,118		7,973
Total operating expenses	45,626		35,461		133,988		103,224

Operating loss	(5,566)		(4,508)		(20,955)		(18,685)
Other expense (income):
Interest expense, net	404		21		1,302		105
Loss on early extinguishment of debt	3,230		—		3,230		—
Fair value adjustment of contingent consideration	—		—		—		(2,974)
Other expense (income), net	(63)		(787)		33		(1,407)
Total other expense (income), net	3,571		(766)		4,565		(4,276)

Loss before income taxes	$	(9,137)	$	(3,742)	$	(25,520)	$	(14,409)
Provision for income taxes (benefit)	(1,218)		849		(3,767)		(126)


Net loss	$	(7,919)	$	(4,591)	$	(21,753)	$	(14,283)
Weighted average shares outstanding
Basic and diluted	23,171,249		22,762,823		23,046,155		22,646,087

Net loss per share
Basic and diluted	$	(0.34)	$	(0.20)	$	(0.94)	$	(0.63)

See notes to condensed consolidated financial statements.

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS

(Unaudited) (In Thousands)


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net loss	$	(7,919)	$	(4,591)	$	(21,753)	$	(14,283)
Other comprehensive loss:
Foreign currency translation adjustment	3,623		(3,947)		(1,066)		(6,767)
Unrealized gain on short-term investments	—		251		109		861
Adjustment for realized gain on securities	—		(559)		(118)		(860)
Other comprehensive income (loss), net of tax	3,623		(4,255)		(1,075)		(6,766)
Comprehensive loss	$	(4,296)	$	(8,846)	$	(22,828)	$	(21,049)

See notes to condensed consolidated financial statements.

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY

(Unaudited)

(In Thousands, Except Share Data)


		Three and Nine Months Ended September 30, 2024
							Accumulated
					Additional		Other		Total
	Common Stock		Paid-in		Accumulated	Comprehensive	Stockholders'
		Shares	Value				Capital		Deficit		Loss		Equity
Balance at January 1, 2024		23,378,408	$	6			$	580,287	$	(197,742)	$	(5,526)	$	377,025
Net loss		—	—				—		(7,805)		—		(7,805)
Other comprehensive loss		—	—				—		—		(1,435)		(1,435)

Restricted stock		162,003	—				2,799		—		—		2,799


Balance at March 31, 2024		23,540,411	$	6			$	583,086	$	(205,547)	$	(6,961)	$	370,584
Net loss		—	—				—		(6,029)		—		(6,029)
Other comprehensive loss		—	—				—		—		(3,263)		(3,263)
Stock portion of MedTech anniversary payment		4,288	—				133		—		—		133
Stock portion of ApiFix anniversary installment		245,812	—				6,929		—		—		6,929

Restricted stock		426,227	—				2,939		—		—		2,939
Balance at June 30, 2024		24,216,738	$	6			$	593,087	$	(211,576)	$	(10,224)	$	371,293
Net loss		—	—				—		(7,919)		—		(7,919)
Other comprehensive income		—	—				—		—		3,623		3,623

Restricted stock		(2,692)	—				3,922		—		—		3,922
Balance at September 30, 2024		24,214,046	$	6			$	597,009	$	(219,495)	$	(6,601)	$	370,919

See notes to condensed consolidated financial statements.

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY

(Unaudited)

(In Thousands, Except Share Data)


	Three and Nine Months Ended September 30, 2023
									Accumulated
					Additional				Other		Total
	Common Stock			Paid-in	Accumulated		Comprehensive		Stockholders'
	Shares	Value			Capital		Deficit		Loss		Equity
Balance at January 1, 2023	22,877,962	$	6		$	560,810	$	(176,768)	$	(5,400)	$	378,648
Net loss	—	—			—		(6,806)		—		(6,806)
Other comprehensive loss	—	—			—		—		(646)		(646)

Restricted stock	264,156	—			1,959		—		—		1,959


Balance at March 31, 2023	23,142,118	$	6		$	562,769	$	(183,574)	$	(6,046)	$	373,155
Net loss	—	—			—		(2,886)		—		(2,886)
Other comprehensive loss	—	—			—		—		(1,865)		(1,865)

Restricted stock	14,591	—			3,456		—		—		3,456
Consideration for MedTech acquisition	43,751	—			2,274		—		—		2,274
Stock portion of ApiFix anniversary installment	140,003	—			6,178		—		—		6,178
Balance at June 30, 2023	23,340,463	$	6		$	574,677	$	(186,460)	$	(7,911)	$	380,312
Net loss	—	—			—		(4,591)		—		(4,591)
Other comprehensive loss	—	—			—		—		(4,255)		(4,255)
Stock option exercise	670	—			21		—		—		21
Restricted stock	(1,290)	—			2,364		—		—		2,364
Consideration for Rhino	11,133	—			478		—		—		478
Balance at September 30, 2023	23,350,976	$	6		$	577,540	$	(191,051)	$	(12,166)	$	374,329

See notes to condensed consolidated financial statements.

ORTHOPEDIATRICS CORP.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited) (In Thousands)


	Nine Months Ended September 30,
	2024		2023
OPERATING ACTIVITIES
Net loss	$	(21,753)	$	(14,283)
Adjustments to reconcile net loss to net cash used in operating activities:
Tradename impairment	—		985
Depreciation and amortization	15,087		12,198
Stock-based compensation	9,660		7,779
Loss on early extinguishment of debt	3,230		—
Fair value adjustment of contingent consideration	—		(2,974)
Accretion of acquisition installment payable	599		1,092
Deferred income taxes	(3,907)		(899)

Changes in certain operating assets and liabilities:
Accounts receivable - trade	(5,178)		(12,878)
Inventories, net	(14,154)		(22,198)

Prepaid expenses and other current assets	(2,134)		(196)
Accounts payable - trade	(1,768)		11,492
Accrued expenses and other liabilities	308		3,288
Other	(3,051)		(2,909)


Net cash used in operating activities	(23,061)		(19,503)

INVESTING ACTIVITIES
Acquisition of Boston O&P, net of cash acquired	(20,225)		—
Clinic acquisition, net of cash acquired	(475)		—
Acquisition of MedTech, net of cash acquired	—		(3,097)
Acquisition of Rhino assets	—		(546)
Investment in private companies	(380)		—
Sale of short-term marketable securities	49,855		89,040
Purchase of short-term marketable securities	(25,000)		(48,600)

Purchases of property and equipment	(14,525)		(13,042)


Net cash (used in) provided by investing activities	(10,750)		23,755

FINANCING ACTIVITIES
Installment payment for ApiFix	(2,250)		(2,000)
Installment payment for MedTech	(1,250)		—
Proceeds from issuance of debt	73,533		—
Payment on debt	(12,231)		—
Payment of debt issuance costs	(3,085)		—
Proceeds from exercise of stock options	—		21
Payments on acquisition note	(928)		—
Payments on mortgage notes	(113)		(107)
Net cash provided by (used in) financing activities	53,676		(2,086)

Effect of exchange rate changes on cash, cash equivalents and restricted cash	153		(396)

NET INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH	20,018		1,770

Cash, cash equivalents and restricted cash, beginning of year	$	33,027	$	10,462
Cash, cash equivalents and restricted cash, end of period	$	53,045	$	12,232



SUPPLEMENTAL DISCLOSURES
Cash paid for interest	$	1,381	$	32
Issuance of common shares to acquire Rhino	$	—	$	478
Transfer of instruments between property and equipment and inventory	$	966	$	431
Issuance of common shares for ApiFix installment	$	6,929	$	6,178
Issuance of common shares for MedTech installment	$	133	$	2,274
Right-of-use assets obtained in exchange for lease liabilities	$	3,220	$	367
Debt issuance costs not yet paid	$	260	$	—

See notes to condensed consolidated financial statements.

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 Boston Brace 3D, implants and related surgical instrumentation while our orthopedic bracing products are manufactured in-house. We also operate multiple orthotic and prosthetic ("O&P") clinics delivering leading pediatric non-surgical O&P treatment.

We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis, sports medicine, specialty bracing and clinical services 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 operations for the three and nine months ended September 30, 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 $219,495 and $197,742 as of September 30, 2024 and December 31, 2023, respectively. Management continues to monitor cash flows and liquidity on a regular basis. We believe that our cash balance at September 30, 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 September 30, 2023		Nine Months Ended September 30, 2023
Sales and marketing (prior presentation)	$	13,582	$	38,963

Reclassification	360		1,061
Sales and marketing (new presentation)	$	13,942	$	40,024


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
General and administrative (prior presentation)	$	18,507	$	55,827

Reclassification	(534)		(1,585)
General and administrative (new presentation)	$	17,973	$	54,242


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
Research and development (prior presentation)	$	2,387	$	7,449

Reclassification	174		524
Research and development (new presentation)	$	2,561	$	7,973

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.

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 $21,534 in cash, after adjusting for closing net working capital, transaction expenses, and funded indebtedness. Additionally, certain employees and executives of Boston O&P also received awards of restricted stock of the Company which will vest in three years subject to continuous service. The Restricted Stock Award Agreements were to approximately 170 individuals for an aggregate of approximately 83,000 shares representing approximately $2,500 (based on a share price of $30.12, which was the average closing price during the four-month period ending on January 4, 2024) and were granted pursuant to the Company’s 2017 Incentive Award Plan. The restricted stock 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	$	21,534
Assets
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,557
Other non-current liabilities	1,803
Total liabilities	8,162
Less: total net assets	13,238
Goodwill	$	8,296

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


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

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

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net revenue	$	54,573	$	46,585	$	152,491	$	130,857
Net loss	$	(7,903)	$	(4,475)	$	(21,712)	$	(13,935)

On July 1, 2024, Boston O&P also completed an acquisition of the assets, including inventory, related to orthotic and prosthetic device clinics located in Virginia and Maryland. Boston O&P paid $950 in total consideration, which was comprised of $475 of cash and a promissory note in the original principal amount of $475 payable in six quarterly installments with interest at a rate of 5.0% per annum.

Rhino Pediatric Orthopedic Designs, Inc.

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

Medtech Concepts LLC

On May 1, 2023, the Company purchased all of the issued and outstanding membership interest of Medtech Concepts LLC, a Delaware limited liability company (“MedTech”). MedTech has developed an early-stage, pre-commercial enabling technology platform designed to increase efficiency in the perioperative environment. The solution combines hardware, software, and data analytics to help streamline operative care and support better decision making in the operating room. In the future, the Company believes this enabling technology platform will provide valuable intraoperative resources for surgeons that will improve decision making, drive operating room efficiency, and ultimately improve healthcare for children. The Company also expects that the acquisition will further support future market share gains for its implant systems, similar to what the Company has experienced with the FIREFLY® Technology and the 7D Surgical FLASHTM Navigation platform. No revenue was recorded from this platform in 2023, 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.


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

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

During the nine months ended September 30, 2024, the Company paid the first anniversary payment consisting of $1,250 in cash and issued 4,288 of the Company's common stock approximating $133 which reduced the amount of the acquisition installment payable on our balance sheet. In addition, we issued 38,594 shares of our common stock to one individual on the first anniversary date in exchange for their continued service through the vesting date which had been accounted for as stock based compensation expense in the post-combination consolidated financial statements.

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

NOTE 4 - GOODWILL AND INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the nine months ended September 30, 2024 were as follows:


	Total



Goodwill at January 1, 2024	$	83,699
Boston O&P acquisition	8,296
Other clinic acquisitions	627
Foreign currency translation impact	(1,360)
Goodwill at September 30, 2024	$	91,262

Intangible Assets

As of September 30, 2024, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	10.5 years	$	44,903	$	(13,147)	$	31,756
Intellectual Property & Capitalized Software	8.4 years	16,027		(3,681)		12,346
Customer Relationships & Other	11.7 years	21,777		(4,462)		17,315
License Agreements	3.0 years	10,583		(6,045)		4,538
Total amortizable assets		$	93,290	$	(27,335)	$	65,955

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


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

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 $18,744 and $15,287 as of September 30, 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 nine months ended September 30, 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 table summarizes the assets and liabilities measured at fair value on a recurring basis as of September 30, 2024 and December 31, 2023.


	September 30, 2024
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Exchange Trade Mutual Funds	$	25,017	$	—	$	—	$	25,017







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

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

Other	$	207	$	—	$	—	$	207

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

The Company's Level 2 assets pertain to 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 September 30, 2024 and December 31, 2023.

NOTE 6 - DEBT AND CREDIT ARRANGEMENTS

Long-term debt consisted of the following as of the dates indicated:


	September 30, 2024		December 31, 2023
Term loan and Final Payment	$	25,500	$	10,300
Convertible note	50,000		—
Mortgage payable to affiliate	649		763
Acquisition note payable	710		—
Total debt	76,859		11,063
Less: debt discount and issuance costs	3,721		1,003
Less: current maturities	624		152
Long-term debt, net of current maturities	$	72,514	$	9,908

Braidwell Term Loan

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

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

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

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

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

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

Braidwell Convertible Note

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

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

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

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

the conversion rate applicable to the conversion of that Note will be increased in certain circumstances if it is converted after it is called for redemption.

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

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

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

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

MidCap Term Loan

Borrowings under the MidCap Credit Agreement accrued interest at an annual rate equal to the greater of (a) One Month Term SOFR plus 6.50% or (b) 9.0% and interest on the Revolving Loan would have accrued at the greater of (a) One Month Term SOFR plus 4.0% or (b) 6.50% (the “Applicable Rate”). The Company paid MidCap an unused commitment fee in an amount equal to the per annum rate of 0.50% (computed on the basis of a year of 360 days and the actual number of days elapsed) times the

daily unused portion of the revolving credit commitment. The unused commitment fee was payable quarterly in arrears.

Borrowings under the MidCap Credit Agreement were made under a term loan (the "MidCap Term Loan") of $10,000 and a Revolving Loan of $50,000, payable, jointly and severally, by the Company and each of its subsidiaries party thereto. The MidCap Term Loan and Revolving Loan matured at the earlier of (i) December 1, 2028; (ii) the occurrence of any transaction or series of transactions pursuant to which any person or entity in the aggregate acquire(s) 35% or more of the voting capital stock of the Company; (iii) a change in the majority of the Company’s Board of Directors over a 12-month period; (iv) the Company ceases to own directly or indirectly, 100% of the capital stock of any of its subsidiaries (with the exception of any subsidiaries permitted to be dissolved, merged or otherwise disposed of by the MidCap Credit Agreement), or (v) the occurrence of a change in control, fundamental change, deemed liquidation event or terms of similar import under any document or instrument governing or relating to debt of or equity interests of the Company.

Borrowings under the MidCap Credit Agreement were secured by a security interest in the Company’s and other Borrowers' assets. The MidCap Credit Agreement provided for customary events of default. If an event of default is not cured within the time periods specified (if any), the Lenders and Agent would have had the right to accelerate the Company’s payment of principal and interest in addition to other rights and remedies. The MidCap Credit Agreement included certain customary non-financial covenants, and also include certain financial covenants related to the Company achieving minimum revenue targets over a trailing twelve month period and maintaining minimum liquidity of $10,000. The MidCap Credit Agreement was amended on May 3, 2024 to clarify the inputs into the financial covenant calculations.

As a result of the termination of the MidCap Credit Agreement, the Company recorded a loss on the extinguishment of debt in the amount of $3,230 on the consolidated statement of operations for the three and nine months ended September 30, 2024.

Squadron Revolver

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

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

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

Borrowings under the Squadron Loan Agreement were secured by substantially all of the Company's assets and were unconditionally guaranteed by each of its subsidiaries with the exception of Vilex in

Tennessee, Inc. ("Vilex"). There were no traditional financial covenants associated with the Squadron Loan Agreement. However, there were negative covenants that prohibited us from, among other things, transferring any of our material assets, merging with or acquiring another entity, entering into a transaction that would result in a change of control, incurring additional indebtedness, creating any lien on our property, making investments in third parties and redeeming stock or paying dividends, in each case subject to certain exceptions.

Other Debt

In connection with the purchase of our office and warehouse space in Warsaw, Indiana in August 2013, we entered into a mortgage note payable to Tawani Enterprises Inc., an affiliate of Squadron. Pursuant to the terms of the mortgage note, we pay Tawani Enterprises Inc. monthly principal and interest installments of $16 with interest compounded at 5% until maturity in 2028, at which time a final payment of remaining principal and interest is due. At September 30, 2024, the mortgage balance was $649 of which current principal of $158 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., the term loan with MidCap, the term loan with Braidwell, and the convertible note with Braidwell, was $945 and $10 for the three months ended September 30, 2024 and 2023, respectively, and $1,705 and $32 for the nine months ended September 30, 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 nine months ended September 30, 2024, the income tax benefit was $3,767 compared to $126 for the nine months ended September 30, 2023. Our effective income tax rate was 14.8% and 0.9% for the nine months ended September 30, 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 September 30, 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. and Pega Medical (OrthoPediatrics Canada ULC). The Company has recorded a tax benefit for losses generated in Israel and a tax expense for income generated in Canada during the period ended September 30, 2024.

Management assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets. A significant piece of objective negative evidence evaluated was the cumulative loss incurred over the three-year period ended September 30, 2024. Such objective evidence limits the ability to consider other subjective evidence, such as our projections for future growth.

NOTE 8 - STOCKHOLDERS’ EQUITY

Restricted Stock

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


		Weighted-Average		Weighted-Average
	Restricted	Remaining	Restricted	Remaining
	Stock	Contractual Terms	Stock	Contractual Terms
	Awards	(in Years)	Units	(in Years)
Outstanding at January 1, 2024	592,453	1.6	13,851	1.7
Granted	556,109		7,900
Forfeited	(9,165)		(200)
Vested	(96,616)		—
Outstanding at September 30, 2024	1,042,781	1.8	21,551	1.4

On June 11, 2024, we granted an aggregate of 345,985 shares of restricted stock to eight members of management. The restricted stock was granted pursuant to the Company's 2024 Incentive Award Plan. While restricted stock awards generally vest over three years, these restricted stock awards provide for a vesting period ending on March 15, 2027 in order to align the vesting dates with the vesting dates of other restricted stock awards held by members of management.

At September 30, 2024, there was $22,247 of unrecognized compensation expense remaining related to our service-based restricted stock awards and restricted stock units. The unrecognized compensation cost is expected to be recognized over a weighted-average period of 1.8 years or earlier upon an elimination of the restriction period as a result of a change in control event.

Stock-based compensation expense on restricted stock amounted to $3,922 and $2,368 for the three months ended September 30, 2024 and 2023, respectively, and $9,660 and $7,779 for the nine months ended September 30, 2024 and 2023, respectively.

In connection with its approval of the Term Loan Agreement, Purchase Agreement, the Indenture and Notes, on August 2, 2024, the Board of Directors of the Company also approved a stock repurchase program of up to $5,000 in aggregate investment of the Company’s outstanding common stock, contingent upon the closing of the Term Loan and the Notes. The stock repurchases may, at the discretion of management, be made from time to time, through solicited or unsolicited transactions in the open market, in privately negotiated transactions or pursuant to a Rule 10b5-1 plan all as effected in accordance with Rule 10b-18 under the Securities Exchange Act of 1934, as amended. The Company is not obligated to purchase any shares under the program, and the program may be discontinued at any time. No shares have been purchased under this program as of September 30, 2024.

NOTE 9 – NET LOSS PER SHARE

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


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Net loss	$	(7,919)	$	(4,591)	$	(21,753)	$	(14,283)

Weighted average shares outstanding for basic and diluted	23,171,249		22,762,823		23,046,155		22,646,087
Net loss per share - basic and diluted	$	(0.34)	$	(0.20)	$	(0.94)	$	(0.63)

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

For the periods presented with a net loss, the weighted average shares outstanding remained consistent between basic and diluted as the effect of any outstanding common stock equivalents would have been anti-dilutive.

The contingently issuable shares in the paragraph above do not include shares of our common stock associated with our obligation to issue a variable number of our common shares as a result of our recent acquisitions of Pega Medical, ApiFix or MedTech. See Note 3 for additional information regarding our commitment to issue future equity under the MedTech acquisition. Additionally, as a component of the acquisition of ApiFix, the Company was 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. During the nine months ended September 30, 2024, the final anniversary payment was made to ApiFix and no additional shares of common stock are issuable under the ApiFix acquisition.

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 and nine months ended September 30, 2024 or 2023. No individual customer accounted for more than 10% of consolidated accounts receivable as of September 30, 2024 and December 31, 2023.

Product sales by source were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2024		2023		2024		2023
U.S.	$	42,714	$	29,360	$	118,269	$	82,748
International	11,859		10,612		33,791		28,371
Total	$	54,573	$	39,972	$	152,060	$	111,119


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2024		2023		2024		2023
Trauma and deformity	$	37,642	$	28,806	$	108,715	$	79,715
Scoliosis	15,635		10,304		39,521		28,270
Sports medicine/other	1,296		862		3,824		3,134
Total	$	54,573	$	39,972	$	152,060	$	111,119

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 $206 and $234 for the three months ended September 30, 2024 and 2023, respectively, and $729 and $628 for the nine months ended September 30, 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 and Boston O&P receive contribution matches up to 3% of their salary.

NOTE 13 – COMMITMENTS AND CONTINGENCIES

Leases

As of September 30, 2024, the Company has recorded a lease liability of $6,572 and corresponding right-of-use asset of $6,940 on its condensed consolidated balance sheet. We assumed $2,828 of operating right-of-use assets and 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.

On September 20, 2024, the Court dismissed IMED’s lawsuit, without prejudice, for failure to prosecute. However, contemporaneously, IMED re-initiated arbitration.

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

Boston O&P Litigation

This lawsuit arises from the alleged wrongful death of a patient following his January 2016, tracheal and laryngeal resection procedure at Boston Children’s Hospital, which was performed by two physicians named as defendants in the suit. The Plaintiffs allege that as a result of the patient’s post-operative care, which included placing his neck in a position of flexion in a modified brace provided by Boston O&P, the patient was paralyzed, and years later, he died due to complications caused by his paralysis. The Company acquired all of the outstanding shares of Boston O&P on January 5, 2024 as described more fully under Note 3 - Business Combinations and Asset Acquisitions.

The lawsuit commenced in December 2018, in Suffolk Superior Court in Boston, Massachusetts. The Plaintiffs assert counts of negligence against each individual defendant, lack of informed consent against the physician defendants, failure to warn, breach of warranty and alleged improper use against Boston O&P, and loss of consortium against all defendants. Trial is currently scheduled to begin in December 2025.

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

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

Purchase Obligations and Performance Requirements

As a result of entering into a license agreement for the exclusive distribution of the 7D Surgical FLASHTM Navigation platform during 2021, the Company agreed to a minimum purchase commitment for the first twelve months of that agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of September 30, 2024, the Company met its purchase commitment for the year ended December 31, 2024 and $1,456 future purchase commitments are required 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 nine months ended September 30, 2024, the Company recorded an expense of $1,200 based on current estimates. The Company recorded $1,053 of expense for the nine months ended September 30, 2023.

Royalties

As of September 30, 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 September 30, 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.

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 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 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 over 70 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 41 independent sales agencies employing over 220 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, expanding our product offering and expanding clinics to many other childrens hospitals.

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 1.1 million 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 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 2023 and 2022, 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.

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 and Nine Months Ended September 30, 2024 and 2023

The following table sets forth our results of operations for the three and nine months ended September 30, 2024 and 2023 (dollars in thousands):


	Three Months Ended September 30,								Nine Months Ended September 30,
	2024		2023		Increase (Decrease)		%		2024		2023		Increase (Decrease)		%
Net revenue	$	54,573	$	39,972	$	14,601	37	%	$	152,060	$	111,119	$	40,941	37	%
Cost of revenue	14,513		9,019		5,494		61	%	39,027		26,580		12,447		47	%
Sales and marketing expenses	16,750		13,942		2,808		20	%	47,512		40,024		7,488		19	%
General and administrative expenses	26,299		17,973		8,326		46	%	78,358		54,242		24,116		44	%
Trademark impairment	—		985		(985)		(100)	%	—		985		(985)		(100)	%
Research and development expenses	2,577		2,561		16		1	%	8,118		7,973		145		2	%
Other expense (income), net	3,571		(766)		4,337		(566)	%	4,565		(4,276)		8,841		(207)	%
Provision for income taxes (benefit)	(1,218)		849		(2,067)		243	%	(3,767)		(126)		(3,641)		(2890)	%


Net loss	$	(7,919)	$	(4,591)	$	3,328	72	%	$	(21,753)	$	(14,283)	$	7,470	52	%

Net Revenue

The following tables set forth our net revenue by geography and product category for the three and nine months ended September 30, 2024 and 2023 (dollars in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2024		2023		2024		2023
U.S.	$	42,714	$	29,360	$	118,269	$	82,748
International	11,859		10,612		33,791		28,371
Total	$	54,573	$	39,972	$	152,060	$	111,119
	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2024		2023		2024		2023
Trauma and deformity	$	37,642	$	28,806	$	108,715	$	79,715
Scoliosis	15,635		10,304		39,521		28,270
Sports medicine/other	1,296		862		3,824		3,134
Total	$	54,573	$	39,972	$	152,060	$	111,119

Net revenue increased $14.6 million, or 37%, from $40.0 million for the three months ended September 30, 2023 to $54.6 million for the three months ended September 30, 2024. Net revenue increased $40.9 million, or 37%, from $111.1 million for the nine months ended September 30, 2023 to $152.1 million for the nine months ended September 30, 2024. The increase during the three and nine month periods ended September 30, 2024 was primarily driven by the addition of Boston O&P sales, as well as strong performance across global Trauma and Deformity, Scoliosis and OP Specialty Bracing.

Trauma and deformity sales increased $8.8 million, or 31%, from $28.8 million during the three months ended September 30, 2023, to $37.6 million for the three months ended September 30, 2024, and sales increased $29.0 million, or 36%, from $79.7 million during the nine months ended September 30, 2023, to $108.7 million for the nine months ended September 30, 2024. The increase for the three and nine month periods ended September 30, 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 $5.3 million, or 52%, from $10.3 million during the three months ended September 30, 2023, to $15.6 million for the three months ended September 30, 2024. Sales increased $11.3 million, or 40%, from $28.3 million during the nine months ended September 30, 2023, to $39.5 million for the nine months ended September 30, 2024. The increase for three and nine month period ended September 30, 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 $0.4 million, or 50%, during the three months ended September 30, 2024, and $0.7 million, or 22%, during the nine months ended September 30, 2024. 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 $5.5 million, or 61%, from $9.0 million for the three months ended September 30, 2023 to $14.5 million for the three months ended September 30, 2024. Cost of revenue increased $12.4 million, or 47%, from $26.6 million for the nine months ended September 30, 2023 to $39.0 million for the nine months ended September 30, 2024. The increases were due primarily to sales volume, including the added cost of revenue associated with the revenue generated by acquisitions. Gross margin was 73% and 77% for the three months ended September 30, 2024 and September 30,

2023, respectively. The gross margin was 74.3% and 76.1% for the nine months ended September 30, 2024 and September 30, 2023, respectively.

Sales and Marketing Expenses

Sales and marketing expenses increased $2.8 million, or 20%, to $16.8 million for the three months ended September 30, 2024 from $13.9 million for the three months ended September 30, 2023. Sales and marketing expenses increased $7.5 million, or 19%, to $47.5 million for the nine months ended September 30, 2024 from $40.0 million for the nine months ended September 30, 2023. The changes in the three and nine month periods ended September 30, 2024 were 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 $8.3 million, or 46%, from $18.0 million for the three months ended September 30, 2023 to $26.3 million for the three months ended September 30, 2024, and increased $24.1 million, or 44%, from $54.2 million for the nine months ended September 30, 2023 to $78.4 million for the nine months ended September 30, 2024. The increases for the three and nine month periods ended September 30, 2024 were due primarily to the addition of Boston O&P. Stock compensation increased $1.9 million for the nine months ended September 30, 2024 due to 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 $0.5 million, or 12%, from $4.6 million for the three months ended September 30, 2023 to $5.1 million for the three months ended September 30, 2024, and increased $2.9 million, or 24%, from $12.2 million for the nine months ended September 30, 2023 to $15.1 million for the nine months ended September 30, 2024. The increase in depreciation for the three and nine month periods ended September 30, 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 remained flat from $2.6 million year over year, and increased $0.1 million, or 2%, from $8.0 million for the nine months ended September 30, 2023 to $8.1 million for the nine months ended September 30, 2024. The fluctuations for the three and nine month periods ended September 30, 2024 were primarily due to the timing of product development and the addition of personnel to support the future growth of the business during the first quarter of 2024.

Total Other (Income) Expenses

Other expense was $3.6 million for the three months ended September 30, 2024 compared to other income of $0.8 million for the three months ended September 30, 2023, a change of $4.3 million or 566%, and other expense was $4.6 million for the nine months ended September 30, 2024 compared to other income of $4.3 million for the nine months ended September 30, 2023, a change of $8.8 million or 207%. The change for the three and nine months ended September 30, 2024 was primarily due to the fair value adjustment of contingent consideration associated with our ApiFix acquisition, which generated income in the comparative prior year period, and the early extinguishment of the MidCap Credit Agreement in the third quarter, partially offset by an increase to net interest expense related to the new Term Loan and Convertible Note with Braidwell.

Liquidity and Capital Resources

We have incurred operating losses since inception which resulted in negative cash flows used in operating activities of $23.1 million and $19.5 million for the nine months ended September 30, 2024 and 2023, respectively. As of September 30, 2024, we had an accumulated deficit of $219.5 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 September 30, 2024, we had cash and cash equivalents, restricted cash and short-term investments of $78.1 million.

Cash Flows

The following table sets forth our cash flows from operating, investing and financing activities for the periods indicated (dollars in thousands):


	Nine Months Ended September 30,
	2024		2023
Net cash used in operating activities	$	(23,061)	$	(19,503)

Net cash (used in) provided by investing activities	(10,750)		23,755

Net cash provided by (used in) financing activities	53,676		(2,086)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	153		(396)
Net increase in cash, cash equivalents and restricted cash	$	20,018	$	1,770

Cash Used in Operating Activities

Net cash used in operating activities was $23.1 million and $19.5 million for the nine months ended September 30, 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 $26.0 million for the nine months ended September 30, 2024 compared to $23.4 million for the nine months ended September 30, 2023. The increase in cash used in operating activities was primarily driven by inventory purchases to support sales growth as well as changes in accounts receivable and accounts payable associated with the increased sales and acquired inventory, respectively.

Cash (Used in) Provided by Investing Activities

Net cash provided by investing activities for the nine months ended September 30, 2024 was $10.8 million compared to $23.8 million for the nine months ended September 30, 2023. Net cash used in investing activities for the nine months ended September 30, 2024 consisted primarily of the sale and purchase of short-term marketable securities offset by purchases of property, plant and equipment of $14.5 million, the majority of which is instrument sets and the acquisition of Boston O&P and related clinics. 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 Provided by (Used in) Financing Activities

Net cash used in financing activities for the nine months ended September 30, 2024 was $53.7 million consisting of $2.3 million related to the ApiFix fourth and final anniversary payment and $1.3 million related to the MedTech first year anniversary payment, and $60.2 million related to the new debt agreement with Braidwell, replacing the term loan with MidCap.

Indebtedness

Credit Agreement

On August 05, 2024, the Company signed an $100 million term loan and private placement arrangement with Braidwell LP by and among (i) the Company and other borrowers party to the Credit Agreement, (ii)

Braidwell LP, and (iii) the financial institutions or other entities from time to time party thereto as Lenders. Terms of the financing include a $50 million term loan and $50 million of convertible notes. The term loan consists of an initial term loan of $25 million and access to a delayed draw term loan facility for an additional $25 million, subject to certain terms and conditions. The interest rate on the term loan is SOFR + 6.50% with the Company having the option to make a payment-in-kind interest payment equal to 1.00% per annum of the rate. Payments are interest only until the maturity date in August 2029. Included in the term loan are financial covenants to maintain cash in certain pledged accounts of at least 25% of the outstanding principal amount of the loan and to maintain certain minimum net product sales during the loan period.

The $50 million of convertible notes will accrue interest at a rate of 4.75% per annum. Payments will consist of interest only until the maturity date in February 2030. The notes are convertible into common stock of the Company at an initial conversion price of $40.98, which represents a 30% premium to the Company’s volume weighted average common stock price for the thirty trading days ended August 2, 2024.

In connection with its approval of the financing, the Company’s Board approved a stock repurchase program of up to $5 million in value of the Company’s outstanding common stock. Using the closing price on August 2, 2024, of $29.56, the amount of common stock subject to the repurchase program represents approximately 169,000 shares or 0.7% of the Company’s outstanding common stock.

The proceeds from the financing will be used to repay the Company’s outstanding debt of approximately $10 million, transaction fees incurred in connection with the financing, potential stock repurchases under the program described above, and for general corporate purposes and working capital needs.

The debt facilities replace the $80 million Credit, Security, and Guaranty Agreement with MidCap Funding IV Trust and MidCap Financial Trust and other parties named therein. There was approximately $10 million outstanding under the MidCap Credit Agreement and it was terminated in connection with the Term Loan 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.

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).

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.

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. Other than as described below, there have been no material changes to these Risk Factors since the filing of our Annual Report on Form 10-K.

• Conversion of the Notes will dilute the ownership interest of existing stockholders or may otherwise depress the price of our common stock.

The conversion of some or all of the Notes will dilute the ownership interests of existing stockholders to the extent we deliver shares of our common stock upon conversion of any of the Notes. The Notes may from time to time in the future be convertible at the option of their holders prior to their scheduled terms under certain circumstances. Any sales in the public market of the common stock issuable upon such conversion could adversely affect prevailing market prices of our common stock. In addition, the existence of the Notes may encourage short selling by market participants because the conversion of the Notes could be used to satisfy short positions or anticipated conversion of the Notes into shares of our common stock could depress the price of our common stock.

• Provisions in the indenture governing the Notes could delay or prevent an otherwise beneficial takeover of us.

Certain provisions in the Notes and the indenture governing the Notes could make a third-party attempt to acquire us more difficult or expensive. For example, if a takeover constitutes a fundamental change (as defined in the indenture governing the Notes), then noteholders will have the right to require us to repurchase their Notes for cash. In addition, if a takeover constitutes a make-whole fundamental change (as defined in the indenture governing the Notes), then we may be required to temporarily increase the conversion rate. In either case, and in other cases, our obligations under the Notes and the indenture governing the Notes could increase the cost of acquiring us or otherwise discourage a third-party from acquiring us or removing incumbent management, including in a transaction that noteholders or holders of our common stock may view as favorable.

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.

On August 2, 2024, the Board of Directors of the Company approved a limited stock repurchase program of up to $5.0 million in aggregate investment of the Company’s outstanding common stock, $0.00025 par value per share. If not yet repurchased as of December 31, 2024, the dollar limit on repurchases thereafter is reduced to $250,000 per annum. The program does not have an expiration date. However, it may be discontinued by the Board of Directors at any time. The Company has not yet repurchased any shares of its common stock pursuant to the repurchase program.

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.

b. Modifications to nomination process.

None.

c. Insider trading arrangements.

During the three months ended September 30, 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, except as follows:

On May 31, 2024, Mr. Greg Odle, the Company's President of Scoliosis, adopted a trading

plan intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). The plan provides for the sale of up to 7,500 shares of the Company's common stock. The plan has an effective date of August 29, 2024 and will terminate on August 28, 2025, subject to early termination for certain specified events set forth in the plan.

ITEM 6. EXHIBITS

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

Exhibit

Number

Description

2.1w

Share Purchase Agreement, dated April 1, 2020, by and among OrthoPediatrics Corp., ApiFix Ltd. (“ApiFix”), certain controlling shareholders of ApiFix, and the sellers’ representative named therein (Incorporated by reference to Exhibit 2.1 of registrant's Form 8-K filed on April 1, 2020) (SEC File No. 001-38242)

2.2w

Agreement and Plan of Merger, dated April 1, 2022, by and among OrthoPediatrics Corp., OrthoPediatrics Iowa Holdco, Inc., Mitchell Designs, Inc. (“Designs”), and John Mitchell, the sole shareholder of Designs (Incorporated by reference to Exhibit 10.1 of registrant's Form 8-K filed on April 4, 2022) (SEC File No. 001-38242)

2.3w

Membership Interest Purchase Agreement, dated May 1, 2023, by and among OrthoPediatrics Corp., Kevin Unger, DINZE LLC, and the sole member of DINZE LLC (Incorporated by reference to Exhibit 2.1 of registrant's form 8-K filed on May 1, 2023) (SEC File No. 001-38242)

2.4w

Stock Purchase Agreement, dated January 5, 2024, by and among OrthoPediatrics Corp., Boston Brace International, Inc., GreatBanc Trust Company, solely in its capacity as trustee of Boston Brace International, Inc. Employee Stock Ownership Trust, the Selling Equityholders (as defined therein), and Thomas Morrissey, solely in his capacity as Sellers' Representative (incorporated by reference to Exhibit 2.1 of registrant's Form 8-K filed on January 8, 2024) (SEC File No. 001-38242)

3.1

Amended and Restated Certificate of Incorporation of OrthoPediatrics Corp. (Incorporated by reference to Exhibit 3.1 of registrant's Form 8-K filed on October 16, 2017) (SEC File No. 001-38242)

3.2

Amended and Restated Bylaws of OrthoPediatrics Corp. (Incorporated by reference to Exhibit 3.1 of registrant's Form 8-K filed on November 8, 2023) (SEC File No. 001-38242)

4.1

Specimen stock certificate evidencing the shares of common stock (Incorporated by reference to Exhibit 4.1 of registrant's Amendment No. 3 to Form S-1 filed on October 2, 2017) (SEC File No. 333-212076)

4.2

Registration Rights Agreement, by and between the registrant and Squadron, dated as of May 30, 2014 (Incorporated by reference to Exhibit 4.2 of registrant's Form S-1 filed on June 16, 2016) (SEC File No. 333-212076)

4.3

First Amendment to Registration Rights Agreement, by and between the registrant and Squadron, dated October 16, 2017 (Incorporated by reference to Exhibit 10.2 of registrant's Form 8-K filed on October 16, 2017) (SEC File No. 001-38242)

4.4

Stockholders Agreement, by and between the registrant and Squadron, dated October 16, 2017 (Incorporated by reference to Exhibit 10.1 of registrant's Form 8-K filed on October 16, 2017) (SEC File No. 001-38242)

4.5

Indenture, dated as of August 12, 2024, between OrthoPediatrics Corp. and U.S. Bank Trust Company, National Association, as trustee (incorporated by reference to Exhibit 4.2 of registrant’s Form 8-K filed on August 12, 2024 (SEC File No. 001-38242).

4.6

Form of 4.75% Convertible Senior Notes due February 15, 2030 (incorporated by reference to Exhibit 4.1 of registrant’s Form 8-K filed on August 12, 2024 (SEC File No. 001-38242).

10.1

OrthoPediatrics Corp. Non-Employee Director Compensation Policy, effective January 1, 2023 (Incorporated by reference to Exhibit 10.1 of registrant’s Form 8-K filed on May 1, 2023) (SEC File No. 001-38242)

10.2

Credit, Security and Guaranty Agreement, dated December 29, 2023, by and among OrthoPediatrics Corp., MidCap Financial Trust, and other parties named therein (incorporated by reference to Exhibit 10.1 of registrant's Form 8-K filed on January 2, 2024 (SEC File No. 001-38242)

10.3

Credit Agreement and Guaranty, dated as of August 5, 2024, by and among OrthoPediatrics Corp. and its wholly owned domestic subsidiaries, as borrowers, the guarantors from time to time party thereto, the lenders from time to time party thereto, and Wilmington Trust, National Association, as agent (incorporated by reference to Exhibit 10.1 of registrant's Form 8-K filed on August 5, 2024 (SEC File No. 001-38242)

10.4

Purchase Agreement, dated August 5, 2024, by and between OrthoPediatrics Corp. and Braidwell Transaction Holdings LLC - Series 10 (incorporated by reference to Exhibit 10.2 of registrant's Form 8-K filed on August 5, 2024 (SEC File No. 001-38242)

10.5

Employment Agreement, by and between David R. Bailey and OrthoPediatrics Corp., dated as of October 15, 2024 (incorporated by reference to Exhibit 10.1 of registrant’s Form 8-K filed on October 18, 2024 (SEC File No. 001-38242).

10.6

Employment Agreement, by and between Fred L. Hite and OrthoPediatrics Corp., dated as of October 15, 2024 (incorporated by reference to Exhibit 10.2 of registrant’s Form 8-K filed on October 18, 2024 (SEC File No. 001-38242).

10.7

Employment Agreement, by and between Gregory A. Odle and OrthoPediatrics Corp., dated as of October 15, 2024 (incorporated by reference to Exhibit 10.3 of registrant’s Form 8-K filed on October 18, 2024 (SEC File No. 001-38242).

10.8

Employment Agreement, by and between Daniel J. Gerritzen and OrthoPediatrics Corp., dated as of October 15, 2024 (incorporated by reference to Exhibit 10.4 of registrant’s Form 8-K filed on October 18, 2024 (SEC File No. 001-38242).

10.9

Employment Agreement, by and between Joseph W. Hauser and OrthoPediatrics Corp., dated as of October 15, 2024 (incorporated by reference to Exhibit 10.5 of registrant’s Form 8-K filed on October 18, 2024 (SEC File No. 001-38242).

10.1

OrthoPediatrics Corp. Non-Employee Director Compensation Policy, effective August 8, 2024.

31.1

Certification of Chief Executive Officer pursuant to Exchange Act Rules 13a-14(a) and 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

31.2

Certification of Chief Financial Officer pursuant to Exchange Act Rules 13a-14(a) and 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

32.1

Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

32.2

Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

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

104

Cover 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.

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.



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



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

Exhibit 10.10 ORTHOPEDIATRICS CORP. NON-EMPLOYEE DIRECTOR COMPENSATION POLICY (Effective as of August 8, 2024) OrthoPediatrics Corp. (the “Company”) believes that granting equity and cash compensation to its directors who are not employees of the Company (“Outside Directors”) represents a powerful tool to attract, retain and reward its Outside Directors and to align the interests of its Outside Directors with those of its shareholders. This Non-Employee Director Compensation Policy (this “Policy”) is intended to formalize the Company’s policy regarding grants of equity and cash compensation to its Outside Directors. Unless otherwise defined herein, capitalized terms used in this Policy will have the meanings given to such terms in the Company’s 2024 Incentive Award Plan, or any successor plan(s) thereto (the “Plan”). All amounts granted or paid pursuant to this Policy will be made under the terms of the Plan. 1. Equity Compensation. Each Outside Director who is serving on the Company’s Board of Directors (the “Board”) as of the adjournment of an annual meeting of the Company’s shareholders will be automatically granted $90,000 worth of shares of Restricted Stock (an “Annual Award”) on or about the date of such annual meeting of the Company’s shareholders. One-third of the Annual Award will vest on the earlier of (i) each of the first, second and third anniversary dates of the grant and (ii) the date of the annual meeting of the Company’s shareholders in each of the first, second and third years following the date of grant, as applicable, subject to the Outside Director’s continued status as an Eligible Individual through the applicable vesting dates. The number of shares of Restricted Stock that will make up the Annual Award will be valued as follows: $90,000 divided by the closing price of the Company’s stock on the date of such annual meeting as reported by Bloomberg, L.P. 2. Cash Compensation (a) Fees. The Company will pay each Outside Director a fee of $22,500 each quarter per year for their participation on the Board (each, a “Quarterly Fee”) payable on or after the date of the regular quarterly Board meeting or, if none, at the end of the applicable calendar quarter, with the amount prorated in the event the individual did not serve on the Board for the full calendar quarter. (b) Chairperson Annual Fee. If an Outside Director is serving as the chairperson of the Board, the Compensation Committee or the Corporate Governance Committee (each a “Chairperson”), then, in addition to the Quarterly Fees, the Company will pay to the Chairperson an additional annual fee of $5,000 for serving in such role (the “Chairperson Fee”). If an Outside Director is serving as the chairperson of the Audit Committee (“Audit Chairperson”), then, in addition to the Quarterly Fees, the Company will pay to the Audit Chairperson an additional annual fee of $10,000 for serving in such role (“Audit Chairperson Fee”). The Chairperson Fee and Audit Chairperson Fee will be paid to the Chairperson and Audit Chairperson in four equal installments on a quarterly basis at the end of the applicable c a l e n d a r quarter provided the individual served as the relevant Chairperson or the Audit Chairperson during the full quarter, with the amount prorated in the event the individual did not serve as the relevant Chairperson or the Audit Chairperson for the full quarter. 3. Miscellaneous (a) Revisions. The Board, in its discretion, may change and otherwise revise the terms of this Policy, including, without limitation, the amount of equity or cash compensation to be paid to Outside Directors.

Exhibit 10.10 (b) Section 409A. In no event shall cash compensation payable pursuant to this Policy be paid later than March 15 following the calendar year in which the compensation is earned, in compliance with the “short-term deferral” exception to Section 409A. This Policy is intended to comply with the requirements of Section 409A so that none of the compensation to be provided hereunder shall be subject to the additional tax imposed under Section 409A, and any ambiguities herein shall be interpreted to so comply. * * * * *

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: November 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.;

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: November 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 September 30, 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: November 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 September 30, 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: November 7, 2024

COVER - shares	9 Months Ended
COVER - shares	Sep. 30, 2024	Nov. 04, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 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		24,215,936
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Central Index Key	0001425450
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 51,047	$ 31,055
Restricted cash	1,998	1,972
Short-term investments	25,017	49,251
Accounts receivable - trade, net of allowances of $1,025 and $1,373, respectively	42,827	34,617
Inventories, net	120,934	105,851
Prepaid expenses and other current assets	6,489	3,750
Total current assets	248,312	226,496
Property and equipment, net	54,765	41,048
Other assets:
Amortizable intangible assets, net	65,955	69,275
Goodwill	91,262	83,699
Other intangible assets	18,744	15,287
Other non-current assets	10,256	2,940
Total other assets	186,217	171,201
Total assets	489,294	438,745
Current liabilities:
Accounts payable - trade	11,647	12,649
Accrued compensation and benefits	13,221	11,325
Current portion of long-term debt with affiliate	158	152
Current portion of acquisition installment payable	1,325	10,149
Other current liabilities	8,274	7,391
Total current liabilities	34,625	41,666
Long-term liabilities:
Long-term convertible note	47,831	0
Other long-term debt, net of current portion	244	0
Acquisition installment payable, net of current portion	2,412	3,551
Deferred income taxes	4,025	5,483
Other long-term liabilities	4,799	1,112
Total long-term liabilities	83,750	20,054
Total liabilities	118,375	61,720
Stockholders' equity:
Common stock, $0.00025 par value; 50,000,000 shares authorized; 24,214,046 shares and 23,378,408 shares issued as of September 30, 2024 and December 31, 2023, respectively	6	6
Additional paid-in capital	597,009	580,287
Accumulated deficit	(219,495)	(197,742)
Accumulated other comprehensive loss	(6,601)	(5,526)
Total stockholders' equity	370,919	377,025
Total liabilities and stockholders' equity	489,294	438,745
Nonrelated Party
Long-term liabilities:
Long-term term loan	23,948	9,297
Related Party
Long-term liabilities:
Long-term term loan	$ 491	$ 611

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,025	$ 1,373
Common stock, par value (in dollars per share)	$ 0.00025	$ 0.00025
Common stock, shares authorized (in shares)	50,000,000	50,000,000
Common stock, shares issued (in shares)	24,214,046	23,378,408

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Net revenue	$ 54,573	$ 39,972	$ 152,060	$ 111,119
Cost of revenue	14,513	9,019	39,027	26,580
Gross profit	40,060	30,953	113,033	84,539
Operating expenses:
Sales and marketing	16,750	13,942	47,512	40,024
General and administrative	26,299	17,973	78,358	54,242
Tradename impairment	0	985	0	985
Research and development	2,577	2,561	8,118	7,973
Total operating expenses	45,626	35,461	133,988	103,224
Operating loss	(5,566)	(4,508)	(20,955)	(18,685)
Other expense (income):
Interest expense, net	404	21	1,302	105
Loss on early extinguishment of debt	3,230	0	3,230	0
Fair value adjustment of contingent consideration	0	0	0	(2,974)
Other expense (income), net	(63)	(787)	33	(1,407)
Total other expense (income), net	3,571	(766)	4,565	(4,276)
Loss before income taxes	(9,137)	(3,742)	(25,520)	(14,409)
Provision for income taxes (benefit)	(1,218)	849	(3,767)	(126)
Net loss	$ (7,919)	$ (4,591)	$ (21,753)	$ (14,283)
Weighted average shares outstanding - basic (in shares)	23,171,249	22,762,823	23,046,155	22,646,087
Weighted average shares outstanding for diluted (in shares)	23,171,249	22,762,823	23,046,155	22,646,087
Net loss per share - basic (in dollars per share)	$ (0.34)	$ (0.20)	$ (0.94)	$ (0.63)
Net loss per share - diluted (in dollars per share)	$ (0.34)	$ (0.20)	$ (0.94)	$ (0.63)

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Statement of Comprehensive Income [Abstract]
Net loss	$ (7,919)	$ (4,591)	$ (21,753)	$ (14,283)
Other comprehensive loss:
Foreign currency translation adjustment	3,623	(3,947)	(1,066)	(6,767)
Unrealized gain on short-term investments	0	251	109	861
Adjustment for realized gain on securities	0	(559)	(118)	(860)
Other comprehensive income (loss), net of tax	3,623	(4,255)	(1,075)	(6,766)
Comprehensive loss	$ (4,296)	$ (8,846)	$ (22,828)	$ (21,049)

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Medtech	ApiFix Ltd	Common Stock	Common Stock Medtech	Common Stock ApiFix Ltd	Additional Paid-in Capital	Additional Paid-in Capital Medtech	Additional Paid-in Capital ApiFix Ltd	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 income (loss)	(646)										(646)
Restricted stock	1,959						1,959
Restricted stock (in shares)				264,156
Ending balance at Mar. 31, 2023	373,155			$ 6			562,769			(183,574)	(6,046)
Ending balance (in shares) at Mar. 31, 2023				23,142,118
Beginning balance at Dec. 31, 2022	378,648			$ 6			560,810			(176,768)	(5,400)
Beginning balance (in shares) at Dec. 31, 2022				22,877,962
Increase (Decrease) in Stockholders' Equity
Net loss	(14,283)
Other comprehensive income (loss)	(6,766)
Ending balance at Sep. 30, 2023	374,329			$ 6			577,540			(191,051)	(12,166)
Ending balance (in shares) at Sep. 30, 2023				23,350,976
Beginning balance at Mar. 31, 2023	373,155			$ 6			562,769			(183,574)	(6,046)
Beginning balance (in shares) at Mar. 31, 2023				23,142,118
Increase (Decrease) in Stockholders' Equity
Net loss	(2,886)									(2,886)
Other comprehensive income (loss)	(1,865)										(1,865)
Consideration for MedTech acquisition		$ 2,274						$ 2,274
Consideration for MedTech acquisition (in shares)					43,751
Stock portion of ApiFix anniversary installment			$ 6,178						$ 6,178
Stock portion of ApiFix anniversary installment (in shares)						140,003
Restricted stock	3,456						3,456
Restricted stock (in shares)				14,591
Ending balance at Jun. 30, 2023	380,312			$ 6			574,677			(186,460)	(7,911)
Ending balance (in shares) at Jun. 30, 2023				23,340,463
Increase (Decrease) in Stockholders' Equity
Net loss	(4,591)									(4,591)
Other comprehensive income (loss)	(4,255)										(4,255)
Consideration for MedTech acquisition	478						478
Consideration for MedTech acquisition (in shares)				11,133
Stock option exercise	21						21
Stock option exercise (in shares)				670
Restricted stock	2,364						2,364
Restricted stock (in shares)				(1,290)
Ending balance at Sep. 30, 2023	374,329			$ 6			577,540			(191,051)	(12,166)
Ending balance (in shares) at Sep. 30, 2023				23,350,976
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 income (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
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	(21,753)
Other comprehensive income (loss)	(1,075)
Ending balance at Sep. 30, 2024	370,919			$ 6			597,009			(219,495)	(6,601)
Ending balance (in shares) at Sep. 30, 2024				24,214,046
Beginning balance at Mar. 31, 2024	370,584			$ 6			583,086			(205,547)	(6,961)
Beginning balance (in shares) at Mar. 31, 2024				23,540,411
Increase (Decrease) in Stockholders' Equity
Net loss	(6,029)									(6,029)
Other comprehensive income (loss)	(3,263)										(3,263)
Stock portion of ApiFix anniversary installment		$ 133	$ 6,929					$ 133	$ 6,929
Stock portion of ApiFix anniversary installment (in shares)					4,288	245,812
Restricted stock	2,939						2,939
Restricted stock (in shares)				426,227
Ending balance at Jun. 30, 2024	371,293			$ 6			593,087			(211,576)	(10,224)
Ending balance (in shares) at Jun. 30, 2024				24,216,738
Increase (Decrease) in Stockholders' Equity
Net loss	(7,919)									(7,919)
Other comprehensive income (loss)	3,623										3,623
Restricted stock	3,922						3,922
Restricted stock (in shares)				(2,692)
Ending balance at Sep. 30, 2024	$ 370,919			$ 6			$ 597,009			$ (219,495)	$ (6,601)
Ending balance (in shares) at Sep. 30, 2024				24,214,046

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
OPERATING ACTIVITIES
Net loss	$ (7,919)	$ (7,805)	$ (4,591)	$ (6,806)	$ (21,753)	$ (14,283)
Adjustments to reconcile net loss to net cash used in operating activities:
Tradename impairment	0		985		0	985
Depreciation and amortization					15,087	12,198
Stock-based compensation					9,660	7,779
Loss on early extinguishment of debt	3,230		0		3,230	0
Fair value adjustment of contingent consideration	0		0		0	(2,974)
Accretion of acquisition installment payable					599	1,092
Deferred income taxes					(3,907)	(899)
Changes in certain operating assets and liabilities:
Accounts receivable - trade					(5,178)	(12,878)
Inventories, net					(14,154)	(22,198)
Prepaid expenses and other current assets					(2,134)	(196)
Accounts payable - trade					(1,768)	11,492
Accrued expenses and other liabilities					308	3,288
Other					(3,051)	(2,909)
Net cash used in operating activities					(23,061)	(19,503)
INVESTING ACTIVITIES
Acquisition of Boston O&P, net of cash acquired					(20,225)	0
Clinic acquisition, net of cash acquired					(475)	0
Acquisition of MedTech, net of cash acquired					0	(3,097)
Acquisition of Rhino assets					0	(546)
Investment in private companies					(380)	0
Sale of short-term marketable securities					49,855	89,040
Purchase of short-term marketable securities					(25,000)	(48,600)
Purchases of property and equipment					(14,525)	(13,042)
Net cash (used in) provided by investing activities					(10,750)	23,755
FINANCING ACTIVITIES
Proceeds from issuance of debt					73,533	0
Payment on debt					(12,231)	0
Payment of debt issuance costs					(3,085)	0
Proceeds from exercise of stock options					0	21
Payments on acquisition note					(928)	0
Payments on mortgage notes					(113)	(107)
Net cash provided by (used in) financing activities					53,676	(2,086)
Effect of exchange rate changes on cash, cash equivalents and restricted cash					153	(396)
NET INCREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH					20,018	1,770
Cash, cash equivalents and restricted cash, beginning of year		$ 33,027		$ 10,462	33,027	10,462	$ 10,462
Cash, cash equivalents and restricted cash, end of period	$ 53,045		$ 12,232		53,045	12,232	$ 33,027
SUPPLEMENTAL DISCLOSURES
Cash paid for interest					1,381	32
Transfer of instruments between property and equipment and inventory					966	431
Right-of-use assets obtained in exchange for lease liabilities					3,220	367
Debt issuance costs not yet paid					260	0
ApiFix Ltd
FINANCING ACTIVITIES
Installment payments					(2,250)	(2,000)
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition					6,929	6,178
Medtech
FINANCING ACTIVITIES
Installment payments					(1,250)	0
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition					133	2,274
Rhino
SUPPLEMENTAL DISCLOSURES
Issuance of common shares in acquisition					$ 0	$ 478

BUSINESS	9 Months Ended
BUSINESS	Sep. 30, 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 Boston Brace 3D, implants and related surgical instrumentation while our orthopedic bracing products are manufactured in-house. We also operate multiple orthotic and prosthetic ("O&P") clinics delivering leading pediatric non-surgical O&P treatment. We are the only global medical device company focused exclusively on providing a comprehensive trauma and deformity correction, scoliosis, sports medicine, specialty bracing and clinical services 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.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation

Unaudited Interim Condensed Consolidated Financial Statements

Use of Estimates

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

The following tables present the impact of the reclassification on our condensed consolidated statements of operations:


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
Sales and marketing (prior presentation)	$	13,582	$	38,963

Reclassification	360		1,061
Sales and marketing (new presentation)	$	13,942	$	40,024


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
General and administrative (prior presentation)	$	18,507	$	55,827

Reclassification	(534)		(1,585)
General and administrative (new presentation)	$	17,973	$	54,242


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
Research and development (prior presentation)	$	2,387	$	7,449

Reclassification	174		524
Research and development (new presentation)	$	2,561	$	7,973

Financial Instruments and Concentration of Credit Risk

Recent Accounting Pronouncements

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.

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

9 Months Ended

Sep. 30, 2024

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

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS

Boston Brace International, Inc.


Fair value of estimated total acquisition consideration	$	21,534
Assets
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,557
Other non-current liabilities	1,803
Total liabilities	8,162
Less: total net assets	13,238
Goodwill	$	8,296


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

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

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 September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net revenue	$	54,573	$	46,585	$	152,491	$	130,857
Net loss	$	(7,903)	$	(4,475)	$	(21,712)	$	(13,935)

Rhino Pediatric Orthopedic Designs, Inc.

Medtech Concepts LLC


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

GOODWILL AND INTANGIBLE ASSETS

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND INTANGIBLE ASSETS

Goodwill

Changes in the carrying amount of goodwill for the nine months ended September 30, 2024 were as follows:


	Total



Goodwill at January 1, 2024	$	83,699
Boston O&P acquisition	8,296
Other clinic acquisitions	627
Foreign currency translation impact	(1,360)
Goodwill at September 30, 2024	$	91,262

Intangible Assets

As of September 30, 2024, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	10.5 years	$	44,903	$	(13,147)	$	31,756
Intellectual Property & Capitalized Software	8.4 years	16,027		(3,681)		12,346
Customer Relationships & Other	11.7 years	21,777		(4,462)		17,315
License Agreements	3.0 years	10,583		(6,045)		4,538
Total amortizable assets		$	93,290	$	(27,335)	$	65,955

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


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

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

FAIR VALUE OF FINANCIAL INSTRUMENTS

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

FAIR VALUE OF FINANCIAL INSTRUMENTS

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

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

The following table summarizes the assets and liabilities measured at fair value on a recurring basis as of September 30, 2024 and December 31, 2023.


	September 30, 2024
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Exchange Trade Mutual Funds	$	25,017	$	—	$	—	$	25,017







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

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

Other	$	207	$	—	$	—	$	207

DEBT AND CREDIT ARRANGEMENTS

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

DEBT AND CREDIT ARRANGEMENTS

Long-term debt consisted of the following as of the dates indicated:


	September 30, 2024		December 31, 2023
Term loan and Final Payment	$	25,500	$	10,300
Convertible note	50,000		—
Mortgage payable to affiliate	649		763
Acquisition note payable	710		—
Total debt	76,859		11,063
Less: debt discount and issuance costs	3,721		1,003
Less: current maturities	624		152
Long-term debt, net of current maturities	$	72,514	$	9,908

Braidwell Term Loan

Braidwell Convertible Note

the conversion rate applicable to the conversion of that Note will be increased in certain circumstances if it is converted after it is called for redemption.

MidCap Term Loan

daily unused portion of the revolving credit commitment. The unused commitment fee was payable quarterly in arrears.

Squadron Revolver

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

Other Debt

INCOME TAXES	9 Months Ended
INCOME TAXES	Sep. 30, 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 nine months ended September 30, 2024, the income tax benefit was $3,767 compared to $126 for the nine months ended September 30, 2023. Our effective income tax rate was 14.8% and 0.9% for the nine months ended September 30, 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 September 30, 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. and Pega Medical (OrthoPediatrics Canada ULC). The Company has recorded a tax benefit for losses generated in Israel and a tax expense for income generated in Canada during the period ended September 30, 2024. Management assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets. A significant piece of objective negative evidence evaluated was the cumulative loss incurred over the three-year period ended September 30, 2024. Such objective evidence limits the ability to consider other subjective evidence, such as our projections for future growth.

STOCKHOLDERS' EQUITY

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

STOCKHOLDERS' EQUITY

STOCKHOLDERS’ EQUITY

Restricted Stock

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


		Weighted-Average		Weighted-Average
	Restricted	Remaining	Restricted	Remaining
	Stock	Contractual Terms	Stock	Contractual Terms
	Awards	(in Years)	Units	(in Years)
Outstanding at January 1, 2024	592,453	1.6	13,851	1.7
Granted	556,109		7,900
Forfeited	(9,165)		(200)
Vested	(96,616)		—
Outstanding at September 30, 2024	1,042,781	1.8	21,551	1.4

NET LOSS PER SHARE

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

NET LOSS PER SHARE

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


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Net loss	$	(7,919)	$	(4,591)	$	(21,753)	$	(14,283)

Weighted average shares outstanding for basic and diluted	23,171,249		22,762,823		23,046,155		22,646,087
Net loss per share - basic and diluted	$	(0.34)	$	(0.20)	$	(0.94)	$	(0.63)

BUSINESS SEGMENT

9 Months Ended

Sep. 30, 2024

Segment Reporting [Abstract]

BUSINESS SEGMENT

Product sales by source were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2024		2023		2024		2023
U.S.	$	42,714	$	29,360	$	118,269	$	82,748
International	11,859		10,612		33,791		28,371
Total	$	54,573	$	39,972	$	152,060	$	111,119


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2024		2023		2024		2023
Trauma and deformity	$	37,642	$	28,806	$	108,715	$	79,715
Scoliosis	15,635		10,304		39,521		28,270
Sports medicine/other	1,296		862		3,824		3,134
Total	$	54,573	$	39,972	$	152,060	$	111,119

RELATED PARTY TRANSACTIONS	9 Months Ended
RELATED PARTY TRANSACTIONS	Sep. 30, 2024
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	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 $206 and $234 for the three months ended September 30, 2024 and 2023, respectively, and $729 and $628 for the nine months ended September 30, 2024 and 2023, respectively.

EMPLOYEE BENEFIT PLAN	9 Months Ended
EMPLOYEE BENEFIT PLAN	Sep. 30, 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 and Boston O&P receive contribution matches up to 3% of their salary.

COMMITMENTS AND CONTINGENCIES	9 Months Ended
COMMITMENTS AND CONTINGENCIES	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES Leases As of September 30, 2024, the Company has recorded a lease liability of $6,572 and corresponding right-of-use asset of $6,940 on its condensed consolidated balance sheet. We assumed $2,828 of operating right-of-use assets and 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. On September 20, 2024, the Court dismissed IMED’s lawsuit, without prejudice, for failure to prosecute. However, contemporaneously, IMED re-initiated arbitration. Although we believe the Company has strong defenses to the IMED arbitration and we intend to vigorously defend the claims asserted against us, arbitration can involve complex factual and legal questions, and an adverse resolution of such proceedings could have a material adverse effect on our business, operating results and financial condition. Boston O&P Litigation This lawsuit arises from the alleged wrongful death of a patient following his January 2016, tracheal and laryngeal resection procedure at Boston Children’s Hospital, which was performed by two physicians named as defendants in the suit. The Plaintiffs allege that as a result of the patient’s post-operative care, which included placing his neck in a position of flexion in a modified brace provided by Boston O&P, the patient was paralyzed, and years later, he died due to complications caused by his paralysis. The Company acquired all of the outstanding shares of Boston O&P on January 5, 2024 as described more fully under Note 3 - Business Combinations and Asset Acquisitions. The lawsuit commenced in December 2018, in Suffolk Superior Court in Boston, Massachusetts. The Plaintiffs assert counts of negligence against each individual defendant, lack of informed consent against the physician defendants, failure to warn, breach of warranty and alleged improper use against Boston O&P, and loss of consortium against all defendants. Trial is currently scheduled to begin in December 2025. Although we believe Boston O&P has strong defenses to this lawsuit and we intend to vigorously defend the claims asserted against us, litigation can involve complex factual and legal questions, and an adverse resolution of such proceedings could have a material adverse effect on our business, operating results and financial condition. We are not presently a party to any other legal proceedings the outcome of which, if determined adversely to us, would individually or in the aggregate materially affect our financial position or results of operations or cash flows. Purchase Obligations and Performance Requirements As a result of entering into a license agreement for the exclusive distribution of the 7D Surgical FLASHTM Navigation platform during 2021, the Company agreed to a minimum purchase commitment for the first twelve months of that agreement. Additionally, the contract requires future purchase commitments based upon a percentage of historical purchases. As a result and as of September 30, 2024, the Company met its purchase commitment for the year ended December 31, 2024 and $1,456 future purchase commitments are required 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 nine months ended September 30, 2024, the Company recorded an expense of $1,200 based on current estimates. The Company recorded $1,053 of expense for the nine months ended September 30, 2023. Royalties As of September 30, 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 September 30, 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.

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net loss	$ (7,919)	$ (6,029)	$ (7,805)	$ (4,591)	$ (2,886)	$ (6,806)	$ (21,753)	$ (14,283)

Insider Trading Arrangements	3 Months Ended	9 Months Ended
Insider Trading Arrangements	Sep. 30, 2024 shares	Sep. 30, 2024 shares
Trading Arrangements, by Individual
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Greg Odle [Member]
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		On May 31, 2024, Mr. Greg Odle, the Company's President of Scoliosis, adopted a trading plan intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). The plan provides for the sale of up to 7,500 shares of the Company's common stock. The plan has an effective date of August 29, 2024 and will terminate on August 28, 2025, subject to early termination for certain specified events set forth in the plan.
Name	Greg Odle
Title	President
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 29, 2024
Expiration Date	August 28, 2025
Arrangement Duration	364 days
Aggregate Available	7,500	7,500

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	9 Months Ended
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	Sep. 30, 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 and nine months ended September 30, 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.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)

9 Months Ended

Sep. 30, 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 September 30, 2023		Nine Months Ended September 30, 2023
Sales and marketing (prior presentation)	$	13,582	$	38,963

Reclassification	360		1,061
Sales and marketing (new presentation)	$	13,942	$	40,024


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
General and administrative (prior presentation)	$	18,507	$	55,827

Reclassification	(534)		(1,585)
General and administrative (new presentation)	$	17,973	$	54,242


	Three Months Ended September 30, 2023		Nine Months Ended September 30, 2023
Research and development (prior presentation)	$	2,387	$	7,449

Reclassification	174		524
Research and development (new presentation)	$	2,561	$	7,973

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS (Tables)

9 Months Ended

Sep. 30, 2024

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

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed


Fair value of estimated total acquisition consideration	$	21,534
Assets
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,557
Other non-current liabilities	1,803
Total liabilities	8,162
Less: total net assets	13,238
Goodwill	$	8,296

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


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

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

Schedule of Business Acquisition, Pro Forma Information

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Net revenue	$	54,573	$	46,585	$	152,491	$	130,857
Net loss	$	(7,903)	$	(4,475)	$	(21,712)	$	(13,935)

Schedule of Total Consideration Transferred after Discounting Future Payments

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


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

GOODWILL AND INTANGIBLE ASSETS (Tables)

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Goodwill

Changes in the carrying amount of goodwill for the nine months ended September 30, 2024 were as follows:


	Total



Goodwill at January 1, 2024	$	83,699
Boston O&P acquisition	8,296
Other clinic acquisitions	627
Foreign currency translation impact	(1,360)
Goodwill at September 30, 2024	$	91,262

Schedule of the Balances of Amortizable Intangible Assets

As of September 30, 2024, the balances of amortizable intangible assets were as follows:


	Weighted-Average Amortization Period	Gross Intangible Assets		Accumulated Amortization		Net Intangible Assets
Patents	10.5 years	$	44,903	$	(13,147)	$	31,756
Intellectual Property & Capitalized Software	8.4 years	16,027		(3,681)		12,346
Customer Relationships & Other	11.7 years	21,777		(4,462)		17,315
License Agreements	3.0 years	10,583		(6,045)		4,538
Total amortizable assets		$	93,290	$	(27,335)	$	65,955

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


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

FAIR VALUE OF FINANCIAL INSTRUMENTS (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

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

The following table summarizes the assets and liabilities measured at fair value on a recurring basis as of September 30, 2024 and December 31, 2023.


	September 30, 2024
	Level 1		Level 2		Level 3		Total
Financial Assets

Short-term investments
Exchange Trade Mutual Funds	$	25,017	$	—	$	—	$	25,017







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

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

Other	$	207	$	—	$	—	$	207

DEBT AND CREDIT ARRANGEMENTS (Tables)

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

Long-term debt consisted of the following as of the dates indicated:


	September 30, 2024		December 31, 2023
Term loan and Final Payment	$	25,500	$	10,300
Convertible note	50,000		—
Mortgage payable to affiliate	649		763
Acquisition note payable	710		—
Total debt	76,859		11,063
Less: debt discount and issuance costs	3,721		1,003
Less: current maturities	624		152
Long-term debt, net of current maturities	$	72,514	$	9,908

STOCKHOLDERS' EQUITY (Tables)

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

Schedule of Restricted Stock Activity

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


		Weighted-Average		Weighted-Average
	Restricted	Remaining	Restricted	Remaining
	Stock	Contractual Terms	Stock	Contractual Terms
	Awards	(in Years)	Units	(in Years)
Outstanding at January 1, 2024	592,453	1.6	13,851	1.7
Granted	556,109		7,900
Forfeited	(9,165)		(200)
Vested	(96,616)		—
Outstanding at September 30, 2024	1,042,781	1.8	21,551	1.4

NET LOSS PER SHARE (Tables)

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

Schedule of Reconciliation of Basic and Diluted Net Loss Per Share

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


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2024		2023		2024		2023
Net loss	$	(7,919)	$	(4,591)	$	(21,753)	$	(14,283)

Weighted average shares outstanding for basic and diluted	23,171,249		22,762,823		23,046,155		22,646,087
Net loss per share - basic and diluted	$	(0.34)	$	(0.20)	$	(0.94)	$	(0.63)

BUSINESS SEGMENT (Tables)

9 Months Ended

Sep. 30, 2024

Segment Reporting [Abstract]

Schedule of Product Sales by Geographic Location

Product sales by source were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by geographic location:	2024		2023		2024		2023
U.S.	$	42,714	$	29,360	$	118,269	$	82,748
International	11,859		10,612		33,791		28,371
Total	$	54,573	$	39,972	$	152,060	$	111,119

Schedule of Product Sales by Category


	Three Months Ended September 30,				Nine Months Ended September 30,
Product sales by category:	2024		2023		2024		2023
Trauma and deformity	$	37,642	$	28,806	$	108,715	$	79,715
Scoliosis	15,635		10,304		39,521		28,270
Sports medicine/other	1,296		862		3,824		3,134
Total	$	54,573	$	39,972	$	152,060	$	111,119

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Accounting Policies [Abstract]
Accumulated deficit	$ 219,495	$ 197,742

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Schedule of Reclassifications (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Reclassification [Line Items]
Sales and marketing	$ 16,750	$ 13,942	$ 47,512	$ 40,024
General and administrative	26,299	17,973	78,358	54,242
Research and development	$ 2,577	2,561	$ 8,118	7,973
Previously Reported
Reclassification [Line Items]
Sales and marketing		13,582		38,963
General and administrative		18,507		55,827
Research and development		2,387		7,449
Reclassification
Reclassification [Line Items]
Sales and marketing		360		1,061
General and administrative		(534)		(1,585)
Research and development		$ 174		$ 524

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Narrative (Details) $ / shares in Units, $ in Thousands						9 Months Ended
	Jul. 01, 2024 USD ($)	Jun. 11, 2024	Jan. 05, 2024 USD ($) individual $ / shares shares	Jul. 01, 2023 USD ($) $ / shares shares	May 01, 2023 USD ($) $ / shares shares	Sep. 30, 2024 USD ($) $ / shares shares	Sep. 30, 2023 USD ($)	Dec. 31, 2023 $ / shares
Business Acquisition
Cash paid to acquire						$ 20,225	$ 0
Common stock, par value (in dollars per share) \| $ / shares						$ 0.00025		$ 0.00025
Clinic in virginia and maryland \| Boston O&P acquisition
Business Acquisition
Total consideration transferred	$ 950
Cash consideration	475
Clinic in virginia and maryland \| Promissory Note Maturing December 2025 \| Boston O&P acquisition
Business Acquisition
Notes payable	$ 475
Interest rate (as a percent)	5.00%
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					$ 10,871
Cash consideration					3,000
Asset acquisition					97
Issuance of common stock					2,274
Total compensation					$ 15,274
Business combination, consideration paid In cash (as a percent)					50.00%
Stock based compensation capitalized					$ 4,500
Stock based compensation service period (in years)					4 years
Asset acquisition, contingent consideration cash consideration						$ 1,250
Asset acquisition, contingent consideration (in shares) \| shares						4,288
Asset acquisition, contingent consideration, value						$ 133
Medtech Concepts LLC \| Present Value
Business Acquisition
Total consideration transferred					$ 10,043
Cash consideration					3,000
Asset acquisition					97
Issuance of common stock					2,274
Restricted Stock
Business Acquisition
Vesting period (in years)		3 years
Share-Based Payment Arrangement \| Medtech Concepts LLC
Business Acquisition
Asset acquisition, contingent consideration (in shares) \| shares						38,594
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 (in dollars 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 (in dollars 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 O&P acquisition
Business Acquisition
Cash paid to acquire			$ 21,534
Issuance of common stock			$ 2,500
Boston O&P acquisition \| Restricted Stock
Business Acquisition
Vesting period (in years)			3 years
Business combination, number of individuals received restricted stock awards \| individual			170
Consideration for acquisition (in shares) \| shares			83,000
Share acquisition price (in dollars per share) \| $ / shares			$ 30.12

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Recognized Identified Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Jan. 05, 2024	Sep. 30, 2024	Dec. 31, 2023
Liabilities
Goodwill		$ 91,262	$ 83,699
Boston O&P acquisition
Business Acquisition
Fair value of estimated total acquisition consideration	$ 21,534
Assets
Cash	1,310
Accounts receivable - trade	2,749
Inventories	1,075
Prepaid expenses and other current assets	447
Property and equipment	6,259
Amortizable intangible assets	2,963
Other intangible assets	3,610
Other non-current assets	2,987
Total assets	21,400
Liabilities
Accounts payable-trade	581
Other current liabilities	2,064
Long-term debt, including current portion	1,157
Deferred tax liability	2,557
Other non-current liabilities	1,803
Total liabilities	8,162
Less: total net assets	13,238
Goodwill	$ 8,296

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

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Business Acquisition, Pro Forma Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Net revenue	$ 54,573	$ 46,585	$ 152,491	$ 130,857
Net loss	$ (7,903)	$ (4,475)	$ (21,712)	$ (13,935)

BUSINESS COMBINATIONS AND ASSET ACQUISITIONS - Schedule of Total Consideration Transferred after Discounting 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

GOODWILL AND INTANGIBLE ASSETS - Schedule of Changes in Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Goodwill
Goodwill, beginning balance	$ 83,699
Foreign currency translation impact	(1,360)
Goodwill, ending balance	91,262
Boston O&P acquisition
Goodwill
Acquistions	8,296
Other clinic acquisitions
Goodwill
Acquistions	$ 627

GOODWILL AND INTANGIBLE ASSETS - Schedule of the Balances of Amortizable Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets, Net [Abstract]
Gross Intangible Assets	$ 93,290	$ 91,267
Accumulated Amortization	(27,335)	(21,992)
Net Intangible Assets	$ 65,955	$ 69,275
Patents
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	10 years 6 months	11 years 2 months 12 days
Gross Intangible Assets	$ 44,903	$ 45,646
Accumulated Amortization	(13,147)	(11,008)
Net Intangible Assets	$ 31,756	$ 34,638
Intellectual Property & Capitalized Software
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	8 years 4 months 24 days	9 years 1 month 6 days
Gross Intangible Assets	$ 16,027	$ 16,026
Accumulated Amortization	(3,681)	(2,524)
Net Intangible Assets	$ 12,346	$ 13,502
Customer Relationships & Other
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	11 years 8 months 12 days	12 years 4 months 24 days
Gross Intangible Assets	$ 21,777	$ 18,862
Accumulated Amortization	(4,462)	(3,270)
Net Intangible Assets	$ 17,315	$ 15,592
License Agreements
Finite-Lived Intangible Assets, Net [Abstract]
Weighted-Average Amortization Period	3 years	3 years 9 months 18 days
Gross Intangible Assets	$ 10,583	$ 10,733
Accumulated Amortization	(6,045)	(5,190)
Net Intangible Assets	$ 4,538	$ 5,543

GOODWILL AND INTANGIBLE ASSETS - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Business Acquisition
Other intangible assets	$ 18,744		$ 18,744		$ 15,287
Tradename impairment	0	$ 985	0	$ 985
Trademarks
Business Acquisition
Other intangible assets	$ 18,744		$ 18,744		15,287
Trademarks \| ApiFix Ltd
Business Acquisition
Tradename impairment					$ 985

FAIR VALUE OF FINANCIAL INSTRUMENTS - Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Certificates of Deposit
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments		$ 25,792
Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	$ 25,017	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
Level 1 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	25,017	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		25,792
Level 2 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	0	0
Level 2 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments		0
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
Level 3 \| Exchange Trade Mutual Funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments	$ 0	0
Level 3 \| Treasury Bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments		0
Level 3 \| Other
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis
Short-term investments		$ 0

DEBT AND CREDIT ARRANGEMENTS - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument
Total debt	$ 76,859	$ 11,063
Less: debt discount and issuance costs	3,721	1,003
Less: current maturities	624	152
Long-term debt, net of current maturities	72,514	9,908
Revolving Credit Facility \| Term Loan
Debt Instrument
Total debt	25,500	10,300
Convertible note
Debt Instrument
Total debt	50,000	0
Mortgage payable to affiliate
Debt Instrument
Total debt	649	763
Less: current maturities	158	152
Acquisition note payable \| Acquisition note payable
Debt Instrument
Total debt	$ 710	$ 0

DEBT AND CREDIT ARRANGEMENTS - Braidwell Term Loan And Convertible Note (Details)	Aug. 05, 2024 USD ($) $ / shares	Jun. 13, 2022	Dec. 30, 2021	Sep. 30, 2024 USD ($)
Term Loan Agreement \| Scenario, Plan
Debt Instrument
Long term debt face amount	$ 25,000
Interest rate (as a percent)	6.50%
Payment in kind interest rate per annum (percent)	1.00%
Debt instrument, exit fee (percent)	2.00%
Debt covenant, required cash on hand as a percentage of outstanding debt (percent)	25.00%
Term Loan Agreement \| Period One \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	3.00%
Term Loan Agreement \| Period Two \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	2.00%
Term Loan Agreement \| Period Three \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	1.00%
Term Loan Agreement \| Period Four \| Scenario, Plan
Debt Instrument
Debt instrument early repayment fee (percent)	0.00%
Term Loan Agreement \| Minimum \| Scenario, Plan
Debt Instrument
Debt instrument, basis spread on variable rate (as a percent)	3.25%
Delayed Draw Term Loan Facility \| Scenario, Plan
Debt Instrument
Revolving credit facility	$ 25,000,000
Fourth Amended Loan Agreement \| Revolving Credit Facility
Debt Instrument
Revolving credit facility				$ 50,000,000
Debt instrument, basis spread on variable rate (as a percent)		8.69%	8.61%
Interest rate (as a percent)		10.00%	10.00%
4.75% Convertible Senior Notes \| Scenario, Plan
Debt Instrument
Long term debt face amount	$ 50,000,000
Interest rate (as a percent)	4.75%
Proceeds from the issuance of convertible debt	$ 49,500,000
Debt conversion price (percent)	130.00%
Debt covenant, percentage trigger for conversion, as a percentage of principal (percent)	98.00%
Debt instrument, convertible, conversion ratio	0.0244021
Debt instrument, convertible, conversion price (in dollars per share) \| $ / shares	$ 40.98
Debt covenant, debt conversion trigger as a percentage of conversion price (percent)	140.00%
Threshold cured period	60 days
Debt covenant, default trigger	$ 25,000,000
Debt covenant, percentage of debt in default that would trigger recall (percent)	25.00%
Debt covenant, special interest rate upon debt default (percent)	0.50%
MidCap Credit Agreement \| Revolving Credit Facility
Debt Instrument
Revolving credit facility				80,000,000
Line of credit				$ 10,000,000

DEBT AND CREDIT ARRANGEMENTS - Midcap Term Loan (Details) - USD ($) $ in Thousands				3 Months Ended		9 Months Ended
	Dec. 29, 2023	Jun. 13, 2022	Dec. 30, 2021	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Debt Instrument
Loss on early extinguishment of debt				$ 3,230	$ 0	$ 3,230	$ 0
Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt instrument, maximum distribution per tranche	$ 50,000
Revolving Credit Facility \| Fourth Amended Loan Agreement
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]		Secured Overnight Financing Rate (SOFR) [Member]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)		8.69%	8.61%
Interest rate (as a percent)		10.00%	10.00%
Unused commitment fee percentage (as a percent)	0.50%		0.50%
Revolving Credit Facility \| Term Loan
Debt Instrument
Debt instrument, maximum distribution per tranche	$ 10,000
Debt instrument, debt repayment trigger, as a basis of capital stock ownership (percent)	35.00%
Revolving Credit Facility \| Security and Guaranty Agreement
Debt Instrument
Debt instrument, liquidity requirement				$ 10,000		10,000
Loss on early extinguishment of debt						$ 3,230
Option One \| Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)	6.50%
Interest rate (as a percent)	9.00%
Option Two \| Revolving Credit Facility \| Revolving Loan
Debt Instrument
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	Secured Overnight Financing Rate (SOFR) [Member]
Debt instrument, basis spread on variable rate (as a percent)	4.00%
Applicable debt rate (percent)	6.50%

DEBT AND CREDIT ARRANGEMENTS - Squadron Revolver And Other Debt (Details) - USD ($)				3 Months Ended		9 Months Ended
	Dec. 29, 2023	Jun. 13, 2022	Dec. 30, 2021	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Debt Instrument
Total debt				$ 76,859,000		$ 76,859,000		$ 11,063,000
Current portion of long-term debt with affiliate				624,000		624,000		152,000
Interest expense				$ 945,000	$ 10,000	$ 1,705,000	$ 32,000
Mortgage payable to affiliate
Debt Instrument
Interest rate (as a percent)				5.00%		5.00%
Monthly interest and principal installments						$ 16,000
Total debt				$ 649,000		649,000		763,000
Current portion of long-term debt with affiliate				158,000		158,000		$ 152,000
Revolving Credit Facility \| Fourth Amended Loan Agreement
Debt Instrument
Revolving credit facility				$ 50,000,000		$ 50,000,000
Debt instrument, basis spread on variable rate (as a percent)		8.69%	8.61%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]		Secured Overnight Financing Rate (SOFR) [Member]	Secured Overnight Financing Rate (SOFR) [Member]
Interest rate (as a percent)		10.00%	10.00%
Unused commitment fee percentage (as a percent)	0.50%		0.50%

INCOME TAXES (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
INCOME TAXES (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income tax benefit	$ 1,218	$ (849)	$ 3,767	$ 126
Effective income tax rate (as a percent)			14.80%	0.90%

STOCKHOLDERS' EQUITY - Schedule of Restricted Stock (Details) - shares		9 Months Ended	12 Months Ended
	Jun. 11, 2024	Sep. 30, 2024	Dec. 31, 2023
Restricted Stock
Restricted Stock
Outstanding at period start (in shares)		592,453
Granted (in shares)	345,985	556,109
Forfeited (in shares)		(9,165)
Vested (in shares)		(96,616)
Outstanding at period end (in shares)		1,042,781	592,453
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)		1 year 9 months 18 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)		(200)
Vested (in shares)		0
Outstanding at period end (in shares)		21,551	13,851
Weighted-Average Remaining Contractual Terms (in Years)
Weighted-average remaining contractual terms (in years)		1 year 4 months 24 days	1 year 8 months 12 days

STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	Jun. 11, 2024	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Aug. 02, 2024
Share-based Compensation Arrangement by Share-based Payment Award
Stock-based compensation				$ 9,660	$ 7,779
Term Loan Agreement
Share-based Compensation Arrangement by Share-based Payment Award
Share repurchase program, authorized, amount						$ 5,000
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award
Granted (in shares)	345,985			556,109
Vesting period (in years)	3 years
Unrecognized compensation expense		$ 22,247		$ 22,247
Unrecognized compensation expense, weighted average period of recognition (in years)				1 year 9 months 18 days
Stock-based compensation		$ 3,922	$ 2,368	$ 9,660	$ 7,779

NET LOSS PER SHARE - Reconciliation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net loss	$ (7,919)	$ (6,029)	$ (7,805)	$ (4,591)	$ (2,886)	$ (6,806)	$ (21,753)	$ (14,283)
Weighted average shares outstanding for basic (in shares)	23,171,249			22,762,823			23,046,155	22,646,087
Weighted average shares outstanding for diluted (in shares)	23,171,249			22,762,823			23,046,155	22,646,087
Net loss per share - basic (in dollars per share)	$ (0.34)			$ (0.20)			$ (0.94)	$ (0.63)
Net loss per share - diluted (in dollars per share)	$ (0.34)			$ (0.20)			$ (0.94)	$ (0.63)

BUSINESS SEGMENT - Narrative (Details)	9 Months Ended
BUSINESS SEGMENT - Narrative (Details)	Sep. 30, 2024 segment
Segment Reporting [Abstract]
Number of operating segments	1
Number of reportable segments	1

BUSINESS SEGMENT - Schedule of Product Sales by Geographic Location (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues from External Customers and Long-Lived Assets
Total	$ 54,573	$ 39,972	$ 152,060	$ 111,119
U.S.
Revenues from External Customers and Long-Lived Assets
Total	42,714	29,360	118,269	82,748
International
Revenues from External Customers and Long-Lived Assets
Total	$ 11,859	$ 10,612	$ 33,791	$ 28,371

BUSINESS SEGMENT - Schedule of Product Sales by Category (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Segment Reporting Information
Total	$ 54,573	$ 39,972	$ 152,060	$ 111,119
Trauma and deformity
Segment Reporting Information
Total	37,642	28,806	108,715	79,715
Scoliosis
Segment Reporting Information
Total	15,635	10,304	39,521	28,270
Sports medicine/other
Segment Reporting Information
Total	$ 1,296	$ 862	$ 3,824	$ 3,134

RELATED PARTY TRANSACTIONS (Details) $ in Thousands	3 Months Ended		9 Months Ended
RELATED PARTY TRANSACTIONS (Details) $ in Thousands	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) supplier	Sep. 30, 2023 USD ($)
Structure Medical, LLC \| Supplier
Related Party Transaction
Payments to related party \| $	$ 206	$ 234	$ 729	$ 628
Affiliated Entity
Related Party Transaction
Number of related party suppliers \| supplier			1

EMPLOYEE BENEFIT PLAN (Details)	9 Months Ended
EMPLOYEE BENEFIT PLAN (Details)	Sep. 30, 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%

COMMITMENTS AND CONTINGENCIES (Details) - USD ($) $ in Thousands			1 Months Ended	3 Months Ended		9 Months Ended
	Jul. 20, 2021	Dec. 31, 2019	Jun. 30, 2019	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Long-term Purchase Commitment
Operating lease liability				$ 6,572		$ 6,572
Operating lease, right-of-use asset				$ 6,940		$ 6,940
Operating Lease, Liability, Current, Statement of Financial Position				Other long-term liabilities		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		Assets, Noncurrent, Excluding Property, Plant And Equipment
Purchase obligation, to be paid, year one				$ 1,456		$ 1,456
Cost of revenue				14,513	$ 9,019	$ 39,027	$ 26,580
Minimum
Long-term Purchase Commitment
Royalty agreement percentage (as a percent)						0.50%
Maximum
Long-term Purchase Commitment
Royalty agreement percentage (as a percent)						20.00%
Firefly Technology \| License Agreements
Long-term Purchase Commitment
Finite lived intangible asset useful life extension period (in years)	5 years
Cost of revenue						$ 1,200
Tradename impairment							$ 1,053
Boston O&P
Long-term Purchase Commitment
Operating lease liability				2,828		2,828
Operating lease, right-of-use asset				$ 2,828		$ 2,828
Squadron Capital LLC \| Team Note B \| Affiliated Entity
Long-term Purchase Commitment
Repayments of related party debt		$ 25,000
Vilex and Orthex
Long-term Purchase Commitment
Fair value of estimated total acquisition consideration			$ 60,000

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