DOCUMENT AND ENTITY INFORMATION - shares	9 Months Ended
DOCUMENT AND ENTITY INFORMATION - shares	Sep. 30, 2018	Oct. 30, 2018
Document and Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2018
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	Q3
Trading Symbol	iart
Entity Registrant Name	INTEGRA LIFESCIENCES HOLDINGS CORP
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Common Stock, Shares Outstanding (in shares)		85,179,535

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Statement [Abstract]
Total revenue, net	$ 365,854	$ 278,834	$ 1,089,126	$ 819,634
Costs and expenses:
Cost of goods sold	143,245	101,757	425,032	287,340
Research and development	20,309	15,034	57,742	46,275
Selling, general and administrative	173,355	145,945	513,518	433,457
Intangible asset amortization	5,268	5,456	15,944	14,976
Total costs and expenses	342,177	268,192	1,012,236	782,048
Operating income	23,677	10,642	76,890	37,586
Interest income	75	89	325	160
Interest expense	(14,478)	(6,761)	(50,750)	(18,073)
Other income (expense), net	1,750	(735)	6,422	(3,691)
Income before income taxes	11,024	3,235	32,887	15,982
Income tax (benefit) expense	(2,271)	76	(2,776)	(4,406)
Net income	$ 13,295	$ 3,159	$ 35,663	$ 20,388
Net income per share
Basic (in dollars per share)	$ 0.16	$ 0.04	$ 0.43	$ 0.27
Diluted (in dollars per share)	$ 0.15	$ 0.04	$ 0.43	$ 0.26
Weighted average common shares outstanding (See Note 12):
Basic (in shares)	85,193	78,186	82,058	76,387
Diluted (in shares)	86,299	79,455	83,142	78,973
Comprehensive income (See Note 13)	$ 12,330	$ 13,534	$ 33,731	$ 53,759

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 205,991	$ 174,935
Trade accounts receivable, net of allowances of $3,897 and $8,882	248,738	251,799
Inventories, net	290,846	296,332
Prepaid expenses and other current assets	82,408	99,080
Total current assets	827,983	822,146
Property, plant and equipment, net	287,000	269,251
Intangible assets, net	1,097,259	1,159,627
Goodwill	926,369	937,905
Deferred tax assets, net	7,234	6,250
Other assets	32,797	16,078
Total assets	3,178,642	3,211,257
Current liabilities:
Short-term portion of borrowings under senior credit facility	11,250	60,000
Accounts payable, trade	86,380	93,967
Accrued compensation	71,393	73,392
Short-term portion of contingent consideration	5,000	22,793
Accrued expenses and other current liabilities	84,317	98,759
Total current liabilities	258,340	348,911
Long-term borrowings under senior credit facility	1,421,001	1,781,142
Deferred tax liabilities	72,997	65,130
Other liabilities	61,223	53,768
Total liabilities	1,813,561	2,248,951
Commitments and contingencies
Stockholders’ equity:
Preferred stock; no par value; 15,000 authorized shares; none outstanding	0	0
Common stock; $0.01 par value; 240,000 authorized shares; 88,016 and 81,306 issued at September 30, 2018 and December 31, 2017, respectively	880	813
Additional paid-in capital	1,187,963	821,758
Treasury stock, at cost; 2,883 shares and 2,912 shares at September 30, 2018 and December 31, 2017, respectively	(120,727)	(121,644)
Accumulated other comprehensive loss	(26,271)	(23,807)
Retained earnings	323,236	285,186
Total stockholders’ equity	1,365,081	962,306
Total liabilities and stockholders’ equity	$ 3,178,642	$ 3,211,257

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 3,897	$ 8,882
Preferred stock, authorized shares (in shares)	15,000,000	15,000,000
Preferred stock, outstanding shares (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, authorized shares (in shares)	240,000,000	240,000,000
Common stock, issued shares (in shares)	88,016,000	81,306,000
Treasury stock, shares (in shares)	2,883,000	2,912,000

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
OPERATING ACTIVITIES:
Net income	$ 35,663	$ 20,388
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	83,053	62,281
Non-cash impairment charges	4,941	3,290
Deferred income tax	789	(935)
Amortization of debt issuance costs	4,953	1,178
Realized loss on sale of short-term investment	0	2,287
Loss on disposal of property and equipment	969	443
Change in fair value of contingent consideration and other	1,214	(2,773)
Share-based compensation	15,786	16,359
Changes in assets and liabilities, net of business acquisitions:
Accounts receivable	1,180	(9,861)
Inventories	(3,441)	(862)
Prepaid expenses and other current assets	3,432	(14,691)
Other non-current assets	(1,397)	(1,977)
Accounts payable, accrued expenses and other current liabilities	9,418	24,021
Deferred revenue	(111)	1,405
Other non-current liabilities	546	2,442
Net cash provided by operating activities	156,995	102,995
INVESTING ACTIVITIES:
Purchases of property and equipment	(52,056)	(29,806)
Proceeds from sale of short-term investments	0	16,951
Proceeds from note receivable	679	483
Proceeds from sale of property and equipment	298	157
Cash provided by business acquisitions	26,704
Cash used in business acquisitions		(225,552)
Net cash used in investing activities	(24,375)	(237,767)
FINANCING ACTIVITIES:
Borrowings under senior credit facility	50,000	571,383
Repayments under senior credit facility	(460,000)	(65,000)
Payment of debt issuance costs	(4,388)	0
Proceeds from the issuance of common stock, net of issuance costs	349,590	0
Net cash paid for financing liabilities from business acquisitions	(33,843)	(4,661)
Proceeds from exercised stock options	9,239	9,774
Cash taxes paid in net equity settlement	(7,415)	(6,763)
Net cash (used in) provided by financing activities	(96,817)	504,733
Effect of exchange rate changes on cash and cash equivalents	(4,747)	9,927
Net increase in cash and cash equivalents	31,056	379,888
Cash and cash equivalents at beginning of period	174,935	102,055
Cash and cash equivalents at end of period	$ 205,991	$ 481,943

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'S EQUITY - USD ($) $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income (Loss)	Retained Earnings
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2016		77,666,000
Balance, Beginning of Period at Dec. 31, 2016	$ 839,667	$ 777	$ (123,051)	$ 798,652	$ (57,154)	$ 220,443
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Dec. 31, 2016			(2,946,000)
Net income	6,394					6,394
Other comprehensive income (loss), net of tax	5,701				5,701
Issuance of common stock (in shares)		132,000
Issuance of common stock	1	$ 1
Issuance of common stock through employee stock purchase plan (in shares)		12,000
Issuance of common stock through employee stock purchase plan	509			509
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(161,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(5,470)	$ 1		(5,471)
Share-based compensation	5,688			5,688
Exercise of warrants (in shares)		214,000
Exercise of warrants	1	$ 3		(2)
Balance End of Period, Shares (in shares) at Mar. 31, 2017		78,185,000
Balance, End of Period at Mar. 31, 2017	852,491	$ 782	$ (123,051)	799,376	(51,453)	226,837
Balance, End of Period, Treasury Stock, shares (in shares) at Mar. 31, 2017			(2,946,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2016		77,666,000
Balance, Beginning of Period at Dec. 31, 2016	839,667	$ 777	$ (123,051)	798,652	(57,154)	220,443
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Dec. 31, 2016			(2,946,000)
Net income	20,388
Balance End of Period, Shares (in shares) at Sep. 30, 2017		81,301,000
Balance, End of Period at Sep. 30, 2017	913,116	$ 813	$ (121,816)	817,071	(23,783)	240,831
Balance, End of Period, Treasury Stock, shares (in shares) at Sep. 30, 2017			(2,916,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2016		77,666,000
Balance, Beginning of Period at Dec. 31, 2016	839,667	$ 777	$ (123,051)	798,652	(57,154)	220,443
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Dec. 31, 2016			(2,946,000)
Balance End of Period, Shares (in shares) at Dec. 31, 2017		81,306,000
Balance, End of Period at Dec. 31, 2017	$ 962,306	$ 813	$ (121,644)	821,758	(23,807)	285,186
Balance, End of Period, Treasury Stock, shares (in shares) at Dec. 31, 2017	(2,912,000)		(2,912,000)
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2017		78,185,000
Balance, Beginning of Period at Mar. 31, 2017	$ 852,491	$ 782	$ (123,051)	799,376	(51,453)	226,837
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Mar. 31, 2017			(2,946,000)
Net income	10,835					10,835
Other comprehensive income (loss), net of tax	17,295				17,295
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(498,000)	(25,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	8,238	$ 5	$ 1,037	7,196
Share-based compensation	5,695			5,695
Exercise of warrants (in shares)		1,680,000
Exercise of warrants		$ 17		(17)
Balance End of Period, Shares (in shares) at Jun. 30, 2017		80,363,000
Balance, End of Period at Jun. 30, 2017	894,554	$ 804	$ (122,014)	812,250	(34,158)	237,672
Balance, End of Period, Treasury Stock, shares (in shares) at Jun. 30, 2017			(2,921,000)
Net income	3,159					3,159
Other comprehensive income (loss), net of tax	10,375				10,375
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(8,000)	(5,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(271)	$ 1	$ 198	(470)
Share-based compensation	5,301			5,301
Exercise of warrants (in shares)		946,000
Exercise of warrants	(2)	$ 8		(10)
Balance End of Period, Shares (in shares) at Sep. 30, 2017		81,301,000
Balance, End of Period at Sep. 30, 2017	913,116	$ 813	$ (121,816)	817,071	(23,783)	240,831
Balance, End of Period, Treasury Stock, shares (in shares) at Sep. 30, 2017			(2,916,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2017		81,306,000
Balance, Beginning of Period at Dec. 31, 2017	$ 962,306	$ 813	$ (121,644)	821,758	(23,807)	285,186
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Dec. 31, 2017	(2,912,000)		(2,912,000)
Net income	$ 10,992					10,992
Other comprehensive income (loss), net of tax	21,612				22,144	(532)
Issuance of common stock (in shares)		297,000
Issuance of common stock	3,110	$ 3		3,107
Issuance of common stock through employee stock purchase plan (in shares)		0
Issuance of common stock through employee stock purchase plan	553			553
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(108,000)	(22,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(6,732)	$ 1	$ 910	(7,643)
Share-based compensation	4,745			4,745
Balance End of Period, Shares (in shares) at Mar. 31, 2018		81,711,000
Balance, End of Period at Mar. 31, 2018	998,440	$ 817	$ (120,734)	822,520	(1,663)	297,500
Balance, End of Period, Treasury Stock, shares (in shares) at Mar. 31, 2018			(2,890,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2017		81,306,000
Balance, Beginning of Period at Dec. 31, 2017	$ 962,306	$ 813	$ (121,644)	821,758	(23,807)	285,186
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Dec. 31, 2017	(2,912,000)		(2,912,000)
Net income	$ 35,663
Other comprehensive income (loss), net of tax	(1,932)
Balance End of Period, Shares (in shares) at Sep. 30, 2018		88,016,000
Balance, End of Period at Sep. 30, 2018	$ 1,365,081	$ 880	$ (120,727)	1,187,963	(26,271)	323,236
Balance, End of Period, Treasury Stock, shares (in shares) at Sep. 30, 2018	(2,883,000)		(2,883,000)
Adoption of ASC 606 \| Accounting Standards Update 2014-09	$ 1,854					1,854
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2018		81,711,000
Balance, Beginning of Period at Mar. 31, 2018	998,440	$ 817	$ (120,734)	822,520	(1,663)	297,500
Balance, Beginning of Period, Treasury Stock, shares (in shares) at Mar. 31, 2018			(2,890,000)
Net income	11,376					11,376
Other comprehensive income (loss), net of tax	(22,578)				(23,643)	1,065
Issuance of common stock (in shares)		39,000
Issuance of common stock	65			65
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(16,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(467)		$ 2	(469)
Share-based compensation	5,471			5,471
Equity offering (in shares)		6,038,000
Equity offering	349,598	$ 60		349,538
Balance End of Period, Shares (in shares) at Jun. 30, 2018		87,772,000
Balance, End of Period at Jun. 30, 2018	1,341,905	$ 877	$ (120,732)	1,177,125	(25,306)	309,941
Balance, End of Period, Treasury Stock, shares (in shares) at Jun. 30, 2018			(2,890,000)
Net income	13,295					13,295
Other comprehensive income (loss), net of tax	(965)				(965)
Issuance of common stock (in shares)		261,000
Issuance of common stock	5,502	$ 3		5,499
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		(17,000)	(7,000)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(215)		$ 5	(220)
Share-based compensation	5,559			5,559
Balance End of Period, Shares (in shares) at Sep. 30, 2018		88,016,000
Balance, End of Period at Sep. 30, 2018	$ 1,365,081	$ 880	$ (120,727)	$ 1,187,963	$ (26,271)	$ 323,236
Balance, End of Period, Treasury Stock, shares (in shares) at Sep. 30, 2018	(2,883,000)		(2,883,000)

BASIS OF PRESENTATION	9 Months Ended
BASIS OF PRESENTATION	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BASIS OF PRESENTATION	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the September 30, 2018 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 2017 included in the Company’s Annual Report on Form 10-K. The December 31, 2017 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three- and nine-month periods ended September 30, 2018 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amount of assets and liabilities, the disclosure of contingent liabilities, and the reported amounts of revenues and expenses. Significant estimates affecting amounts reported or disclosed in the consolidated financial statements include allowances for doubtful accounts receivable and sales returns and allowances, net realizable value of inventories, valuation of intangible assets including amortization periods for acquired intangible assets, discount rates and estimated projected cash flows used to value and test impairments of long-lived assets and goodwill, estimates of projected cash flows and depreciation and amortization periods for long-lived assets, computation of taxes, valuation allowances recorded against deferred tax assets, the valuation of stock-based compensation, valuation of derivative instruments, valuation of pension assets and liabilities, valuation of contingent liabilities, the fair value of debt instruments and loss contingencies. These estimates are based on historical experience and on various other assumptions that are believed to be reasonable under the current circumstances. Actual results could differ from these estimates. Equity Offering In May 2018, the Company commenced and closed on a public offering of common stock. The Company issued 6.0 million shares of common stock and received total proceeds, net of underwriting fees and offering expenses, of approximately $349.6 million. The net proceeds from the offering were used to reduce outstanding borrowings under the revolving credit portion of the Company's Senior Credit Facility. Recently Issued Accounting Standards In May 2014, the FASB issued Update No. 2014-09, Revenue from Contracts with Customers (Topic 606). The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve that core principle, an entity should 1) identify the contract(s) with a customer, 2) identify the performance obligations in the contract, 3) determine the transaction price, 4) allocate the transaction price to the performance obligations in the contract, and 5) recognize revenue when (or as) the entity satisfies a performance obligation. This update became effective for all annual periods and interim reporting periods beginning after December 15, 2017. The Company adopted Topic 606 as of January 1, 2018 using the modified retrospective method. See Note 3, Revenues from Contracts with Customers, for further details. In February 2016, the FASB issued Update No. 2016-02, Leases (Topic 842). Under current accounting guidance, an entity is not required to report operating leases on the balance sheet. The amendment requires that lessees recognize virtually all of its leases on the balance sheet by recording a right-of-use asset and lease liability (other than leases that meet the definition of a "short-term lease"). This update will become effective for all annual periods and interim reporting periods beginning after December 15, 2018. The new standard must be adopted using a modified retrospective transition. Early adoption is permitted. While the Company has not yet completed its assessment, the adoption of this guidance could have a material impact on the Company's financial position. In August 2016, the FASB issued Update No. 2016-15, Classification of Certain Cash Receipts and Cash Payments. The guidance addresses the classification of cash flows related to debt repayment or extinguishment costs, settlement of zero-coupon debt instruments or debt instruments with coupon rates that are insignificant in relation to the effective interest rate of the borrowing, contingent consideration payments made after business combinations, proceeds from the settlement of insurance claims and corporate-owned life insurance, distributions received from equity method investees and beneficial interests in securitization transaction. This update became effective for all annual periods and interim reporting periods beginning after December 15, 2017. The Company adopted ASU 2016-15 effective January 1, 2018 on a retrospective basis. The adoption of this guidance had no significant impact on the Company's consolidated financial statements. In October 2016, the FASB issued Update No. 2016-16, Intra-Entity Transfers of Assets Other Than Inventory. The guidance requires that the income tax consequences of intra-entity transfers of assets other than inventory be recognized as a current-period income tax expense or benefit and removes the requirement to defer and amortize the consolidated tax consequences of intra-entity transfers. The new standard became effective for all annual periods beginning after December 15, 2017. The Company adopted ASU 2016-16 effective January 1, 2018, and this guidance had no significant impact on its consolidated financial statements. In March 2017, the FASB issued Update No. 2017-07, Compensation - Retirement Benefits (Topic 715): Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost. The guidance requires that an employer report the service cost component in the same line item or items as other compensation costs arising from services rendered by the pertinent employees during the period. The other components of net benefit cost are required to be presented in the income statement separately from the service cost component and outside a subtotal of income from operations, if one is presented. If a separate line item or items were to be used to present the other components of net benefit cost, that line item or items must be appropriately described. If a separate line item or items is/are not used, the line item or items used in the income statement to present the other components of net benefit cost must be disclosed. In addition, the amendments also allow only the service cost component to be eligible for capitalization when applicable. The new standard became effective for annual periods beginning after December 15, 2017. The Company adopted ASU 2017-07 effective January 1, 2018. The Company recognized the components of net periodic benefit cost other than the service cost component in other (expense) income, net in the consolidated statements of operations. The adoption of this guidance had no significant impact on the Company's consolidated financial statements. In May 2017, the FASB issued ASU 2017-09, Stock Compensation (Topic 718): Scope of Modification Accounting. The update serves to provide clarity and reduce both (1) diversity in practice and (2) cost and complexity when applying the guidance in Topic 718, Compensation-Stock Compensation, to a change to the terms or conditions of a share-based payment award. The new standard became effective for all annual periods beginning after December 15, 2017. The Company adopted ASU 2017-09 effective January 1, 2018, and there was no significant impact of this guidance on its consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. This update amends the hedge accounting rules to simplify the application of hedge accounting guidance and better portray the economic results of risk management activities in the financial statements. The guidance expands the ability to hedge non-financial and financial risk components, reduces complexity in fair value hedges of interest rate risk, eliminates the requirement to separately measure and report hedge ineffectiveness, as well as eases certain hedge effectiveness assessment requirements. This update will become effective for all annual periods and interim reporting periods beginning after December 15, 2018. Early adoption is permitted. The Company elected to early adopt ASU 2017-12 effective January 1, 2017 using the modified retrospective method. The implementation of the amended guidance did not have a significant impact on the Company's consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Reclassification of Certain Tax Effects From Accumulated Other Comprehensive Income. This amendment allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from the 2017 Tax Act (as defined in Note 11, Income Taxes). This guidance is effective for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. The Company elected to early adopt the ASU 2018-02 effective January 1, 2018, which resulted in the reclassification of $0.5 million from accumulated other comprehensive loss to retained earnings related to a net unrealized loss on cash flow hedges. In July 2018, the FASB issued ASU Number 2018-09, Codification Improvements. This update provides clarification, corrects errors in and makes minor improvements to the Codification within various ASC topics. Many of the amendments in this update have transition guidance with effective dates for annual periods beginning after December 15, 2018, and some amendments in this update do not require transition guidance and are effective upon issuance of this update. The Company will adopt amendments as they become applicable and has determined that the impact of these improvements will not be material to its consolidated financial condition and results of operations. In July 2018, the FASB issued ASU Number 2018-11, Leases (Topic 842): Targeted Improvements. This update provides entities with an additional and optional transition method to adopt ASU Number 2016-02 with a cumulative-effect adjustment in the period of adoption. This update also provides guidance for a practical expedient that permits lessors to not separate non-lease components from the associated lease components. Additionally, in July 2018, the FASB issued ASU Number 2018-10, Codification Improvements to Topic 842, Leases. This update provides additional guidance on the new lease model with improvements in numerous aspects of the guidance in ASC 842 including, but not limited to, implicit rates, reassessment of lease classification, terms and purchase options, investment tax credits, and various other transition guidance. These updates will be adopted concurrently with ASU Number 2016-02. While the Company has not yet completed its assessment, the adoption of this guidance could have a material impact on the Company's financial position. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework-Changes to the Disclosure Requirements for Fair Value Measurement. The new guidance modifies the disclosure requirements related to fair value measurements in Topic 820, Fair Value Measurement, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and modifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years. Early adoption is permitted. The Company elected to early adopt ASU 2018-13 on October 1, 2018. The adoption is not expected to have a material impact on the Condensed and Consolidated Financial Statements. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans. The new guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and clarifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption is permitted. The adoption is not expected to have a material impact on the Condensed and Consolidated Financial Statements. There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.

BUSINESS ACQUISITIONS AND DIVESTITURE

9 Months Ended

Sep. 30, 2018

Business Combinations [Abstract]

BUSINESS ACQUISITIONS AND DIVESTITURE

Johnson & Johnson's Codman Neurosurgery Business

On October 2, 2017, upon the terms and subject to the conditions set forth in the asset purchase agreement entered into by the Company with DePuy Synthes, Inc., a Delaware corporation (“DePuy Synthes”), a wholly owned subsidiary of Johnson & Johnson (the "Purchase Agreement"), the Company completed the acquisition of certain assets, and assumed certain liabilities of Johnson & Johnson’s Codman Neurosurgery business (the "Codman Acquisition"). Under the terms of the Purchase Agreement, the Company paid an aggregate purchase price of $1.014 billion, subject to adjustments set forth in the Purchase Agreement relating to the book value of inventory transferred to the Company at the closing of the Codman Acquisition. The book value of certain inventory retained by DePuy Synthes will be transferred to the Company in the future along with certain prepaid taxes.

The Codman Acquisition was accounted for using the acquisition method of business combination under ASC 805, Business Combinations. This method requires that assets acquired and liabilities assumed in a business combination be recognized at their fair values as of the acquisition date. During the third quarter of 2018, the Company completed the purchase accounting for the Codman Acquisition.

The Company recorded revenue for Codman Neurosurgery of approximately $78.9 million and $236.0 million in the condensed consolidated statements of operations and comprehensive income for the three and nine months ended September 30, 2018. The net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it is in the process of being integrated into the Company's operations.

The following table summarizes the final fair values of the assets acquired and liabilities assumed at the acquisition date and reflects measurement period adjustments subsequent to the acquisition date:



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Inventory	$	74,962
Assets held for sale	30,813
Other current assets	8,202
Property, plant and equipment	41,339
Intangible assets:
Codman corporate trade name	162,900		Indefinite
Completed technology	375,200		22 years
Goodwill	342,322
Total assets acquired	1,035,738
Accrued expenses	1,730
Pension liabilities	19,917
Net assets acquired	$	1,014,091

During the first three quarters of 2018, the Company received cash of $26.7 million from Depuy Synthes related to working capital adjustments, which was recorded within investing activities on the consolidated statements of cash flows.

The Company recorded measurement period adjustments to goodwill totaling $4.0 million. During the first half of 2018, the Company adjusted goodwill by $3.2 million because of working capital adjustments of $6.2 million that were offset by inventory adjustments of $3.0 million. During the third quarter 2018, the Company adjusted goodwill by $0.8 million after finalizing the valuation step up of property, plant and equipment of $5.5 million. The adjustment for property, plant and equipment was offset by completed technology intangible asset adjustments of $4.7 million.

During the first three quarters of 2018, the Company paid $15.9 million for inventory that was included in the initial purchase accounting. The payment was included within financing activities on the consolidated statements of cash flows.

The Company recorded $2.8 million and $17.3 million in cost of goods sold related to fair value inventory purchase accounting adjustments for the three and nine months ended September 30, 2018.

Goodwill related to the Codman Acquisition was allocated to the Codman Specialty Surgical segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is generally deductible for income tax purposes.

In the fourth quarter of 2017, the Company wrote-off construction in progress of $6.3 million related to a project acquired as part of the Codman Acquisition that the Company decided to discontinue after the acquisition.

Divestiture to Natus

On September 8, 2017, to facilitate the acquisition of the Codman Neurosurgery Business and to comply with legal requirements, the Company and certain of its subsidiaries entered into an asset purchase agreement (the “Divestiture Agreement”) with Natus Medical Incorporated (“Natus”), pursuant to which the Company agreed to divest its global Camino® Intracranial Pressure monitoring product lines and the U.S. rights to its fixed pressure shunts business within its Codman Specialty Surgical segment together with certain neurosurgery assets acquired as part of the Codman Acquisition, which includes Codman U.S. dural graft implant, external ventricular drainage catheter and cerebrospinal fluid collection systems businesses (the “Divestiture”). The Divestiture Agreement was entered into in connection with the review of the Codman Acquisition by the Federal Trade Commission and the antitrust authority of Spain.

On October 6, 2017, upon the terms and subject to the conditions of the Divestiture Agreement, the Divestiture was completed and Natus paid an aggregate purchase price of $46.4 million.

Assets and liabilities divested consisted of the following as of October 6, 2017 (amounts in thousands):



Inventories	$	8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets divested	$	43,180

Deferred revenue	$	1,082
Accrued compensation	209
Total liabilities divested	$	1,291

The transitional supply agreement with Natus requires the Company to provide to Natus certain assets defined in the transitional supply agreement upon termination. The Company recognized a liability of $1.3 million, included in other liabilities in the consolidated balance sheet, related to estimated cost of assets to be provided to Natus upon termination of the transitional supply agreement.

The Divestiture does not represent a strategic shift that will have a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method. In the fourth quarter of 2017, the Company recognized a pretax gain on sale of business of $2.6 million included in other income, net in its consolidated statement of operations for the year ended December 31, 2017.

Derma Sciences

On February 24, 2017, the Company executed the Agreement and Plan of Merger (the "Merger Agreement") under which the Company acquired all of the outstanding shares of Derma Sciences, Inc., a Delaware corporation ("Derma Sciences") for an aggregate purchase price of approximately $210.8 million, including payment of certain of Derma Sciences' closing expenses and settlement of stock-based compensation plans of $4.8 million and $4.3 million, respectively. The purchase price consisted of a cash payment to the former stockholders of Derma Sciences of approximately $201.7 million upon the closing of the transaction.

Derma Sciences is a tissue regeneration company focused on advanced wound and burn care that offers products to help manage chronic and hard-to-heal wounds, especially those resulting from diabetes and poor vascular functioning.

The revenue and the net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it has been integrated into the Company's operations.

The Derma Sciences acquisition was accounted for using the acquisition method of business combination under ASC 805, Business Combinations. This method requires that assets acquired and liabilities assumed in a business combination be recognized at their fair values as of the acquisition date.

The following table summarizes the final fair values of the assets acquired and liabilities assumed at the acquisition date and reflects purchase accounting adjustments subsequent to the acquisition date:



	Final Valuation
	(Dollars in thousands)
Cash and cash equivalents	$	16,512
Short-term investments	19,238
Accounts receivable	8,949
Inventory	17,977
Prepaid expenses and other current assets	4,369
Property, plant and equipment	4,311
Intangible assets:			Wtd. Avg. Life:
Customer relationship	78,300		14 years
Trademarks/brand names	13,500		15 years
Completed technology	11,600		14 years
Non-compete agreement	280		1 year
Goodwill	73,765
Deferred tax assets	14,524
Other assets	101
Total assets acquired	263,426
Accounts payable	4,560
Accrued expenses and other current liabilities	7,409
Contingent liability	37,174
Other liabilities	3,805
Net assets acquired	$	210,478

Goodwill related to the Derma Sciences acquisition was allocated to the Orthopedics and Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is not deductible for income tax purposes. During the first quarter of 2018, the Company completed its purchase accounting of Derma Sciences.

Short-term Investments

Short-term investments recognized at the acquisition date of Derma Sciences are investments in equity and debt securities including certificates of deposit purchased with an original maturity greater than three months which are deposited in various U.S. financial institutions and are fully insured by the Federal Deposit Insurance Corporation. The Company considers securities with original maturities of greater than 90 days to be available for sale securities. Securities under this classification are recorded at fair value and unrealized gains and losses are recorded within accumulated other comprehensive income. The estimated fair value of the available for sale securities is determined based on quoted market prices. The Company evaluates securities with unrealized losses to determine whether such losses, if any, are other than temporary. Short-term investments are classified as Level 1 in fair value hierarchy. Fair values of short-term investments are determined using the unadjusted quoted prices in active markets for identical assets or liabilities that the Company has the ability to access at the balance sheet date.

In the second quarter of 2017, the Company sold the acquired short-term investments and recognized a loss of $2.3 million included in other income (expense), net in the consolidated statement of operations.

Deferred Taxes

The acquired deferred taxes of $14.5 million include a deferred tax asset of $39.7 million related to a federal net operating loss which the Company expects to utilize against income in future periods and a deferred tax asset of $16.4 million related to intangibles acquired by Derma Sciences in previous periods, offset by a deferred tax liability of $41.1 million for new intangibles for which the Company will not receive a tax benefit and a deferred tax liability of $0.5 million related to various deferred items. In the second quarter of 2017, the Company decreased the preliminary estimated value of this deferred tax liability by $1.5 million to reflect the adjustments to preliminary estimated fair values of assets and liabilities acquired. In the fourth quarter of 2017, the Company decreased the preliminary value of the deferred tax asset by $3.3 million to reflect returns filed for periods prior to the acquisition date and adjustments for expected effective state tax rates.

United States Food and Drug Administration ("FDA") Untitled Letter

On June 22, 2015, the FDA issued an Untitled Letter (the "Untitled Letter") alleging that BioD LLC's ("BioD") morselized amniotic membrane-based products do not meet the criteria for regulation as human cellular tissue-based products (“HCT/Ps”) solely under Section 361 of the Public Health Service Act and that, as a result, BioD would need a biologics license to lawfully market those morselized products. Since the issuance of the Untitled Letter, BioD and more recently, the Company, has been in discussions with the FDA to communicate its disagreement with the FDA’s assertion that certain products do not fall within the HCT/Ps. The FDA has not changed its position that certain of the BioD acquired products are not eligible for marketing solely under Section 361.

In November 2017, the FDA issued its final guidance document related to human tissue titled, “Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use” (the “HCT/P Final Guidance”). The HCT/P Final Guidance maintains the FDA’s position that products such as the Company’s morselized amniotic membrane tissue based products do not meet the criteria for regulation solely as HCT/Ps. In addition, the FDA articulated a risk-based approach to enforcement and, while some uses for amniotic membrane tissue-based products would enjoy as much as thirty-six months of enforcement discretion, other high risk uses could be subject to immediate enforcement action. The Company does not believe the uses for its amniotic membrane tissue based products fall into the high-risk category. Nonetheless, the Company can make no assurances that the FDA will continue to exercise its enforcement discretion with respect to the Company’s amniotic membrane tissue based products, and any potential action of the FDA could have a financial impact regarding the sales of such products. The Company has been considering and continues to consider regulatory approval pathways for its amniotic membrane tissue-based products. Revenues from BioD morselized amniotic material based products for the three and nine months ended September 30, 2018 and 2017 were less than 1.0% of consolidated revenues.

Contingent Consideration

The Company assumed contingent consideration incurred by Derma Sciences related to its acquisitions of BioD and the intellectual property related to the Medihoney product. The Company accounted for the contingent liabilities by recording their fair value on the date of the acquisition based on a discounted cash-flow model. The contingent liabilities recognized as part of the Derma Sciences acquisition relate to the following:


i.	contractual incentive payments that could be made to former equity owners of BioD if net sales of BioD products exceed a certain amount for the twelve-month periods ending June 30, 2017 and 2018 ("BioD Earnout Payments");


ii.	a contractual incentive payment that could be made to the former equity owners if there has been no specific enforcement action or notice by the FDA against the specific BioD products as a result of the Untitled Letter for a certain period after closing as defined by the agreement ("Product Payment"); and


iii.	contractual incentive payments that could be made to the former owner of the intellectual property relating to the Medihoney product line, if net sales of Medihoney products exceed certain amounts defined in the agreement between Derma Sciences and the former owner of the intellectual property of Medihoney for any twelve-month period ("Medihoney Earnout Payments").

At the date of the acquisition, net sales used in estimating the BioD Earnout Payments was based on the weighted average of different possible scenarios using a revenue volatility of 13.5%. The BioD Earnout Payments were valued using a discount rate of 3.0%. The maximum payout related to the BioD Earnout Payments is $26.5 million. The estimated fair value as of February 24, 2017 was $9.1 million. In August 2017, the Company paid $4.8 million for the twelve-month period ending June 30, 2017 component of the BioD Earnout Payments. The Company made no additional payments after the final earn out period. As of December 31, 2017, the estimated fair value of the BioD Earnout Payments was $0.3 million.

At the date of acquisition, the Company estimated that the probability of the Product Payment was 98.0% and valued it at a discount rate of 2.5%. The maximum payout related to the Product Payment is $29.7 million. The estimated fair value as of February 24, 2017 was $26.8 million. In the second quarter of 2017, the Company adjusted the preliminary estimated fair value to increase the Product Payment by $0.9 million related to additional products that should have been included in the preliminary estimate based on the Merger Agreement. On May 25, 2017, the Company made full payment for the Product Payment of $26.6 million. The payment was included in cash used in business acquisition, net of cash acquired within investing activities in the condensed consolidated statements of cash flows since the payment was made shortly after the acquisition.

At the date of the acquisition, the net sales used in estimating the Medihoney Earnout Payments were based on the weighted average of different possible scenarios using revenue volatility of 27.5%. The Medihoney Earnout Payments were valued using a discount rate of 4.5%. The maximum payout related to the Medihoney Earnout Payments is $5.0 million. During the second quarter of 2018, the Company paid $2.0 million for the Medihoney Earnout Payment. The estimated fair value as of September 30, 2018 was $0.2 million. The estimated fair value as of February 24, 2017 and December 31, 2017 was $1.4 million.

These fair value measurements were based on significant inputs not observed in the market and thus represented a Level 3 measurement. The contingent considerations are re-measured to fair value at each reporting date until the contingency is resolved, and those changes in fair value are recognized in earnings. Depending on the expected timing of the estimated payments, the acquisition date fair values and subsequent remeasurement could change.

Pro Forma Results

The following unaudited pro forma financial information summarizes the results of operations for the three and nine months ended September 30, 2017 as if the acquisitions of Codman Neurosurgery and Derma Sciences and the divestiture to Natus, which were completed by the Company during 2017, had been completed as of the beginning of 2016. The pro forma results are based upon certain assumptions and estimates, and they give effect to actual operating results prior to the acquisitions and adjustments to reflect (i) the change in interest expense, depreciation expenses, intangible asset amortization and inventory step-up, (ii) timing of recognition for certain expenses that will not be recurring in a post-acquisition period, which includes $2.9 million incurred by Derma Sciences prior to the acquisition and $2.4 million and $14.4 million incurred by Integra, for the three and nine months ended September 30, 2017, and (iii) income taxes at a rate consistent with the Company’s statutory rate at the date of the acquisitions. No effect has been given to other cost reductions or operating synergies. As a result, these pro forma results do not necessarily represent results that would have occurred if the acquisition had taken place on the basis assumed above, nor are they indicative of the results of future combined operations.



	Three Months Ended September 30,		Nine Months Ended September 30,
	2017		2017
	(In thousands, except per share amounts)
Total revenue	$	352,351	$	1,059,889
Net income	$	1,385	$	24,064
Basic income per share	$	0.02	$	0.32

REVENUES FROM CONTRACTS WITH CUSTOMERS

9 Months Ended

Sep. 30, 2018

Revenue from Contract with Customer [Abstract]

REVENUES FROM CONTRACTS WITH CUSTOMERS

Summary of Accounting Policies on Revenue Recognition

Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services.

Total revenue, net, includes product sales, product royalties and other revenues, such as fees received from services.

For products shipped with FOB shipping point terms, the control of the product passes to the customer at the time of shipment. For shipments in which the control of the product is transferred when the customer receives the product, the Company recognizes revenue upon receipt by the customer. Certain products that the Company produces for private label customers have no alternative use and the Company has a right of payment for performance to date. Revenues from those products are recognized over the period that the Company manufactures these products, which is typically one to three months. The Company uses the input method to measure the manufacturing activities completed to date, which depicts the progress of the Company's performance obligation of transferring control of goods being manufactured for private label customers.

A portion of the Company's product revenue is generated from consigned inventory maintained at hospitals and distributors, and also from inventory physically held by field sales representatives. For these types of products sales, the Company retains control until the product has been used or implanted, at which time revenue is recognized.

Revenues from sale of products and services are evidenced by either a contract with the customer or a valid purchase order and an invoice which includes all relevant terms of sale. For product sales, invoices are generally issued upon the transfer of control (or upon the completion of the manufacturing in the case of the private label transactions recognized over time) and are typically payable 30 days after the invoice date. The Company performs a review of each specific customer's creditworthiness and ability to pay prior to acceptance as a customer. Further, the Company performs periodic reviews of its customers' creditworthiness prospectively.

Performance Obligations

The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers.

Significant Judgments

Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant.

The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract.

The Company's return policy, as set forth in its product catalogs and sales invoices, requires the Company to review and authorize the return of a product in advance. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days.

The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the good or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers.

Contract Asset and Liability

Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet.

Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability.

The following table summarized the changes in the contract asset and liability balances for the nine months ended September 30, 2018:



Contract Asset
Contract asset, January 1, 2018	$	3,552
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(3,552		)
Contract asset, net of transferred to trade receivables on contracts during the period	3,068
Contract asset, September 30, 2018	$	3,068

Contract Liability
Contract liability, January 1, 2018	$	11,059
Recognition of revenue included in beginning of year contract liability	(4,356		)
Contract liability, net of revenue recognized on contracts during the period	4,259
Foreign currency translation	(30		)
Contract liability, September 30, 2018	$	10,932

At September 30, 2018, the short-term portion of the contract liability of $3.6 million and the long-term portion of $7.3 million were included in accrued expenses and other current liabilities and other liabilities in the consolidated balance sheet.

As of September 30, 2018, the Company is expected to recognize revenue of approximately $1.1 million for the remainder of 2018, $2.8 million in 2019, $2.1 million in 2020, $1.3 million in 2021, $0.8 million in 2022, and $2.8 million thereafter.

Shipping and Handling Fees

The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in the cost of goods sold.

Product Warranties

Certain of the Company's medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet.

Taxes Collected from Customers

The Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer.

Disaggregated Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three and nine months ended September 30, 2018 (amounts in thousands):



	Three Months Ended September 30, 2018		Three Months Ended September 30, 2017		Nine Months Ended September 30, 2018		Nine Months Ended September 30, 2017
	(amounts in thousands)
Neurosurgery	$	171,680	95,887		$	509,166	276,574
Precision Tools and Instruments	67,355		$	68,873	205,488		$	204,333
Total Codman Specialty Surgical	239,035		164,760		714,654		480,907

Wound Reconstruction and Care	78,290		69,667		225,003		194,177
Extremity Orthopedics	22,706		22,912		71,244		71,193
Private Label	25,823		21,495		78,225		73,357
Total Orthopedics and Tissue Technologies	126,819		114,074		374,472		338,727
Total revenue	$	365,854	$	278,834	$	1,089,126	$	819,634

See Note 14, Segment and Geographical Information, for details of revenues based on the location of the customer.

Effect of Adoption of ASC Topic 606

On January 1, 2018, the Company adopted Topic 606 using the modified retrospective method applied to all contracts which were not completed as of January 1, 2018. Results of operations for the reporting periods after January 1, 2018 are presented under Topic 606, while prior period amounts are not adjusted and continue to be reported in accordance with Topic 605, Revenue Recognition.

The adoption of Topic 606 resulted in an increase to the opening retained earnings of $1.9 million, which was recorded net of taxes as of January 1, 2018 to reflect the change in timing of the recognition of revenue related to the Company's private label business from point in time to over time during the manufacturing process and goods in transit for which control was transferred to customers at the time of shipment. The total assets and liabilities increased by $7.1 million and $5.2 million, respectively, as of January 1, 2018.

The impact of adoption of Topic 606 to the Company's consolidated statement of operations for the three and nine months ended September 30, 2018 was as follows:



	Three Months Ended September 30, 2018						Nine Months Ended September 30, 2018
	As Reported			Excluding Impact of Topic 606			As Reported			Excluding Impact of Topic 606
	(Amounts in thousands)
Statement of Operations
Total revenue, net	$	365,854		$	368,990		$	1,089,126		$	1,089,153
Cost of goods sold	143,245			143,918			425,032			424,969
Income tax benefit	(2,271		)	(1,092		)	(2,776		)	(2,754		)
Net income	13,295			14,579			35,663			35,731

The adoption of Topic 606 had no significant impact on the Company's consolidated balance sheet as of September 30, 2018.

GOODWILL AND OTHER INTANGIBLE ASSETS

9 Months Ended

Sep. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Changes in the carrying amount of goodwill for the nine-month period ended September 30, 2018 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2017	$	634,767		$	303,138		$	937,905
Codman acquisition measurement period adjustments	(3,964		)	—			(3,964		)
Foreign currency translation	(5,114		)	(2,458		)	(7,572		)
Goodwill at September 30, 2018	$	625,689		$	300,680		$	926,369

The components of the Company’s identifiable intangible assets were as follows:



	September 30, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	855,799	$	(156,157	)	$	699,642
Customer relationships	13 years	232,083		(102,618		)	129,465
Trademarks/brand names	28 years	104,347		(24,903		)	79,444
Codman trade name	Indefinite	162,900		—			162,900
Supplier relationships	27 years	34,721		(16,162		)	18,559
All other	4 years	11,019		(3,770		)	7,249
		$	1,400,869	$	(303,610	)	$	1,097,259



	December 31, 2017
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	869,174	$	(124,096	)	$	745,078
Customer relationships	13 years	233,430		(91,961		)	141,469
Trademarks/brand names	28 years	104,879		(22,293		)	82,586
Codman trade name	Indefinite	162,900		—			162,900
Supplier relationships	27 years	34,721		(15,092		)	19,629
All other	4 years	11,511		(3,546		)	7,965
		$	1,416,615	$	(256,988	)	$	1,159,627

Goodwill and Intangible Assets with Indefinite Lives

The Company tests goodwill and intangible assets with indefinite lives for impairment annually in the third quarter in accordance with ASC Topic 350. Additionally, the Company may perform interim tests if an event occurs or circumstances change that could potentially reduce the fair value of a reporting unit or indefinite lived intangible asset below its carrying amount. The carrying value of each reporting unit is determined by assigning the assets and liabilities, including the existing goodwill and intangible assets, to those reporting units.

The Company tests goodwill for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass this qualitative assessment for some or all of its reporting units and perform a quantitative test.

For goodwill, the Company elected to bypass the qualitative assessment for its three reporting units and perform a quantitative test during the third quarter of 2018. In performing this test, the Company utilized a discount rate of 9.0%. The assumptions used in evaluating goodwill for impairment are subject to change and are tracked against historical results by management. Based on the results of this quantitative test, the Company recorded no impairment of goodwill.

For intangible assets with indefinite lives, the Company elected to bypass the qualitative assessment for its Codman Tradename intangible asset and perform a quantitative test during the third quarter 2018. In performing this test, the Company utilized a discount rate of 13.0%. The assumptions used in evaluating the Codman Tradename for impairment are subject to change and are tracked against historical results by management. Based on the results of the quantitative test, the Company recorded no impairment to the Codman Tradename intangible asset.

Definite Lived Intangible Assets

Product rights and other definite-lived intangible assets are tested periodically for impairment in accordance with ASC Topic 360 when events or changes in circumstances indicate that an asset’s carrying value may not be recoverable. The impairment testing involves comparing the carrying amount of the asset or asset group to the forecasted undiscounted future cash flows. In the event the carrying value of the asset exceeds the undiscounted future cash flows, the carrying value is considered not recoverable and an impairment exists. An impairment loss is measured as the excess of the asset’s carrying value over its fair value, calculated using discounted future cash flows. The computed impairment loss is recognized in the period that the impairment occurs.

During the third quarter of 2018, the Company recorded an impairment charge of $4.9 million in cost of goods sold related to completed technology assets acquired from Koby Ventures II, L.P dba Metasurg ("Metasurg Technology") due to recent contract negotiations and revised future projections. The remaining net book value of these intangible assets total $2.3 million as of September 30, 2018. Metasurg Technology is included in the Orthopedic and Tissue Technology segment. Of the total impairment charge of $4.9 million, $2.5 million was related to an out-of-period adjustment included in the three and nine months ended September 30, 2018. The out-of-period adjustment is attributed to the timing of performing the impairment test based on the contract termination associated with the intangible asset. The Company determined that the adjustment was not material to the consolidated financial statements for any previously reported annual or interim period and the adjustment to correct the misstatements is not material to the three or nine months ended September 30, 2018.

During the third quarter of 2017, the Company recorded an impairment charge of $3.3 million in cost of goods sold related to completed technology assets acquired from Tarsus Medical, Inc. ("Tarsus Technology"), since the underlying product will no longer be sold. Tarsus Technology was included in the Orthopedic and Tissue Technology segment.

Based on quarter-end exchange rates, annual amortization expense (including amounts reported in cost of product revenues, but excluding any possible future amortization associated with acquired IPR&D) is expected to be approximately $71.6 million in 2018, $66.4 million in 2019, $66.2 million in 2020, $65.2 million in 2021, $61.7 million in 2022, $60.8 million in 2023 and $599.3 million thereafter. Identifiable intangible assets are initially recorded at fair market value at the time of acquisition using an income or cost approach.

DEBT

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

DEBT

Amended and Restated Senior Credit Agreement

On May 3, 2018, the Company entered into the fifth amendment and restatement (the "May 2018 Amendment") of its Senior Credit Facility (the "Senior Credit Facility") with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The May 2018 Amendment extended the maturity date to May 3, 2023 and decreased the applicable rate, as described below. The Company continues to have the aggregate principal amount of $2.2 billion available to it through the following facilities:


i.	a $900.0 million Term Loan facility; and


ii.	a $1.3 billion revolving credit facility, which includes a $60.0 million sublimit for the issuance of standby letters of credit and a $60.0 million sublimit for swingline loans.

In connection with the May 2018 Amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) was modified to the following:



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of May 2018 Amendment through March 31, 2019		5.50 : 1.00
June 30, 2019 through March 31, 2020		5.00 : 1.00
June 30, 2020 through March 31, 2021		4.50 : 1.00
June 30, 2021 and thereafter		4.00 : 1.00.

Borrowings under the Senior Credit Facility bear interest, at the Company’s option, at a rate equal to the following:


i.	the Eurodollar Rate (as defined in the Senior Credit Facility) in effect from time to time plus the applicable rate (ranging from 1.00% to 1.75%), or


ii.	the highest of:


1.	the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50%, plus the applicable rate (ranging from 0% to 0.75%),


2.	the prime lending rate of Bank of America, N.A. plus the applicable rate (ranging from 0% to 0.75%), and


3.	the one-month Eurodollar Rate plus 1.00% plus the applicable rate (ranging from 0% to 0.75%).

The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA at the time of the applicable borrowing).

The Company will pay an annual commitment fee ranging from 0.15% to 0.30%, based on the Company's consolidated total leverage ratio, on the amount available for borrowing under the revolving credit facility.

The Senior Credit Facility is collateralized by substantially all of the assets of the Company’s U.S. subsidiaries, excluding intangible assets. The Senior Credit Facility is subject to various financial and negative covenants and at September 30, 2018, the Company was in compliance with all such covenants. The Company capitalized $0.5 million of incremental financing costs in 2017 in connection with modifications to the Senior Credit Facility. In connection with the May 2018 Amendment, the Company capitalized $4.2 million of financing costs and wrote off $0.8 million of previously capitalized financing costs during the second quarter of 2018.

In October 2017, the Company capitalized $19.1 million of incremental financing costs related to the drawing of the Term Loan A-1 component of the Senior Credit Facility.

At September 30, 2018 and December 31, 2017, there were $545.0 million and $655.0 million outstanding, respectively, under the revolving credit component of the Senior Credit Facility at weighted average interest rates of 3.8% and 3.7%, respectively. At September 30, 2018 and December 31, 2017, there were $900.0 million and $1.2 billion outstanding, respectively, under the Term Loan component of the Senior Credit Facility at weighted average interest rates of 3.7% and 3.6%, respectively. At September 30, 2018, there was approximately $754.4 million available for borrowing under the Senior Credit Facility. At September 30, 2018, $11.3 million of the Term Loan component of the Senior Credit Facility is classified as current on the consolidated balance sheet.

The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at September 30, 2018 was approximately $524.1 million and, $875.4 million, respectively. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly, and are other than active market observable inputs that reflect unadjusted quoted prices for identical assets or liabilities.

Letters of credit outstanding as of September 30, 2018 and December 31, 2017 totaled $0.6 million. There were no amounts drawn as of September 30, 2018.

Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows:



Year Ended December 31,	Principal Repayment
	(In thousands)
Remainder of 2018	$	—
2019	22,500
2020	45,000
2021	56,250
2022	67,500
2023	708,750
	$	900,000

The outstanding balance of the revolving credit component of the Senior Credit Facility is due on May 3, 2023.

DERIVATIVE INSTRUMENTS

9 Months Ended

Sep. 30, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

DERIVATIVE INSTRUMENTS

Interest Rate Hedging

The Company’s interest rate risk relates to U.S. dollar denominated variable interest rate borrowings. The Company uses interest rate swap derivative instruments to manage earnings and cash flow exposure resulting from changes in interest rates. These interest rate swaps apply a fixed interest rate on a portion of our expected LIBOR-indexed floating-rate borrowings. The Company held the following interest rate swaps as of September 30, 2018 (amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Floating Rate	Estimated Fair Value
									Assets (Liabilities)
3-month USD LIBOR Loan	$	50,000	June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	3-month USD LIBOR	$	588
3-month USD LIBOR Loan	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	3-month USD LIBOR	924
1-month USD LIBOR Loan	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	1-month USD LIBOR	637
3-month USD LIBOR Loan	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	3-month USD LIBOR	590
1-month USD LIBOR Loan	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	1-month USD LIBOR	1,950
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	1-month USD LIBOR	2,342
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1-month USD LIBOR	4,322
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1-month USD LIBOR	4,277
1-month USD LIBOR Loan	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1-month USD LIBOR	2,786
1-month USD LIBOR Loan	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1-month USD LIBOR	1,339
1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	1-month USD LIBOR	7,174
Total interest rate derivatives designated as cash flow hedge	$	1,050,000							$	26,929

The Company has designated these derivative instruments as cash flow hedges. The Company assesses the effectiveness of these derivative instruments and has recorded the changes in the fair value of the derivative instrument designated as a cash flow hedge as unrealized gains or losses in accumulated other comprehensive income (“AOCI”), net of tax, until the hedged item affected earnings, at which point any gain or loss was reclassified to earnings. If the hedged cash flow does not occur, or if it becomes probable that it will not occur, the Company will reclassify the remaining amount of any gain or loss on the related cash flow hedge recorded in AOCI to interest expense at that time. On October 10, 2018, the Company entered into additional interest rate swap derivative instruments designated as cash flow hedges with a total notional amount of $225.0 million.

Foreign Currency Hedging

From time to time the Company enters into foreign currency hedge contracts intended to protect the U.S. dollar value of certain forecasted foreign currency denominated transactions. The Company assesses the effectiveness of the contracts that are designated as hedging instruments. The changes in fair value of foreign currency cash flow hedges are recorded in AOCI, net of tax, until the hedged item affects earnings. Once the related hedged item affects earnings, the Company reclassifies amounts recorded in AOCI to earnings. If the hedged forecasted transaction does not occur, or if it becomes probable that it will not occur, the Company will reclassify the amount of any gain or loss on the related cash flow hedge to earnings at that time. For contracts not designated as hedging instruments, the changes in fair value of the contracts are recognized in other income (expense), net in the consolidated statements of operation, along with the offsetting foreign currency gain or loss on the underlying assets or liabilities.

The success of the Company’s hedging program depends, in part, on forecasts of certain activity denominated in foreign currency. The Company may experience unanticipated currency exchange gains or losses to the extent that there are differences between forecasted and actual activities during periods of currency volatility. In addition, changes in currency exchange rates related to any unhedged transactions may affect earnings and cash flows.

On November 28, 2017, the Company entered into a foreign currency forward contract, with a notional amount of $8.9 million, to mitigate the foreign currency exchange risk related to a certain intercompany loan denominated in Swiss Francs ("CHF"). The contract is not designated as a hedging instrument. For the three and nine months ended September 30, 2018, the Company recognized a $0.2 million loss from the change in fair value of the contract, which was included in other income (expense), net in the consolidated statement of operations. The foreign currency forward contract was settled on September 28, 2018.

Cross-Currency Rate Swap

On October 2, 2017, the Company entered into cross-currency swap agreements to convert a notional amount of $300.0 million equivalent to 291.2 million of CHF denominated intercompany loans into U.S. dollars. The CHF-denominated intercompany loans were the result of the purchase of intellectual property by a subsidiary in Switzerland as part of the Codman Acquisition. The objective of these cross-currency swaps is to reduce volatility of earnings and cash flows associated with changes in the foreign currency exchange rate. Under the terms of these contracts, which have been designated as cash flow hedges, the Company will make interest payments in Swiss Francs and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in Swiss Francs and receive U.S. dollars from the counterparties.

The Company held the following cross-currency rate swaps as of September 30, 2018 (dollar amounts in thousands):



	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Liability

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(1,286	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(1,286	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(1,110		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(1,110		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(4,467		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(4,467		)

Total						$	(6,863	)

The cross-currency swaps were carried on the consolidated balance sheet at fair value, and changes in the fair values were recorded as unrealized gains or losses in AOCI. For the three and nine months ended September 30, 2018, the Company recorded a loss of $2.6 million and gain of $2.2 million in other income (expense), net for the foreign currency rate translation to offset the gains or losses recognized on the intercompany loans. For the three and nine months ended September 30, 2018, the Company recorded losses of $3.1 million and gains of $3.0 million in AOCI related to the change in fair value of the cross-currency swap and gains of $1.9 million and $5.9 million in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swap. As of September 30, 2018, an estimated gain of $7.6 million is expected to be reclassified within the next twelve months to other income, net from AOCI. As of September 30, 2018, the Company does not expect any gains or losses will be reclassified into earnings as a result of the discontinuance of these cash flow hedges because the original forecasted transaction will not occur.

Counterparty Credit Risk

The Company manages its concentration of counterparty credit risk on its derivative instruments by limiting acceptable counterparties to a group of major financial institutions with investment grade credit ratings, and by actively monitoring their credit ratings and outstanding positions on an ongoing basis. Therefore, the Company considers the credit risk of the counterparties to be low. Furthermore, none of the Company’s derivative transactions is subject to collateral or other security arrangements, and none contain provisions that depend upon the Company’s credit ratings from any credit rating agency.

Fair Value of Derivative Instruments

The Company has classified all of its derivative instruments within Level 2 of the fair value hierarchy because observable inputs are available for substantially the full terms of the derivative instruments. The fair value of the interest rate swaps and the cross-currency swaps was developed using a market approach based on publicly available market yield curves and the terms of the related swap. The Company performs ongoing assessments of counterparty credit risk.

The following table summarizes the fair value and presentation for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of September 30, 2018 and December 31, 2017:



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2018		December 31, 2017
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Interest rate swap⁽²⁾	$	6,682	$	1,521
Cross-currency swap	7,603		7,757
Other assets
Interest rate swap⁽²⁾	20,246		2,491
Total derivatives designated as hedges — Assets	$	34,531	$	11,769

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Interest rate swap⁽²⁾	$	—	$	1,845
Other liabilities
Interest rate swap⁽²⁾	—		1,575
Cross-currency swap	14,466		11,714
Total derivatives designated as hedges — Liabilities	$	14,466	$	15,134


⁽¹⁾	The Company classifies derivative assets and liabilities as non-current based on the cash flows expected to be incurred within the following 12 months.


⁽²⁾	At September 30, 2018 and December 31, 2017, the notional amount related to the Company’s interest rate swaps was $1.05 billion. The notional amount will be reduced by $150.0 million in June 2019.

The following presents the effect of derivative instruments designated as cash flow hedges on the accompanying condensed consolidated statement of operations during the three and nine months ended September 30, 2018 and 2017:



	Balance in AOCI Beginning of Quarter			Amount of Gain (Loss) Recognized in AOCI			Amount of Gain (Loss) Reclassified from AOCI into Earnings			Balance in AOCI End of Quarter			Location in Statements of Operations
	(In thousands)
Three Months Ended September 30, 2018
Interest rate swap	$	22,344		$	5,059		$	473		$	26,930		Interest (expense)
Cross-currency swap	(7,892		)	(3,067		)	(707		)	(10,252		)	Other income (expense)
	$	14,452		$	1,992		$	(234	)	$	16,678
Three Months Ended September 30, 2017
Interest rate swap	$	935		$	297		$	(63	)	$	1,295		Interest (expense)
	$	935		$	297		$	(63	)	$	1,295
	Balance in AOCI Beginning of Year			Amount of Gain (Loss) Recognized in AOCI- Effective Portion			Amount of Gain (Loss) Reclassified from AOCI into Earnings-Effective Portion			Balance in AOCI End of Quarter			Location in Statements of Operations
	(In thousands)
Nine Months Ended September 30, 2018
Interest rate swap	$	592		$	26,307		$	(31	)	$	26,930		Interest (expense)
Cross-currency swap	(5,104		)	3,000			8,148			(10,252		)	Other income (expense)
	$	(4,512	)	$	29,307		$	8,117		$	16,678
Nine Months Ended September 30, 2017
Interest rate swap	$	1,871		$	(618	)	$	(42	)	$	1,295		Interest (expense)
	$	1,871		$	(618	)	$	(42	)	$	1,295

At September 30, 2018, the Company expects $14.3 million of pre-tax income recorded in AOCI related to cash flow hedges to be reclassified to earnings in the next twelve months.

Net Investment Hedges

The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk in its international operations from foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business. On October 1, 2018, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries. On the consummation date, the total notional amount of cross-currency swaps designated as net investment hedges was $354.5 million.

STOCK-BASED COMPENSATION	9 Months Ended
STOCK-BASED COMPENSATION	Sep. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of September 30, 2018, the Company had stock options, restricted stock awards, performance stock units, contract stock awards and restricted stock unit awards outstanding under two plans, the 2001 Equity Incentive Plan (the “2001 Plan”) and the 2003 Equity Incentive Plan (the “2003 Plan,” and collectively, the “Plans”). Stock options issued under the Plans become exercisable over specified periods, generally within three to four years from the date of grant for officers and employees, and within a year from date of grant for directors and generally expire eight years from the grant date for employees, and from eight to ten years for directors and certain executive officers. Restricted stock issued under the Plans vests over specified periods, generally three years after the date of grant. The vesting of performance stock issued under the Plans is subject to service and performance conditions. Stock Options As of September 30, 2018, there were approximately $4.8 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately two years. There were 139,938 stock options granted during the nine months ended September 30, 2018. Awards of Restricted Stock and Performance Stock Performance stock and restricted stock awards generally have requisite service periods of three years. Performance stock units are subject to graded vesting conditions, and the Company expenses their fair value over the requisite service period. The Company expenses the fair value of restricted stock awards on a straight-line basis over the requisite service period. As of September 30, 2018, there were approximately $24.3 million of total unrecognized compensation costs related to these unvested awards. The Company expects to recognize these costs over a weighted-average period of approximately two years. The Company granted 266,354 restricted stock awards and 119,459 performance stock during the nine months ended September 30, 2018. The Company has no formal policy related to the repurchase of stock for the purpose of satisfying stock-based compensation obligations. The Company also maintains an Employee Stock Purchase Plan (the “ESPP”), which provides eligible employees with the opportunity to acquire shares of common stock at periodic intervals by means of accumulated payroll deductions. The ESPP is a non-compensatory plan based on its terms.

DEFINED BENEFIT PLANS	9 Months Ended
DEFINED BENEFIT PLANS	Sep. 30, 2018
Retirement Benefits [Abstract]
DEFINED BENEFIT PLANS	DEFINED BENEFIT PLANS The Company maintains defined benefit pension plans that cover certain employees in Austria, France, Japan, Germany and Switzerland. Net periodic benefit costs for the Company’s defined benefit pension plans for the three and nine months ended September 30, 2018 were $0.5 million and $1.7 million, respectively. The components of the net periodic benefit costs other than the service cost component of $0.7 million and $2.1 million for the three and nine months ended September 30, 2018, respectively, are included in other income (expense), net in the consolidated statements of operations. The Company previously disclosed in its consolidated financial statements for the year ended December 31, 2017 that it expected to contribute $1.8 million to its defined benefit pension plans in 2018. For the nine months ended September 30, 2018, the Company contributed $1.1 million, to the defined benefit plans. As of September 30, 2018, the Company anticipates contributing an additional $0.9 million to its defined benefit plans in 2018, for a total of $2.0 million. The estimated fair values of plan assets were $30.4 million and $26.9 million as of September 30, 2018 and December 31, 2017, respectively. The net plan assets of the pension plans are invested in common trusts as of September 30, 2018 and December 31, 2017. Common trusts are classified as Level 2 in the fair value hierarchy. The fair value of common trusts is valued at the net asset value based on the fair values of the underlying investments of the trusts as determined by the sponsor of the trusts. The investment strategy of the Company's defined benefit plans is both to meet the liabilities of the plans as they fall due and to maximize the return on invested assets within an appropriate risk profile.

TREASURY STOCK	9 Months Ended
TREASURY STOCK	Sep. 30, 2018
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
TREASURY STOCK	TREASURY STOCK On October 25, 2016, the Board of Directors terminated its October 2014 authorization for the repurchase of its outstanding common stock and authorized management to repurchase up to $150.0 million of its outstanding common stock through December 31, 2018. Shares may be repurchased either in the open market or in privately negotiated transactions. As of September 30, 2018, there remained $150.0 million available for repurchase under this authorization. As of September 30, 2018 and December 31, 2017, there were 2.9 million shares of treasury stock outstanding with a cost of $120.7 million and $121.6 million, respectively, at a weighted average of $41.87 per share. There were no cash treasury stock repurchases during the nine months ended September 30, 2018 or in 2017.

INCOME TAXES

9 Months Ended

Sep. 30, 2018

Income Tax Disclosure [Abstract]

INCOME TAXES

The following table provides a summary of the Company's effective tax rate:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
Reported tax rate	(20.6	)%	2.3	%	(8.4	)%	(27.6	)%

The Company’s effective income tax rates for the three months ended September 30, 2018 and 2017 were (20.6)% and 2.3%, respectively. For the three months ended September 30, 2018, in addition to the reduction of the federal statutory rate from 35% to 21% under the Tax Cuts and Jobs Act, the primary drivers of the reduction in the rate are the additional excess tax benefit of $2.1 million from share-based compensation and $1.1 million of foreign tax credits, partially offset by the inclusion of the new GILTI (as defined below) provisions of $0.8 million and other tax reform-related changes.

The Company's effective income tax rates for the nine months ended September 30, 2018 and 2017 were (8.4)% and (27.6)%, respectively. For the nine months ended September 30, 2018, the primary drivers of the higher tax rate were higher income before income taxes compared to the same period in 2017, and the inclusion of the new GILTI (as defined below) provisions of $2.2 million and other tax reform-related changes; offset in part, by the reduction in the federal statutory rate from 35% to 21% and additional foreign tax credits of $1.1 million. The nine months ended September 30, 2017 included an additional tax benefit of $1.9 million related to share-based compensation, when compared to the same period in 2018.

The Tax Cuts and Jobs Act (the "2017 Tax Act"), enacted in December 2017, made significant changes to the previous tax laws. Included among the numerous changes were a reduction of the federal statutory rate from 35% to 21%, limitations on the deductibility of interest expense and executive compensation, and the elimination of certain domestic tax deductions such as the domestic production activities deduction. Additionally, the 2017 Tax Act provided for a one-time repatriation tax on accumulated foreign subsidiaries’ untaxed foreign earnings (the “Toll Tax”).

The 2017 Tax Act implemented a territorial tax system and includes base erosion provisions on non-U.S. earnings, which subjects certain foreign earnings to additional taxation as global intangible low-taxed income (“GILTI”). These provisions became effective on January 1, 2018. As of September 30, 2018, the Company included GILTI related to current-year operations in its estimated annual effective tax rate. Pursuant to SAB 118, the Company has not yet determined whether GILTI should be a deferred tax item.

The 2017 Tax Act eliminated the deferral of U.S. income tax on unrepatriated earnings from foreign subsidiaries through the imposition of the Toll Tax, a one-time tax in 2017 on deemed repatriated foreign earnings, which is paid over an eight-year period. The tax is assessed on the foreign subsidiary accumulated foreign earnings that were not previously taxed. Foreign earnings in cash and cash equivalents are taxed at 15.5% and all other earnings are taxed at 8.0%. The calculation of the Toll Tax allows for the ability to offset positive foreign earnings with existing foreign deficits and use of foreign tax credits. The Company prepared a reasonable estimate of this tax and expects to continue to refine the estimate as it finalizes its 2017 tax returns. During 2017, the Company recorded an estimated income tax expense of $5.5 million related to the Toll Tax, of which, $4.6 million is expected to be paid within one year. The Company continued to analyze its foreign earnings and profits (“E&P”) during the nine months ended September 30, 2018 and has not made any adjustments to the provisional amounts recognized during 2017. The Company will continue to refine its E&P analysis, which may affect the measurement of the Toll Tax liability.

As a result of the 2017 Tax Act’s reduction of the federal statutory rate from 35% to 21%, the Company remeasured deferred tax assets and liability and recorded a tax benefit of $43.4 million as of December 31, 2017. The Company did not record any adjustments to this provisional amount during the nine months ended September 30, 2018 and will continue to analyze and refine its calculations related to the remeasurement as the impact of the 2017 Tax Act is finalized.

On December 22, 2017, the SEC staff issued Staff Accounting Bulletin No. 118 to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the 2017 Tax Act. The Company made reasonable estimates of the impact of the 2017 Tax Act on its consolidated financial statements as of December 31, 2017 and recognized the provisional tax impacts related to the deemed repatriated earnings and the revaluation of deferred tax assets and liabilities and included these amounts in its consolidated financial statements for the twelve months ended December 31, 2017. The ultimate impact may differ from these provisional amounts, possibly materially, due to, among other things, additional analysis, changes in interpretations and assumptions the Company has made, additional regulatory guidance that may be issued, and actions the Company may take as a result of the 2017 Tax Act.

NET INCOME PER SHARE

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

NET INCOME PER SHARE

Basic and diluted net income per share was as follows:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
	(In thousands, except per share amounts)
Basic net income per share:
Net income	$	13,295	$	3,159	$	35,663	$	20,388
Weighted average common shares outstanding	85,193		78,186		82,058		76,387
Basic net income per common share	$	0.16	$	0.04	$	0.43	$	0.27

Diluted net income per share:
Net income	$	13,295	$	3,159	$	35,663	$	20,388

Weighted average common shares outstanding — Basic	85,193		78,186		82,058		76,387
Effect of dilutive securities:
Warrants	—		158		—		1,295
Stock options and restricted stock	1,106		1,111		1,084		1,291
Weighted average common shares for diluted earnings per share	86,299		79,455		83,142		78,973

Diluted net income per common share	$	0.15	$	0.04	$	0.43	$	0.26

Shares of common stock of approximately 0.2 million and 0.3 million at September 30, 2018 and 2017, respectively, that are issuable through the exercise of dilutive securities were not included in the computation of diluted net income per share because their effect would have been antidilutive.

In connection with the issuance of the 1.625% Convertible Senior Notes due in 2016, which the Company extinguished on December 15, 2016, the Company entered into call transactions and warrant transactions with the affiliates of the initial purchasers of such notes. The warrants expired on a series of expiration dates from March 2017 to August 2017. For the year ended December 31, 2017, the hedge participants exercised 8,707,202 warrants. As a result, the Company issued 2,839,743 shares of common stock for the year ended December 31, 2017. The company has no outstanding warrants as of September 30, 2018.

For the three and nine months ended September 30, 2017, the potential excess conversion value on warrants was included in the Company's dilutive share calculation because the average stock price for the three and nine months ended September 30, 2017 exceeded the conversion price.

Vested restricted and performance units that entitle the holders to approximately 0.5 million shares of common stock are included in the basic and diluted weighted average shares outstanding calculation because no further consideration is due related to the issuance of the underlying common shares.

COMPREHENSIVE INCOME

9 Months Ended

Sep. 30, 2018

Equity [Abstract]

COMPREHENSIVE INCOME

Comprehensive income was as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2018			2017			2018			2017
	(In thousands)
Net income	$	13,295		$	3,159		$	35,663		$	20,388
Foreign currency translation adjustment	(2,353		)	10,175			(16,359		)	33,724
Change in unrealized gain (loss) on derivatives, net of tax	1,386			207			14,419			(331		)
Pension liability adjustment, net of tax	2			(7		)	8			(22		)
Comprehensive income, net	$	12,330		$	13,534		$	33,731		$	53,759

Changes in Accumulated Other Comprehensive Income by component between December 31, 2017 and September 30, 2018 are presented in the table below, net of tax:



	Cash Flow Hedges			Defined Benefit Pension Items			Foreign Currency Items			Total
	(In thousands)
Balance at December 31, 2017	$	(2,979	)	$	(93	)	$	(20,735	)	$	(23,807	)
Reclassification of stranded tax effect	(532		)	—			—			(532		)
Balance at January 1, 2018	(3,511		)	(93		)	(20,735		)	(24,339		)
Other comprehensive income (loss)	20,661			8			(16,359		)	4,310
Amounts reclassified from accumulated other comprehensive income	6,242			—			—			6,242
Net current-period other comprehensive income (loss)	14,419			8			(16,359		)	(1,932		)
Balance at September 30, 2018	$	10,908		$	(85	)	$	(37,094	)	$	(26,271	)

For the nine months ended September 30, 2018, the Company reclassified a $6.2 million gain from AOCI to other income (expenses), net, respectively.

SEGMENT AND GEOGRAPHIC INFORMATION

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

SEGMENT AND GEOGRAPHIC INFORMATION

In October 2017, the Company leveraged the globally recognized Codman name by rebranding the Specialty Surgical Solutions segment as Codman Specialty Surgical.

The Company internally manages two global reportable segments and reports the results of its businesses to its chief operating decision maker. The two reportable segments and their activities are described below.

•

The Codman Specialty Surgical segment includes (i) the Neurosurgery business, which sells a full line of products for neurosurgery and neuro critical care such as tissue ablation equipment, dural repair products, cerebral spinal fluid management devices, intracranial monitoring equipment, and cranial stabilization equipment and (ii) the precision tools and instruments business, which sells more than 60,000 instrument patterns and surgical and lighting products to hospitals, surgery centers, dental, podiatry, and veterinary offices.


•	The Orthopedics and Tissue Technologies segment includes such offerings as skin and wound repair, bone and joint fixation implants in the upper and lower extremities, bone grafts and nerve and tendon repair products.

The Corporate and other category includes (i) various executive, finance, human resource, information systems and legal functions, (ii) brand management, and (iii) share-based compensation costs.

The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions, and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by reportable segment for the three and nine months ended September 30, 2018 and 2017 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2018			2017			2018		2017
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	239,035		$	164,760		$	714,654	$	480,907
Orthopedics and Tissue Technologies	126,819			114,074			374,472		338,727
Total revenues	$	365,854		$	278,834		$	1,089,126	$	819,634
Segment Profit
Codman Specialty Surgical	$	91,871		$	68,289		$	272,480	$	198,242
Orthopedics and Tissue Technologies	35,515			30,411			105,094		88,500
Segment profit	127,386			98,700			377,574		286,742
Amortization	(5,268		)	(5,456)			(15,944)		(14,976)
Corporate and other	(98,441		)	(82,602		)	(284,740)		(234,180		)
Operating income	$	23,677		$	10,642		$	76,890	$	37,586

The Company does not allocate any assets to the reportable segments. No asset information is reported to the chief operating decision maker and disclosed in the financial information for each segment.

The Company attributes revenues to geographic areas based on the location of the customer. Total revenue by major geographic area consisted of the following:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
	(In thousands)
United States	$	260,870	$	213,685	$	769,509	$	634,047
Europe	47,472		32,609		150,650		93,924
Asia Pacific	37,022		16,887		108,304		48,540
Rest of World	20,490		15,653		60,663		43,123
Total Revenues	$	365,854	$	278,834	$	1,089,126	$	819,634

COMMITMENTS AND CONTINGENCIES

9 Months Ended

Sep. 30, 2018

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

In consideration for certain technology, manufacturing, distribution, and selling rights and licenses granted to the Company, the Company has agreed to pay royalties on sales of certain products that it sells. The royalty payments that the Company made under these agreements were not significant for any of the periods presented.

The Company is subject to various claims, lawsuits and proceedings in the ordinary course of the Company's business, including claims by current or former employees, distributors and competitors and with respect to its products and product liability claims, lawsuits and proceedings, some of which have been settled by the Company. In the opinion of management, such claims are either adequately covered by insurance or otherwise indemnified, or are not expected, individually or in the aggregate, to result in a material, adverse effect on the Company's financial condition. However, it is possible that the Company's results of operations, financial position and cash flows in a particular period could be materially affected by these contingencies.

TEI, acquired by Integra on July 17, 2015, manufactures a bovine-derived surgical mesh product for Boston Scientific Corporation ("BSC") and has been named as a defendant in lawsuits under a broad range of products liability theories, many of which have not been served on TEI. As of October 11, 2018, only one active case remained against TEI. Pursuant to an indemnification agreement with BSC (i) BSC is managing the litigation; and (ii) TEI has in place a product liability insurance policy, of which it must exhaust $3.0 million before BSC’s indemnity begins to cover relevant claims (and of which only a small portion has been utilized to date and against which the insurer has reserved the entire $3.0 million). In addition, Integra has certain protections in the merger agreements with TEI which would indemnify it for approximately $30.0 million for the first fifteen months after closing and between $20.0 and $30.0 million for the remainder of the three-year period after closing for losses relating to a variety of matters, including half of certain products liability claims (including those related to the product it manufactures for BSC) not covered by insurance. As of September 30, 2018, no indemnification payments were received nor owed in relation to the lawsuits.

The Company accrues for loss contingencies when it is deemed probable that a loss has been incurred and that loss is estimable. The amounts accrued are based on the full amount of the estimated loss before considering insurance proceeds and do not include an estimate for legal fees expected to be incurred in connection with the loss contingency. The Company consistently accrues legal fees expected to be incurred in connection with loss contingencies as those fees are incurred by outside counsel as a period cost.

Contingent Consideration

The Company determined the fair value of contingent consideration during the nine-month period ended September 30, 2018 and 2017 to reflect the change in estimate, additions, payments, transfers and the time value of money during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the nine months ended September 30, 2018 and 2017 is as follows (in thousands):



Nine Months Ended September 30, 2018	Contingent Considerations Liabilities Related to Acquisition of Derma Sciences (See Note 2)						Contingent Consideration Liability Related to Acquisition of Confluent Surgical, Inc.			Location in Financial Statements
	Short-term			Long-term			Short-term
Balance as of January 1, 2018	$	315		$	1,387		$	22,478
Transfers from long-term to current portion	1,387			(1,387		)	—
Payments	(2,000		)	—			(19,000		)
Loss from change in fair value of contingent consideration liabilities	298			230			1,522			Selling, general and administrative
Balance as of September 30, 2018	$	—		$	230		$	5,000



Nine Months Ended September 30, 2017	Contingent Considerations Liabilities Related to Acquisition of Derma Sciences (See Note 2)						Contingent Consideration Liability Related to Acquisition of Confluent Surgical, Inc.					Location in Financial Statements
	Short-term			Long-term			Short-term		Long-term
Balance as of January 1, 2017	$	—		$	—		$	—	$	22,036
Additions from acquisition of Derma Sciences	33,707			3,467			—		—
Transfers from long-term to current portion	2,193			(2,193		)	21,312		(21,312		)
Payments	(31,346		)	—			—		—
(Gain)/Loss from change in fair value of contingent consideration liabilities	(2,421		)	82			—		148			Selling, general and administrative
Balance as of September 30, 2017	$	2,133		$	1,356		$	21,312	$	872

On January 15, 2014, the Company acquired all outstanding shares of Confluent Surgical, Inc., ("Confluent Surgical"). The purchase price includes contingent consideration. The potential maximum undiscounted contingent consideration of $30.0 million consists of $25.0 million upon obtaining certain U.S. governmental approvals (the "U.S. Contingent Consideration") and $5.0 million upon obtaining certain European governmental approvals, both related to the completion of the transition of the Confluent Surgical business. The U.S. Contingent Consideration is subject to adjustment to reduce the amount of maximum payment based on the timing of obtaining the U.S. governmental approval up to the minimum of $19.0 million. The fair values of contingent consideration related to the acquisition of Confluent Surgical were estimated using a discounted cash flow model using discount rate of 2.2%. During the first quarter of 2018, the Company received the U.S. governmental approvals and adjusted the related contingent consideration liability to $19.0 million, which the Company paid in April 2018. During the third quarter of 2018, the Company received certain European governmental approvals. The Company paid the remaining $5.0 million of contingent consideration in October of 2018.

The Company assesses these assumptions on an ongoing basis as additional information affecting the assumptions is obtained. The contingent consideration balance was included in accrued expenses and other current liabilities and other liabilities at September 30, 2018 and September 30, 2017.

Supply Agreement Liability and Above Market Supply Agreement Liability

On January 15, 2014, the Company entered into a transitional supply agreement with Covidien Group S.a.r.l ("Covidien"). This agreement contains financial incentives to Covidien for the timely supply of products each fiscal quarter through the third anniversary of the agreement. The prices paid under the supply agreement were essentially flat through the third anniversary of the agreement, and then increase significantly in each of the following three years.

The Company determined the fair value of its supply agreement liability and above market supply agreement liability with Covidien during the nine-month periods ended September 30, 2018 and 2017 to reflect the payments, change in estimate and the time value of money during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements is as follows (amounts in thousands):



Nine Months Ended September 30, 2018	Above Market Supply Agreement Liability - Short-term			Location in Financial Statements
Balance as of January 1, 2018	$	2,641
Payments	(1,546		)
(Gain)/loss from change in fair value	(628		)	Selling, general and administrative
Transfer to accounts payable	(164		)
Balance as of September 30, 2018	$	303



Nine Months Ended September 30, 2017	Supply Agreement Liability - Short-term			Above Market Supply Agreement Liability - Short- Term			Above Market Supply Agreement Liability - Long-term			Location in Financial Statements
Balance as of January 1, 2017	$	166		$	—		$	2,648
Payments	(166		)	—			(415		)
Transfer from long-term to current portion	—			3,216			(3,216		)
(Gain)/loss from change in fair value	—			(352		)	1,040			Selling, general and administrative
Balance as of September 30, 2017	$	—		$	2,864		$	57

The fair values of supply agreement liability and above market supply agreement liability were estimated using a discounted cash flow model using a discount rate of 12.0%. The Company assesses these assumptions on an ongoing basis as additional information impacting the assumptions is obtained. The above market supply agreement liability - short-term was included in accrued expenses and other current liabilities at September 30, 2018 and December 31, 2017.

There were no transfers between level 1, 2 or 3 during the nine months ended September 30, 2018 and 2017. If the Company's estimate regarding the fair value of its contingent consideration liabilities, supply agreement liability and above market supply agreement liability are inaccurate, a future adjustment to these estimated fair values may be required which could change significantly.

BioD

On April 7, 2017, the Company's indirect wholly-owned subsidiary, BioD filed an action in the Superior Court of New Jersey, Chancery Division, Middlesex County seeking a declaration that the resignation of Russell Olsen, the former CEO of BioD, was “for Good Reason” (as defined in Olsen’s employment agreement); a finding that Olsen breached the implied covenant of good faith and fair dealing, committed legal fraud, equitable fraud and negligent misrepresentation; and an award of damages for such actions, including a return of severance fees paid to Olsen. BioD was acquired in August 2016 by Derma Sciences, which Integra subsequently acquired in February 2017. After receiving a job offer from Integra that Olsen believed materially diminished his title and authority, on February 24, 2017 Olsen indicated his intention to terminate his position with BioD for Good Reason, as otherwise permitted by his employment agreement with BioD. Shortly thereafter, Cynthia Weatherly (as representative of the former equity owners of BioD) claimed in a letter to Derma Sciences that Olsen’s resignation was a “termination Without Cause” (as also defined in Olsen’s employment agreement), which would arguably trigger an acceleration of the earn out under a merger agreement between Derma Sciences, BioD and other parties (the "BioD Merger Agreement"), which was entered into in July 2016, and require as a result of the acceleration the payment of $26.5 million by BioD. As previously disclosed and described in Note 2 - Business Acquisitions and Divestiture, Integra assumed this contingent liability in connection with its acquisition of Derma Sciences. The action for a declaratory judgment was filed to clarify that Olsen’s termination was for Good Reason and not Without Cause. If the employment agreement was terminated for Good Reason, then the Company believes that the earn out provision under the BioD Merger Agreement should not be accelerated and the likelihood of loss is remote.

BASIS OF PRESENTATION (Policies)	9 Months Ended
BASIS OF PRESENTATION (Policies)	Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Recently Issued Accounting Standards	Recently Issued Accounting Standards In May 2014, the FASB issued Update No. 2014-09, Revenue from Contracts with Customers (Topic 606). The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve that core principle, an entity should 1) identify the contract(s) with a customer, 2) identify the performance obligations in the contract, 3) determine the transaction price, 4) allocate the transaction price to the performance obligations in the contract, and 5) recognize revenue when (or as) the entity satisfies a performance obligation. This update became effective for all annual periods and interim reporting periods beginning after December 15, 2017. The Company adopted Topic 606 as of January 1, 2018 using the modified retrospective method. See Note 3, Revenues from Contracts with Customers, for further details. In February 2016, the FASB issued Update No. 2016-02, Leases (Topic 842). Under current accounting guidance, an entity is not required to report operating leases on the balance sheet. The amendment requires that lessees recognize virtually all of its leases on the balance sheet by recording a right-of-use asset and lease liability (other than leases that meet the definition of a "short-term lease"). This update will become effective for all annual periods and interim reporting periods beginning after December 15, 2018. The new standard must be adopted using a modified retrospective transition. Early adoption is permitted. While the Company has not yet completed its assessment, the adoption of this guidance could have a material impact on the Company's financial position. In August 2016, the FASB issued Update No. 2016-15, Classification of Certain Cash Receipts and Cash Payments. The guidance addresses the classification of cash flows related to debt repayment or extinguishment costs, settlement of zero-coupon debt instruments or debt instruments with coupon rates that are insignificant in relation to the effective interest rate of the borrowing, contingent consideration payments made after business combinations, proceeds from the settlement of insurance claims and corporate-owned life insurance, distributions received from equity method investees and beneficial interests in securitization transaction. This update became effective for all annual periods and interim reporting periods beginning after December 15, 2017. The Company adopted ASU 2016-15 effective January 1, 2018 on a retrospective basis. The adoption of this guidance had no significant impact on the Company's consolidated financial statements. In October 2016, the FASB issued Update No. 2016-16, Intra-Entity Transfers of Assets Other Than Inventory. The guidance requires that the income tax consequences of intra-entity transfers of assets other than inventory be recognized as a current-period income tax expense or benefit and removes the requirement to defer and amortize the consolidated tax consequences of intra-entity transfers. The new standard became effective for all annual periods beginning after December 15, 2017. The Company adopted ASU 2016-16 effective January 1, 2018, and this guidance had no significant impact on its consolidated financial statements. In March 2017, the FASB issued Update No. 2017-07, Compensation - Retirement Benefits (Topic 715): Improving the Presentation of Net Periodic Pension Cost and Net Periodic Postretirement Benefit Cost. The guidance requires that an employer report the service cost component in the same line item or items as other compensation costs arising from services rendered by the pertinent employees during the period. The other components of net benefit cost are required to be presented in the income statement separately from the service cost component and outside a subtotal of income from operations, if one is presented. If a separate line item or items were to be used to present the other components of net benefit cost, that line item or items must be appropriately described. If a separate line item or items is/are not used, the line item or items used in the income statement to present the other components of net benefit cost must be disclosed. In addition, the amendments also allow only the service cost component to be eligible for capitalization when applicable. The new standard became effective for annual periods beginning after December 15, 2017. The Company adopted ASU 2017-07 effective January 1, 2018. The Company recognized the components of net periodic benefit cost other than the service cost component in other (expense) income, net in the consolidated statements of operations. The adoption of this guidance had no significant impact on the Company's consolidated financial statements. In May 2017, the FASB issued ASU 2017-09, Stock Compensation (Topic 718): Scope of Modification Accounting. The update serves to provide clarity and reduce both (1) diversity in practice and (2) cost and complexity when applying the guidance in Topic 718, Compensation-Stock Compensation, to a change to the terms or conditions of a share-based payment award. The new standard became effective for all annual periods beginning after December 15, 2017. The Company adopted ASU 2017-09 effective January 1, 2018, and there was no significant impact of this guidance on its consolidated financial statements. In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. This update amends the hedge accounting rules to simplify the application of hedge accounting guidance and better portray the economic results of risk management activities in the financial statements. The guidance expands the ability to hedge non-financial and financial risk components, reduces complexity in fair value hedges of interest rate risk, eliminates the requirement to separately measure and report hedge ineffectiveness, as well as eases certain hedge effectiveness assessment requirements. This update will become effective for all annual periods and interim reporting periods beginning after December 15, 2018. Early adoption is permitted. The Company elected to early adopt ASU 2017-12 effective January 1, 2017 using the modified retrospective method. The implementation of the amended guidance did not have a significant impact on the Company's consolidated financial statements. In February 2018, the FASB issued ASU 2018-02, Reclassification of Certain Tax Effects From Accumulated Other Comprehensive Income. This amendment allows a reclassification from accumulated other comprehensive income to retained earnings for stranded tax effects resulting from the 2017 Tax Act (as defined in Note 11, Income Taxes). This guidance is effective for annual and interim periods beginning after December 15, 2018. Early adoption is permitted. The Company elected to early adopt the ASU 2018-02 effective January 1, 2018, which resulted in the reclassification of $0.5 million from accumulated other comprehensive loss to retained earnings related to a net unrealized loss on cash flow hedges. In July 2018, the FASB issued ASU Number 2018-09, Codification Improvements. This update provides clarification, corrects errors in and makes minor improvements to the Codification within various ASC topics. Many of the amendments in this update have transition guidance with effective dates for annual periods beginning after December 15, 2018, and some amendments in this update do not require transition guidance and are effective upon issuance of this update. The Company will adopt amendments as they become applicable and has determined that the impact of these improvements will not be material to its consolidated financial condition and results of operations. In July 2018, the FASB issued ASU Number 2018-11, Leases (Topic 842): Targeted Improvements. This update provides entities with an additional and optional transition method to adopt ASU Number 2016-02 with a cumulative-effect adjustment in the period of adoption. This update also provides guidance for a practical expedient that permits lessors to not separate non-lease components from the associated lease components. Additionally, in July 2018, the FASB issued ASU Number 2018-10, Codification Improvements to Topic 842, Leases. This update provides additional guidance on the new lease model with improvements in numerous aspects of the guidance in ASC 842 including, but not limited to, implicit rates, reassessment of lease classification, terms and purchase options, investment tax credits, and various other transition guidance. These updates will be adopted concurrently with ASU Number 2016-02. While the Company has not yet completed its assessment, the adoption of this guidance could have a material impact on the Company's financial position. In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework-Changes to the Disclosure Requirements for Fair Value Measurement. The new guidance modifies the disclosure requirements related to fair value measurements in Topic 820, Fair Value Measurement, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and modifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years. Early adoption is permitted. The Company elected to early adopt ASU 2018-13 on October 1, 2018. The adoption is not expected to have a material impact on the Condensed and Consolidated Financial Statements. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans. The new guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans, including removing certain previous disclosure requirements, adding certain new disclosure requirements, and clarifying certain other disclosure requirements. The ASU will be effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption is permitted. The adoption is not expected to have a material impact on the Condensed and Consolidated Financial Statements. There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.
Goodwill and Intangible Assets with Indefinite Lives and Definite Lived Intangible Assets	Goodwill and Intangible Assets with Indefinite Lives The Company tests goodwill and intangible assets with indefinite lives for impairment annually in the third quarter in accordance with ASC Topic 350. Additionally, the Company may perform interim tests if an event occurs or circumstances change that could potentially reduce the fair value of a reporting unit or indefinite lived intangible asset below its carrying amount. The carrying value of each reporting unit is determined by assigning the assets and liabilities, including the existing goodwill and intangible assets, to those reporting units. The Company tests goodwill for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass this qualitative assessment for some or all of its reporting units and perform a quantitative test. For goodwill, the Company elected to bypass the qualitative assessment for its three reporting units and perform a quantitative test during the third quarter of 2018. In performing this test, the Company utilized a discount rate of 9.0%. The assumptions used in evaluating goodwill for impairment are subject to change and are tracked against historical results by management. Based on the results of this quantitative test, the Company recorded no impairment of goodwill. For intangible assets with indefinite lives, the Company elected to bypass the qualitative assessment for its Codman Tradename intangible asset and perform a quantitative test during the third quarter 2018. In performing this test, the Company utilized a discount rate of 13.0%. The assumptions used in evaluating the Codman Tradename for impairment are subject to change and are tracked against historical results by management. Based on the results of the quantitative test, the Company recorded no impairment to the Codman Tradename intangible asset. Definite Lived Intangible Assets Product rights and other definite-lived intangible assets are tested periodically for impairment in accordance with ASC Topic 360 when events or changes in circumstances indicate that an asset’s carrying value may not be recoverable. The impairment testing involves comparing the carrying amount of the asset or asset group to the forecasted undiscounted future cash flows. In the event the carrying value of the asset exceeds the undiscounted future cash flows, the carrying value is considered not recoverable and an impairment exists. An impairment loss is measured as the excess of the asset’s carrying value over its fair value, calculated using discounted future cash flows. The computed impairment loss is recognized in the period that the impairment occurs.
Summary of Accounting Policies on Revenue Recognition and Shipping and Handling Fees	Summary of Accounting Policies on Revenue Recognition Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services. Total revenue, net, includes product sales, product royalties and other revenues, such as fees received from services. For products shipped with FOB shipping point terms, the control of the product passes to the customer at the time of shipment. For shipments in which the control of the product is transferred when the customer receives the product, the Company recognizes revenue upon receipt by the customer. Certain products that the Company produces for private label customers have no alternative use and the Company has a right of payment for performance to date. Revenues from those products are recognized over the period that the Company manufactures these products, which is typically one to three months. The Company uses the input method to measure the manufacturing activities completed to date, which depicts the progress of the Company's performance obligation of transferring control of goods being manufactured for private label customers. A portion of the Company's product revenue is generated from consigned inventory maintained at hospitals and distributors, and also from inventory physically held by field sales representatives. For these types of products sales, the Company retains control until the product has been used or implanted, at which time revenue is recognized. Revenues from sale of products and services are evidenced by either a contract with the customer or a valid purchase order and an invoice which includes all relevant terms of sale. For product sales, invoices are generally issued upon the transfer of control (or upon the completion of the manufacturing in the case of the private label transactions recognized over time) and are typically payable 30 days after the invoice date. The Company performs a review of each specific customer's creditworthiness and ability to pay prior to acceptance as a customer. Further, the Company performs periodic reviews of its customers' creditworthiness prospectively. Performance Obligations The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers. Significant Judgments Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant. The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract. The Company's return policy, as set forth in its product catalogs and sales invoices, requires the Company to review and authorize the return of a product in advance. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days. The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the good or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers. Contract Asset and Liability Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet. Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability. Shipping and Handling Fees The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in the cost of goods sold.
Product Warranties	Product Warranties Certain of the Company's medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet.
Taxes Collected from Customers	Taxes Collected from Customers The Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer.

BUSINESS ACQUISITIONS AND DIVESTITURE (Tables)

9 Months Ended

Sep. 30, 2018

Business Combinations [Abstract]

Schedule of Recognized Identified Assets Acquired and Liabilities Assumed



	Final Valuation		Weighted Average Life
	(Dollars in thousands)
Inventory	$	74,962
Assets held for sale	30,813
Other current assets	8,202
Property, plant and equipment	41,339
Intangible assets:
Codman corporate trade name	162,900		Indefinite
Completed technology	375,200		22 years
Goodwill	342,322
Total assets acquired	1,035,738
Accrued expenses	1,730
Pension liabilities	19,917
Net assets acquired	$	1,014,091



	Final Valuation
	(Dollars in thousands)
Cash and cash equivalents	$	16,512
Short-term investments	19,238
Accounts receivable	8,949
Inventory	17,977
Prepaid expenses and other current assets	4,369
Property, plant and equipment	4,311
Intangible assets:			Wtd. Avg. Life:
Customer relationship	78,300		14 years
Trademarks/brand names	13,500		15 years
Completed technology	11,600		14 years
Non-compete agreement	280		1 year
Goodwill	73,765
Deferred tax assets	14,524
Other assets	101
Total assets acquired	263,426
Accounts payable	4,560
Accrued expenses and other current liabilities	7,409
Contingent liability	37,174
Other liabilities	3,805
Net assets acquired	$	210,478

Schedule of Assets and Liabilities Divested

Assets and liabilities divested consisted of the following as of October 6, 2017 (amounts in thousands):



Inventories	$	8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets divested	$	43,180

Deferred revenue	$	1,082
Accrued compensation	209
Total liabilities divested	$	1,291

Schedule of Pro Forma Information

As a result, these pro forma results do not necessarily represent results that would have occurred if the acquisition had taken place on the basis assumed above, nor are they indicative of the results of future combined operations.



	Three Months Ended September 30,		Nine Months Ended September 30,
	2017		2017
	(In thousands, except per share amounts)
Total revenue	$	352,351	$	1,059,889
Net income	$	1,385	$	24,064
Basic income per share	$	0.02	$	0.32

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 360
-SubTopic 10
-Section 50
-Paragraph 3A
-URI http://asc.fasb.org/extlink&oid=109226691&loc=SL51724579-110230

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1474-107760

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5D
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721677-107760

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 45
-Paragraph 11
-URI http://asc.fasb.org/extlink&oid=109222160&loc=SL51721533-107759

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 3A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721659-107760

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 4B
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721665-107760

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 360
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109226691&loc=d3e2941-110230

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5C
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721675-107760

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721683-107760

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1361-107760

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721671-107760

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5B
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721673-107760

Reference 13: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 4A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721663-107760

+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

9 Months Ended

Sep. 30, 2018

Revenue from Contract with Customer [Abstract]

Schedule of Changes in Contract Assets and Contract Liabilities

The following table summarized the changes in the contract asset and liability balances for the nine months ended September 30, 2018:



Contract Asset
Contract asset, January 1, 2018	$	3,552
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(3,552		)
Contract asset, net of transferred to trade receivables on contracts during the period	3,068
Contract asset, September 30, 2018	$	3,068

Contract Liability
Contract liability, January 1, 2018	$	11,059
Recognition of revenue included in beginning of year contract liability	(4,356		)
Contract liability, net of revenue recognized on contracts during the period	4,259
Foreign currency translation	(30		)
Contract liability, September 30, 2018	$	10,932

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for the three and nine months ended September 30, 2018 (amounts in thousands):



	Three Months Ended September 30, 2018		Three Months Ended September 30, 2017		Nine Months Ended September 30, 2018		Nine Months Ended September 30, 2017
	(amounts in thousands)
Neurosurgery	$	171,680	95,887		$	509,166	276,574
Precision Tools and Instruments	67,355		$	68,873	205,488		$	204,333
Total Codman Specialty Surgical	239,035		164,760		714,654		480,907

Wound Reconstruction and Care	78,290		69,667		225,003		194,177
Extremity Orthopedics	22,706		22,912		71,244		71,193
Private Label	25,823		21,495		78,225		73,357
Total Orthopedics and Tissue Technologies	126,819		114,074		374,472		338,727
Total revenue	$	365,854	$	278,834	$	1,089,126	$	819,634

Schedule of Impact on Statement of Operations

The impact of adoption of Topic 606 to the Company's consolidated statement of operations for the three and nine months ended September 30, 2018 was as follows:



	Three Months Ended September 30, 2018						Nine Months Ended September 30, 2018
	As Reported			Excluding Impact of Topic 606			As Reported			Excluding Impact of Topic 606
	(Amounts in thousands)
Statement of Operations
Total revenue, net	$	365,854		$	368,990		$	1,089,126		$	1,089,153
Cost of goods sold	143,245			143,918			425,032			424,969
Income tax benefit	(2,271		)	(1,092		)	(2,776		)	(2,754		)
Net income	13,295			14,579			35,663			35,731

INVENTORIES (Tables)

9 Months Ended

Sep. 30, 2018

Inventory, Net [Abstract]

Schedule of Inventory, Net

Inventories, net consisted of the following:



	September 30, 2018		December 31, 2017
	(In thousands)
Finished goods	$	183,669	$	190,100
Work in process	51,933		58,637
Raw materials	55,244		47,595
	$	290,846	$	296,332

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

9 Months Ended

Sep. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill for the nine-month period ended September 30, 2018 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2017	$	634,767		$	303,138		$	937,905
Codman acquisition measurement period adjustments	(3,964		)	—			(3,964		)
Foreign currency translation	(5,114		)	(2,458		)	(7,572		)
Goodwill at September 30, 2018	$	625,689		$	300,680		$	926,369

Components of Company's Identifiable Intangible Assets

The components of the Company’s identifiable intangible assets were as follows:



	September 30, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	855,799	$	(156,157	)	$	699,642
Customer relationships	13 years	232,083		(102,618		)	129,465
Trademarks/brand names	28 years	104,347		(24,903		)	79,444
Codman trade name	Indefinite	162,900		—			162,900
Supplier relationships	27 years	34,721		(16,162		)	18,559
All other	4 years	11,019		(3,770		)	7,249
		$	1,400,869	$	(303,610	)	$	1,097,259



	December 31, 2017
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	869,174	$	(124,096	)	$	745,078
Customer relationships	13 years	233,430		(91,961		)	141,469
Trademarks/brand names	28 years	104,879		(22,293		)	82,586
Codman trade name	Indefinite	162,900		—			162,900
Supplier relationships	27 years	34,721		(15,092		)	19,629
All other	4 years	11,511		(3,546		)	7,965
		$	1,416,615	$	(256,988	)	$	1,159,627

DEBT (Tables)

9 Months Ended

Sep. 30, 2018

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios



Fiscal Quarter		Maximum Consolidated Total Leverage Ratio

Execution of May 2018 Amendment through March 31, 2019		5.50 : 1.00
June 30, 2019 through March 31, 2020		5.00 : 1.00
June 30, 2020 through March 31, 2021		4.50 : 1.00
June 30, 2021 and thereafter		4.00 : 1.00.

Schedule of Maturities of Long-term Debt

Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows:



Year Ended December 31,	Principal Repayment
	(In thousands)
Remainder of 2018	$	—
2019	22,500
2020	45,000
2021	56,250
2022	67,500
2023	708,750
	$	900,000

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02.22)
-URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 1A
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28541-108399

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 6
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21506-112644

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08.(e),(f))
-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28551-108399

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21521-112644

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21538-112644

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=75038535&loc=d3e64711-112823

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 55
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=114775985&loc=d3e28878-108400

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21475-112644

+ Details

DERIVATIVE INSTRUMENTS (Tables)

9 Months Ended

Sep. 30, 2018

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following cross-currency rate swaps as of September 30, 2018 (dollar amounts in thousands):



	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Liability

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(1,286	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(1,286	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(1,110		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(1,110		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(4,467		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(4,467		)

Total						$	(6,863	)

The Company held the following interest rate swaps as of September 30, 2018 (amounts in thousands):



Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Floating Rate	Estimated Fair Value
									Assets (Liabilities)
3-month USD LIBOR Loan	$	50,000	June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	3-month USD LIBOR	$	588
3-month USD LIBOR Loan	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	3-month USD LIBOR	924
1-month USD LIBOR Loan	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	1-month USD LIBOR	637
3-month USD LIBOR Loan	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	3-month USD LIBOR	590
1-month USD LIBOR Loan	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	1-month USD LIBOR	1,950
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	1-month USD LIBOR	2,342
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1-month USD LIBOR	4,322
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	1-month USD LIBOR	4,277
1-month USD LIBOR Loan	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1-month USD LIBOR	2,786
1-month USD LIBOR Loan	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	1-month USD LIBOR	1,339
1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	1-month USD LIBOR	7,174
Total interest rate derivatives designated as cash flow hedge	$	1,050,000							$	26,929

Schedule of Fair Value and Presentation of Derivatives



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2018		December 31, 2017
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Interest rate swap⁽²⁾	$	6,682	$	1,521
Cross-currency swap	7,603		7,757
Other assets
Interest rate swap⁽²⁾	20,246		2,491
Total derivatives designated as hedges — Assets	$	34,531	$	11,769

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Interest rate swap⁽²⁾	$	—	$	1,845
Other liabilities
Interest rate swap⁽²⁾	—		1,575
Cross-currency swap	14,466		11,714
Total derivatives designated as hedges — Liabilities	$	14,466	$	15,134


⁽¹⁾	The Company classifies derivative assets and liabilities as non-current based on the cash flows expected to be incurred within the following 12 months.


⁽²⁾	At September 30, 2018 and December 31, 2017, the notional amount related to the Company’s interest rate swaps was $1.05 billion. The notional amount will be reduced by $150.0 million in June 2019.

Effect of Derivative Instruments Designated as Cash Flow Hedges on Statements of Operations



	Balance in AOCI Beginning of Quarter			Amount of Gain (Loss) Recognized in AOCI			Amount of Gain (Loss) Reclassified from AOCI into Earnings			Balance in AOCI End of Quarter			Location in Statements of Operations
	(In thousands)
Three Months Ended September 30, 2018
Interest rate swap	$	22,344		$	5,059		$	473		$	26,930		Interest (expense)
Cross-currency swap	(7,892		)	(3,067		)	(707		)	(10,252		)	Other income (expense)
	$	14,452		$	1,992		$	(234	)	$	16,678
Three Months Ended September 30, 2017
Interest rate swap	$	935		$	297		$	(63	)	$	1,295		Interest (expense)
	$	935		$	297		$	(63	)	$	1,295
	Balance in AOCI Beginning of Year			Amount of Gain (Loss) Recognized in AOCI- Effective Portion			Amount of Gain (Loss) Reclassified from AOCI into Earnings-Effective Portion			Balance in AOCI End of Quarter			Location in Statements of Operations
	(In thousands)
Nine Months Ended September 30, 2018
Interest rate swap	$	592		$	26,307		$	(31	)	$	26,930		Interest (expense)
Cross-currency swap	(5,104		)	3,000			8,148			(10,252		)	Other income (expense)
	$	(4,512	)	$	29,307		$	8,117		$	16,678
Nine Months Ended September 30, 2017
Interest rate swap	$	1,871		$	(618	)	$	(42	)	$	1,295		Interest (expense)
	$	1,871		$	(618	)	$	(42	)	$	1,295

- Definition

Tabular disclosure of pertinent information about a derivative or group of derivatives on a disaggregated basis, such as for individual instruments, or small groups of similar instruments. May include a combination of the type of instrument, risks being hedged, notional amount, hedge designation, related hedged item, inception date, maturity date, or other relevant item.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 4B
-URI http://asc.fasb.org/extlink&oid=109980867&loc=SL5624163-113959

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 1B
-URI http://asc.fasb.org/extlink&oid=109980867&loc=SL5580258-113959

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=109980867&loc=d3e41620-113959

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 1A
-URI http://asc.fasb.org/extlink&oid=109980867&loc=SL5579245-113959

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 4
-URI http://asc.fasb.org/extlink&oid=109980867&loc=d3e41638-113959

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109980867&loc=d3e41678-113959

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=109980867&loc=d3e41641-113959

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 4C
-URI http://asc.fasb.org/extlink&oid=109980867&loc=SL5624171-113959

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08.(n)(2))
-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=109980867&loc=SL5579240-113959

+ Details

NET INCOME PER SHARE (Tables)

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

Basic and Diluted Net Income Per Share

Basic and diluted net income per share was as follows:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
	(In thousands, except per share amounts)
Basic net income per share:
Net income	$	13,295	$	3,159	$	35,663	$	20,388
Weighted average common shares outstanding	85,193		78,186		82,058		76,387
Basic net income per common share	$	0.16	$	0.04	$	0.43	$	0.27

Diluted net income per share:
Net income	$	13,295	$	3,159	$	35,663	$	20,388

Weighted average common shares outstanding — Basic	85,193		78,186		82,058		76,387
Effect of dilutive securities:
Warrants	—		158		—		1,295
Stock options and restricted stock	1,106		1,111		1,084		1,291
Weighted average common shares for diluted earnings per share	86,299		79,455		83,142		78,973

Diluted net income per common share	$	0.15	$	0.04	$	0.43	$	0.26

COMPREHENSIVE INCOME (Tables)

9 Months Ended

Sep. 30, 2018

Equity [Abstract]

Schedule of Comprehensive Income

Comprehensive income was as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2018			2017			2018			2017
	(In thousands)
Net income	$	13,295		$	3,159		$	35,663		$	20,388
Foreign currency translation adjustment	(2,353		)	10,175			(16,359		)	33,724
Change in unrealized gain (loss) on derivatives, net of tax	1,386			207			14,419			(331		)
Pension liability adjustment, net of tax	2			(7		)	8			(22		)
Comprehensive income, net	$	12,330		$	13,534		$	33,731		$	53,759

Schedule of Changes in Accumulated Other Comprehensive Income by Component

Changes in Accumulated Other Comprehensive Income by component between December 31, 2017 and September 30, 2018 are presented in the table below, net of tax:



	Cash Flow Hedges			Defined Benefit Pension Items			Foreign Currency Items			Total
	(In thousands)
Balance at December 31, 2017	$	(2,979	)	$	(93	)	$	(20,735	)	$	(23,807	)
Reclassification of stranded tax effect	(532		)	—			—			(532		)
Balance at January 1, 2018	(3,511		)	(93		)	(20,735		)	(24,339		)
Other comprehensive income (loss)	20,661			8			(16,359		)	4,310
Amounts reclassified from accumulated other comprehensive income	6,242			—			—			6,242
Net current-period other comprehensive income (loss)	14,419			8			(16,359		)	(1,932		)
Balance at September 30, 2018	$	10,908		$	(85	)	$	(37,094	)	$	(26,271	)

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Total Revenue By Major Geographic Area

Net sales and profit by reportable segment for the three and nine months ended September 30, 2018 and 2017 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2018			2017			2018		2017
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	239,035		$	164,760		$	714,654	$	480,907
Orthopedics and Tissue Technologies	126,819			114,074			374,472		338,727
Total revenues	$	365,854		$	278,834		$	1,089,126	$	819,634
Segment Profit
Codman Specialty Surgical	$	91,871		$	68,289		$	272,480	$	198,242
Orthopedics and Tissue Technologies	35,515			30,411			105,094		88,500
Segment profit	127,386			98,700			377,574		286,742
Amortization	(5,268		)	(5,456)			(15,944)		(14,976)
Corporate and other	(98,441		)	(82,602		)	(284,740)		(234,180		)
Operating income	$	23,677		$	10,642		$	76,890	$	37,586

The Company attributes revenues to geographic areas based on the location of the customer. Total revenue by major geographic area consisted of the following:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
	(In thousands)
United States	$	260,870	$	213,685	$	769,509	$	634,047
Europe	47,472		32,609		150,650		93,924
Asia Pacific	37,022		16,887		108,304		48,540
Rest of World	20,490		15,653		60,663		43,123
Total Revenues	$	365,854	$	278,834	$	1,089,126	$	819,634

COMMITMENTS AND CONTINGENCIES (Tables)

9 Months Ended

Sep. 30, 2018

Commitments and Contingencies Disclosure [Abstract]

Schedule of Contingent Consideration

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the nine months ended September 30, 2018 and 2017 is as follows (in thousands):



Nine Months Ended September 30, 2018	Contingent Considerations Liabilities Related to Acquisition of Derma Sciences (See Note 2)						Contingent Consideration Liability Related to Acquisition of Confluent Surgical, Inc.			Location in Financial Statements
	Short-term			Long-term			Short-term
Balance as of January 1, 2018	$	315		$	1,387		$	22,478
Transfers from long-term to current portion	1,387			(1,387		)	—
Payments	(2,000		)	—			(19,000		)
Loss from change in fair value of contingent consideration liabilities	298			230			1,522			Selling, general and administrative
Balance as of September 30, 2018	$	—		$	230		$	5,000



Nine Months Ended September 30, 2017	Contingent Considerations Liabilities Related to Acquisition of Derma Sciences (See Note 2)						Contingent Consideration Liability Related to Acquisition of Confluent Surgical, Inc.					Location in Financial Statements
	Short-term			Long-term			Short-term		Long-term
Balance as of January 1, 2017	$	—		$	—		$	—	$	22,036
Additions from acquisition of Derma Sciences	33,707			3,467			—		—
Transfers from long-term to current portion	2,193			(2,193		)	21,312		(21,312		)
Payments	(31,346		)	—			—		—
(Gain)/Loss from change in fair value of contingent consideration liabilities	(2,421		)	82			—		148			Selling, general and administrative
Balance as of September 30, 2017	$	2,133		$	1,356		$	21,312	$	872

A reconciliation of the opening balances to the closing balances of these Level 3 measurements is as follows (amounts in thousands):



Nine Months Ended September 30, 2018	Above Market Supply Agreement Liability - Short-term			Location in Financial Statements
Balance as of January 1, 2018	$	2,641
Payments	(1,546		)
(Gain)/loss from change in fair value	(628		)	Selling, general and administrative
Transfer to accounts payable	(164		)
Balance as of September 30, 2018	$	303



Nine Months Ended September 30, 2017	Supply Agreement Liability - Short-term			Above Market Supply Agreement Liability - Short- Term			Above Market Supply Agreement Liability - Long-term			Location in Financial Statements
Balance as of January 1, 2017	$	166		$	—		$	2,648
Payments	(166		)	—			(415		)
Transfer from long-term to current portion	—			3,216			(3,216		)
(Gain)/loss from change in fair value	—			(352		)	1,040			Selling, general and administrative
Balance as of September 30, 2017	$	—		$	2,864		$	57

BASIS OF PRESENTATION - Narrative (Details) - USD ($) $ in Thousands		1 Months Ended
	Jan. 01, 2018	May 31, 2018
New Accounting Pronouncement, Early Adoption [Line Items]
Reclassification of stranded tax effect	$ (532)
Accounting Standards Update 2018-02 \| New Accounting Pronouncement, Early Adoption, Effect
New Accounting Pronouncement, Early Adoption [Line Items]
Reclassification of stranded tax effect	$ 500
Public Offering
New Accounting Pronouncement, Early Adoption [Line Items]
Stock issued during the period (in shares)		6,000,000.0
Stock issued during period, value		$ 349,600

BUSINESS ACQUISITIONS AND DIVESTITURE - Narrative (Details)					1 Months Ended	3 Months Ended							6 Months Ended	9 Months Ended
	Oct. 02, 2017 USD ($)	May 25, 2017 USD ($)	Feb. 24, 2017 USD ($)	Feb. 23, 2017 USD ($)	Aug. 31, 2017 USD ($)	Sep. 30, 2018 USD ($)	Jun. 30, 2018 USD ($)	Mar. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Sep. 30, 2017 USD ($)	Jun. 30, 2017 USD ($)	Mar. 31, 2017 USD ($)	Jun. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2017 USD ($)	Oct. 06, 2017 USD ($)
Business Acquisition [Line Items]
Amount drawn from loan														$ 50,000,000	$ 571,383,000
Cash received from working capital adjustment related to business acquisition														26,704,000
Payment for contingent consideration														15,900,000
Cost of good sold related to fair value inventory purchase accounting adjustments						$ 143,245,000				$ 101,757,000				425,032,000	287,340,000
Cash payment to former shareholders															225,552,000
Recognized loss on sale of short-term investment											$ 2,300,000			0	2,287,000
Change in fair value of contingent consideration														1,214,000	(2,773,000)
Net income						$ 13,295,000	$ 11,376,000	$ 10,992,000		$ 3,159,000	10,835,000	$ 6,394,000		$ 35,663,000	$ 20,388,000
BioD Morselized Amniotic Membrane Based Products \| Product Concentration Risk
Business Acquisition [Line Items]
Percentage of revenue to product (less than)						1.00%				1.00%				1.00%	1.00%
Codman Specialty Surgical
Business Acquisition [Line Items]
Aggregate purchase price received																$ 46,400,000
Assets provided upon termination of transitional supply agreement liability						$ 1,300,000								$ 1,300,000
Codman Specialty Surgical \| Disposal Group, Held-for-sale, Not Discontinued Operations
Business Acquisition [Line Items]
Pretax gain on sale of business, included in other income, net									$ 2,600,000
Interest Expense, Intangible Asset Amortization, and External Expenses Related to Acquisition
Business Acquisition [Line Items]
Net income						2,400,000								14,400,000
Interest Expense, Intangible Asset Amortization, and External Expenses Related to Acquisition \| Derma Sciences
Business Acquisition [Line Items]
Net income				$ 2,900,000
Codman
Business Acquisition [Line Items]
Consideration for acquisition	$ 1,014,000,000
Revenue of acquired company						78,900,000								236,000,000
Purchase price adjustment						(800,000)							$ 3,200,000	3,964,000
Purchase price, working capital adjustments													6,200,000
Purchase price, inventory adjustments													$ 3,000,000
Purchase price, property, plant and equipment adjustment						5,500,000
Write off of construction in progress									6,300,000
Codman \| Fair Value Adjustment to Inventory
Business Acquisition [Line Items]
Cost of good sold related to fair value inventory purchase accounting adjustments						2,800,000								17,300,000
Codman \| Completed technology
Business Acquisition [Line Items]
Purchase price, intangible asset adjustment						4,700,000
Derma Sciences
Business Acquisition [Line Items]
Consideration for acquisition			$ 210,800,000
Payment of closing expenses			4,800,000
Settlement of stock compensation plan			4,300,000
Cash payment to former shareholders			201,700,000
Acquired deferred taxes			$ 14,524,000			14,500,000								14,500,000
Deferred tax asset, federal net operating loss						39,700,000								39,700,000
Deferred tax asset, intangibles						16,400,000								16,400,000
Deferred tax liabilities, intangibles						41,100,000								41,100,000
Deferred tax asset, various						500,000								500,000
Deferred tax liabilities, adjustment to estimated fair value											1,500,000
Deferred tax assets, adjustment to estimated fair value									3,300,000
Derma Sciences \| BioD Earnout Payments
Business Acquisition [Line Items]
Payment for contingent consideration					$ 4,800,000	0
Revenue volatility percentage			13.50%
Contingent consideration maximum payout			$ 26,500,000
Estimated fair value of the remaining portion of the contingent consideration, liability			9,100,000						300,000
Derma Sciences \| Product Payment Contingent Consideration
Business Acquisition [Line Items]
Contingent consideration maximum payout			29,700,000.0
Estimated fair value of the remaining portion of the contingent consideration, liability			$ 26,800,000
Product payment rate			98.00%
Change in fair value of contingent consideration											$ 900,000
Payment for the product payment		$ 26,600,000
Derma Sciences \| Medihoney Earnout Payments
Business Acquisition [Line Items]
Payment for contingent consideration							$ 2,000,000
Revenue volatility percentage			27.50%
Contingent consideration maximum payout			$ 5,000,000.0
Estimated fair value of the remaining portion of the contingent consideration, liability			$ 1,400,000			$ 200,000			$ 1,400,000					$ 200,000
Derma Sciences \| Measurement Input, Discount Rate \| BioD Earnout Payments
Business Acquisition [Line Items]
Discounted cash flow model, measurement input			0.030
Derma Sciences \| Measurement Input, Discount Rate \| Product Payment Contingent Consideration
Business Acquisition [Line Items]
Discounted cash flow model, measurement input			0.025
Derma Sciences \| Measurement Input, Discount Rate \| Medihoney Earnout Payments
Business Acquisition [Line Items]
Discounted cash flow model, measurement input			0.045

BUSINESS ACQUISITIONS AND DIVESTITURE - Schedule of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Oct. 02, 2017	Feb. 24, 2017	Sep. 30, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Other current assets	$ 8,202
Intangible assets:
Goodwill			$ 926,369	$ 937,905
Codman
Business Acquisition [Line Items]
Inventory	74,962
Assets held for sale	30,813
Property, plant and equipment	41,339
Intangible assets:
Goodwill	342,322
Total assets acquired	1,035,738
Accrued expenses	1,730
Pension liabilities	19,917
Net assets acquired	1,014,091
Codman \| Completed technology
Intangible assets:
Intangible assets, definite-lived	$ 375,200
Weighted Average Life	22 years
Codman \| Trade Names
Intangible assets:
Intangible assets, indefinite-lived	$ 162,900
Derma Sciences
Business Acquisition [Line Items]
Cash and cash equivalents		$ 16,512
Short-term investments		19,238
Accounts receivable		8,949
Inventory		17,977
Prepaid expenses and other current assets		4,369
Property, plant and equipment		4,311
Intangible assets:
Goodwill		73,765
Deferred tax assets		14,524	$ 14,500
Other assets		101
Total assets acquired		263,426
Accounts payable		4,560
Accrued expenses and other current liabilities		7,409
Contingent liability		37,174
Other liabilities		3,805
Net assets acquired		210,478
Derma Sciences \| Customer relationship
Intangible assets:
Intangible assets, definite-lived		$ 78,300
Weighted Average Life		14 years
Derma Sciences \| Trademarks/brand names
Intangible assets:
Intangible assets, definite-lived		$ 13,500
Weighted Average Life		15 years
Derma Sciences \| Completed technology
Intangible assets:
Intangible assets, definite-lived		$ 11,600
Weighted Average Life		14 years
Derma Sciences \| Non-compete agreement
Intangible assets:
Intangible assets, definite-lived		$ 280
Weighted Average Life		1 year

BUSINESS ACQUISITIONS AND DIVESTITURE - Schedule of Assets and Liabilities Divested (Details) - Codman Specialty Surgical - Disposal Group, Held-for-sale, Not Discontinued Operations $ in Thousands	Oct. 06, 2017 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Inventories	$ 8,348
Prepaid expenses and other current assets	36
Assets held for sale	30,813
Property, plant and equipment, net	1,122
Goodwill	2,861
Total assets divested	43,180
Deferred revenue	1,082
Accrued compensation	209
Total liabilities divested	$ 1,291

BUSINESS ACQUISITIONS AND DIVESTITURE - Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2017	Sep. 30, 2017
Business Combinations [Abstract]
Total revenue	$ 352,351	$ 1,059,889
Net income	$ 1,385	$ 24,064
Basic income per share (in dollars per share)	$ 0.02	$ 0.32

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Jan. 01, 2018	Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Number of days from shipment to issue a credit	90 days
Short-term portion of contract liability	$ 3,600
Long-term portion of contract liability	$ 7,300
Product warranty period (up to)	2 years
Increase to opening retained earnings	$ 323,236		$ 285,186
Increase to total assets	3,178,642		3,211,257
Increase to total liabilities	$ 1,813,561		$ 2,248,951
Accounting Standards Update 2014-09 \| Adjustment Resulting from Adoption of Topic 606
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Increase to total assets		$ 7,100
Increase to total liabilities		5,200
Accounting Standards Update 2014-09 \| Adjustment Resulting from Adoption of Topic 606 \| Transferred over Time \| Private Label
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Increase to opening retained earnings		$ 1,900
Minimum
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance	1 month
Maximum
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance	3 months

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) $ in Millions	Sep. 30, 2018 USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2018-10-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 1.1
Performance obligations expected to be satisfied, expected timing	3 months
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2019-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 2.8
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2020-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 2.1
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 1.3
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 0.8
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied	$ 2.8
Performance obligations expected to be satisfied, expected timing

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2018 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 3,552
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(3,552)
Contract asset, net of transferred to trade receivables on contracts during the period	3,068
Contract asset, End of Period	3,068
Contract Liability
Contract liability, Beginning of Period	11,059
Recognition of revenue included in beginning of year contract liability	(4,356)
Contract liability, net of revenue recognized on contracts during the period	4,259
Foreign currency translation	(30)
Contract liability, End of Period	$ 10,932

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Disaggregation of Revenue [Line Items]
Total Revenues	$ 365,854	$ 278,834	$ 1,089,126	$ 819,634
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	239,035	164,760	714,654	480,907
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	171,680	95,887	509,166	276,574
Codman Specialty Surgical \| Precision Tools and Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	67,355	68,873	205,488	204,333
Orthopedics and Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	126,819	114,074	374,472	338,727
Orthopedics and Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	78,290	69,667	225,003	194,177
Orthopedics and Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total Revenues	22,706	22,912	71,244	71,193
Orthopedics and Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 25,823	$ 21,495	$ 78,225	$ 73,357

REVENUES FROM CONTRACTS WITH CUSTOMERS - Impact of Adoption on Statement of Operations (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2017
Statement of Operations
Total revenue, net	$ 365,854			$ 278,834			$ 1,089,126	$ 819,634
Cost of goods sold	143,245			101,757			425,032	287,340
Income tax benefit	(2,271)			76			(2,776)	(4,406)
Net income	13,295	$ 11,376	$ 10,992	$ 3,159	$ 10,835	$ 6,394	35,663	$ 20,388
Excluding Impact of Topic 606
Statement of Operations
Total revenue, net	368,990						1,089,153
Cost of goods sold	143,918						424,969
Income tax benefit	(1,092)						(2,754)
Net income	$ 14,579						$ 35,731

- Definition

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

+ References + Details

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2018	Dec. 31, 2017
Inventory, Net [Abstract]
Finished goods	$ 183,669	$ 190,100
Work in process	51,933	58,637
Raw materials	55,244	47,595
Inventories, net	$ 290,846	$ 296,332

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended	9 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Sep. 30, 2018
Goodwill [Roll Forward]
Goodwill at December 31, 2017		$ 937,905	$ 937,905
Foreign currency translation			(7,572)
Goodwill at September 30, 2018	$ 926,369		926,369
Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments	800	(3,200)	(3,964)
Codman Specialty Surgical
Goodwill [Roll Forward]
Goodwill at December 31, 2017		634,767	634,767
Foreign currency translation			(5,114)
Goodwill at September 30, 2018	625,689		625,689
Codman Specialty Surgical \| Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments			(3,964)
Orthopedics and Tissue Technologies
Goodwill [Roll Forward]
Goodwill at December 31, 2017		$ 303,138	303,138
Foreign currency translation			(2,458)
Goodwill at September 30, 2018	$ 300,680		300,680
Orthopedics and Tissue Technologies \| Codman
Goodwill [Roll Forward]
Codman acquisition measurement period adjustments			$ 0

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2018	Dec. 31, 2016	Dec. 31, 2017
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,400,869		$ 1,416,615
Accumulated Amortization	(303,610)		(256,988)
Net	1,097,259		1,159,627
Trade Names
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	162,900		162,900
Net	$ 162,900		162,900
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	19 years	19 years
Cost	$ 855,799		869,174
Accumulated Amortization	(156,157)		(124,096)
Net	$ 699,642		745,078
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	13 years	13 years
Cost	$ 232,083		233,430
Accumulated Amortization	(102,618)		(91,961)
Net	$ 129,465		141,469
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 104,347		104,879
Accumulated Amortization	(24,903)		(22,293)
Net	$ 79,444		82,586
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	27 years
Cost	$ 34,721		34,721
Accumulated Amortization	(16,162)		(15,092)
Net	$ 18,559		19,629
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	4 years	4 years
Cost	$ 11,019		11,511
Accumulated Amortization	(3,770)		(3,546)
Net	$ 7,249		$ 7,965

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2018 USD ($)	Sep. 30, 2017 USD ($)	Sep. 30, 2018 USD ($) reporting_unit	Sep. 30, 2017 USD ($)
Goodwill [Line Items]
Number of reporting units \| reporting_unit			3
Reporting unit, discount rate percentage	9.00%		9.00%
Goodwill, impairment	$ 0
Intangible assets, indefinite life, discount rate percentage	13.00%		13.00%
Impairment charge			$ 4,941,000	$ 3,290,000
Expected annual amortization expense, 2018	$ 71,600,000		71,600,000
Expected annual amortization expense, 2019	66,400,000		66,400,000
Expected annual amortization expense, 2020	66,200,000		66,200,000
Expected annual amortization expense, 2021	65,200,000		65,200,000
Expected annual amortization expense, 2022	61,700,000		61,700,000
Expected annual amortization expense, 2023	60,800,000		60,800,000
Expected annual amortization expense, thereafter	599,300,000		599,300,000
Metasurg \| Orthopedics and Tissue Technologies
Goodwill [Line Items]
Impairment charge	4,900,000		4,900,000
Impairment charge, out of period adjustment included in original impairment	2,500,000		2,500,000
Metasurg \| Orthopedics and Tissue Technologies \| Completed technology
Goodwill [Line Items]
Remaining net book value	$ 2,300,000		$ 2,300,000
Tarsus \| Orthopedics and Tissue Technologies
Goodwill [Line Items]
Impairment charge		$ 3,300,000

DEBT - Narrative (Details) - USD ($)	3 Months Ended	9 Months Ended
DEBT - Narrative (Details) - USD ($)	Jun. 30, 2018	Sep. 30, 2018	May 03, 2018	Dec. 31, 2017	Oct. 31, 2017
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 2,200,000,000.0
Previously capitalized financing costs, written-off	$ 800,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity			1,300,000,000
Line of credit facility outstanding		$ 545,000,000		$ 655,000,000
Weighted average interest rate on debt		3.80%		3.70%
Revolving Credit Facility \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		$ 524,100,000
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity			60,000,000
Swingline Loans
Debt Instrument [Line Items]
Maximum borrowing capacity			60,000,000
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 900,000,000
Term Loan Facility \| Secured Debt \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		875,400,000
Senior Credit Facility
Debt Instrument [Line Items]
Incremental financing costs capitalized	$ 4,200,000			$ 500,000
Available borrowings under senior secured revolving credit facility		$ 754,400,000
Senior Credit Facility \| Federal Funds
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.50%
Senior Credit Facility \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available to the Company at its option		1.00%
Senior Credit Facility \| Minimum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage		0.15%
Senior Credit Facility \| Minimum \| Eurodollar
Debt Instrument [Line Items]
Interest rates available to the Company at its option		1.00%
Senior Credit Facility \| Minimum \| Federal Funds
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.00%
Senior Credit Facility \| Minimum \| Prime Rate
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.00%
Senior Credit Facility \| Minimum \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.00%
Senior Credit Facility \| Maximum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage		0.30%
Senior Credit Facility \| Maximum \| Eurodollar
Debt Instrument [Line Items]
Interest rates available to the Company at its option		1.75%
Senior Credit Facility \| Maximum \| Federal Funds
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.75%
Senior Credit Facility \| Maximum \| Prime Rate
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.75%
Senior Credit Facility \| Maximum \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available to the Company at its option		0.75%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding		$ 0
Letters of credit outstanding		600,000		600,000
Term Loan A-1 \| Secured Debt
Debt Instrument [Line Items]
Incremental financing costs capitalized					$ 19,100,000
Term Loan A \| Secured Debt
Debt Instrument [Line Items]
Line of credit facility outstanding		$ 900,000,000		$ 1,200,000,000
Weighted average interest rate on debt		3.70%		3.60%
Term Loan A \| Secured Debt \| Secured Debt, Current
Debt Instrument [Line Items]
Line of credit facility outstanding		$ 11,300,000

DEBT - Maximum Total Leverage Ratio Table (Details) - Senior Credit Facility	Sep. 30, 2018
Execution of May 2018 Amendment through March 31, 2019
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5.50
June 30, 2019 through March 31, 2020
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5.00
June 30, 2020 through March 31, 2021
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.50
June 30, 2021 and thereafter
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.00

DEBT - Contractual Maturity Table (Details) $ in Thousands	Sep. 30, 2018 USD ($)
Debt Disclosure [Abstract]
Remainder of 2018	$ 0
2019	22,500
2020	45,000
2021	56,250
2022	67,500
2023	708,750
Principal Repayment	$ 900,000

DERIVATIVE INSTRUMENTS - Schedule of Derivatives (Details) - Cash Flow Hedging - Designated as Hedging Instrument	Sep. 30, 2018 USD ($)
Derivative [Line Items]
Current Notional Amount	$ 1,050,000,000
Estimated Fair Value, Assets (Liabilities)	26,929,000
3-Month USD LIBOR \| Interest Rate Swap Designated June 22, 2016 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 50,000,000
Fixed Interest Rate	1.062%
Estimated Fair Value, Assets (Liabilities)	$ 588,000
3-Month USD LIBOR \| Interest Rate Swap Designated June 22, 2016 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 50,000,000
Fixed Interest Rate	1.062%
Estimated Fair Value, Assets (Liabilities)	$ 924,000
3-Month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 50,000,000
Fixed Interest Rate	1.834%
Estimated Fair Value, Assets (Liabilities)	$ 590,000
1-Month USD LIBOR \| Interest Rate Swap Designated July 12, 2016
Derivative [Line Items]
Current Notional Amount	$ 50,000,000
Fixed Interest Rate	0.825%
Estimated Fair Value, Assets (Liabilities)	$ 637,000
1-Month USD LIBOR \| Interest Rate Swap Designated February 6, 2017 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 100,000,000
Fixed Interest Rate	1.652%
Estimated Fair Value, Assets (Liabilities)	$ 1,950,000
1-Month USD LIBOR \| Interest Rate Swap Designated March 27, 2017
Derivative [Line Items]
Current Notional Amount	$ 100,000,000
Fixed Interest Rate	1.971%
Estimated Fair Value, Assets (Liabilities)	$ 2,342,000
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 150,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Assets (Liabilities)	$ 4,322,000
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 150,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Assets (Liabilities)	$ 4,277,000
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Current Notional Amount	$ 100,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Assets (Liabilities)	$ 2,786,000
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 4
Derivative [Line Items]
Current Notional Amount	$ 50,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Assets (Liabilities)	$ 1,339,000
1-Month USD LIBOR \| Interest Rate Swap Designated December 13, 2017 Tranche 5
Derivative [Line Items]
Current Notional Amount	$ 200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value, Assets (Liabilities)	$ 7,174,000

DERIVATIVE INSTRUMENTS - Narrative (Details)	3 Months Ended	9 Months Ended
DERIVATIVE INSTRUMENTS - Narrative (Details)	Sep. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Oct. 10, 2018 USD ($)	Oct. 01, 2018 USD ($)	Dec. 31, 2017 USD ($)	Nov. 28, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)	Oct. 02, 2017 USD ($)
Derivative [Line Items]
Pre-tax income recorded in AOCI related to cash flow hedges to be reclassified to earnings in the next twelve months	$ 14,300,000	$ 14,300,000
Designated as Hedging Instrument \| Cash Flow Hedging
Derivative [Line Items]
Notional amount	1,050,000,000	1,050,000,000
Interest Rate Swap
Derivative [Line Items]
Notional amount	1,050,000,000	1,050,000,000			$ 1,050,000,000
Interest Rate Swap \| Designated as Hedging Instrument \| Cash Flow Hedging \| Subsequent Event
Derivative [Line Items]
Notional amount			$ 225,000,000.0
Foreign Exchange Forward \| Not Designated as Hedging Instrument
Derivative [Line Items]
Notional amount						$ 8,900,000.0
Loss from the change in fair value	200,000	200,000
Cross-currency swap \| Codman
Derivative [Line Items]
Gain (loss), reclassification from AOCI, foreign currency rate translation, intercompany loan	(2,600,000)	2,200,000
Gain reclassified into income	1,900,000	5,900,000
Pre-tax income recorded in AOCI related to cash flow hedges to be reclassified to earnings in the next twelve months	7,600,000	7,600,000
Cross-currency swap \| Codman \| Other income (expense)
Derivative [Line Items]
Gain (loss) recorded to AOCI	$ (3,100,000)	$ 3,000,000
Cross-currency swap \| Short \| Codman
Derivative [Line Items]
Notional amount								$ 300,000,000.0
Cross-currency swap \| Long \| Codman
Derivative [Line Items]
Notional amount \| SFr							SFr 291,200,000.0
Cross-currency swap \| Designated as Hedging Instrument \| Net Investment Hedging \| Subsequent Event
Derivative [Line Items]
Notional amount				$ 354,500,000.0

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details)	Sep. 30, 2018 CHF (SFr)	Sep. 30, 2018 USD ($)	Oct. 02, 2017 CHF (SFr)	Oct. 02, 2017 USD ($)
Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Aggregate Notional Amount \| SFr			SFr 291,200,000.0
Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Aggregate Notional Amount				$ 300,000,000.0
Cash Flow Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount		$ 1,050,000,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Liability		(6,863,000)
Cash Flow Hedging \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Liability		$ (1,286,000)
Cash Flow Hedging \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.75%	1.75%
Aggregate Notional Amount \| SFr	SFr 97,065,000
Cash Flow Hedging \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.38%	4.38%
Aggregate Notional Amount		$ 100,000,000
Cash Flow Hedging \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Liability		$ (1,110,000)
Cash Flow Hedging \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%
Aggregate Notional Amount \| SFr	SFr 48,533,000
Cash Flow Hedging \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%
Aggregate Notional Amount		$ 50,000,000
Cash Flow Hedging \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Liability		$ (4,467,000)
Cash Flow Hedging \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount \| SFr	SFr 145,598,000
Cash Flow Hedging \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount		$ 150,000,000

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) - USD ($)	9 Months Ended
	Sep. 30, 2018	Dec. 31, 2017
Derivatives, Fair Value [Line Items]
Expected reduction to notional amount in June 2019	$ 150,000,000
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	34,531,000	$ 11,769,000
Derivatives designated as hedges — Liabilities	14,466,000	15,134,000
Interest Rate Swap
Derivatives, Fair Value [Line Items]
Notional amount	1,050,000,000	1,050,000,000
Interest Rate Swap \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	6,682,000	1,521,000
Interest Rate Swap \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	20,246,000	2,491,000
Interest Rate Swap \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	0	1,845,000
Interest Rate Swap \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	0	1,575,000
Cross-currency swap \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	7,603,000	7,757,000
Cross-currency swap \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	$ 14,466,000	$ 11,714,000

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,341,905	$ 894,554	$ 962,306	$ 839,667
Balance, End of Period	1,365,081	913,116	1,365,081	913,116
Cash Flow
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	14,452	935	(4,512)	1,871
Amount of Gain (Loss) Recognized in AOCI	1,992	297	29,307	(618)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(234)	(63)	8,117	(42)
Balance, End of Period	16,678	1,295	16,678	1,295
Cash Flow \| Interest rate swap \| Interest (expense)
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	22,344	935	592	1,871
Amount of Gain (Loss) Recognized in AOCI	5,059	297	26,307	(618)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	473	(63)	(31)	(42)
Balance, End of Period	26,930	$ 1,295	26,930	$ 1,295
Cash Flow \| Cross-currency swap \| Other income (expense)
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(7,892)		(5,104)
Amount of Gain (Loss) Recognized in AOCI	(3,067)		3,000
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(707)		8,148
Balance, End of Period	$ (10,252)		$ (10,252)

STOCK-BASED COMPENSATION - Narrative (Details) $ in Millions	9 Months Ended
	Sep. 30, 2018 USD ($) plan shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation arrangement by share-based payment award, number of plans \| plan	2
Grants in period, net of forfeitures (in shares)	139,938
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs \| $	$ 4.8
Weighted-average period for cost recognition	2 years
Stock options \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	3 years
Stock options \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	4 years
Stock options \| Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	1 year
Stock options \| Employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	8 years
Stock options \| Directors and Certain Executive Officers \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	8 years
Stock options \| Directors and Certain Executive Officers \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	10 years
Performance stock and Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Requisite service periods of awards	3 years
Restricted stock awards/stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	3 years
Total unrecognized compensation costs \| $	$ 24.3
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares)	266,354
Performance shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards granted during the period (in shares)	119,459

DEFINED BENEFIT PLANS - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2018	Dec. 31, 2017
Retirement Benefits [Abstract]
Net periodic benefit costs	$ 0.5	$ 1.7
Service cost component	0.7	2.1
Expected future employer contributions, next fiscal year			$ 1.8
Employer contributions		1.1
Expected additional employer contributions	0.9	0.9
Expected employer contributions, this fiscal year	2.0	2.0
Estimated fair value of plan assets	$ 30.4	$ 30.4	$ 26.9

TREASURY STOCK - Narrative (Details) - USD ($)	9 Months Ended		12 Months Ended
TREASURY STOCK - Narrative (Details) - USD ($)	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017	Oct. 25, 2016
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
Stock repurchase program, authorized amount (up to)				$ 150,000,000.0
Amount available for share repurchase under this latest authorization	$ 150,000,000.0
Treasury stock (in shares)	2,900,000		2,900,000
Treasury stock	$ 120,700,000		$ 121,600,000
Treasury stock, average cost per share (in dollars per share)	$ 41.87		$ 41.77
Stock repurchased during period (in shares)	0	0

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		9 Months Ended
INCOME TAXES - Summary of Effective Tax Rate (Details)	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Income Tax Disclosure [Abstract]
Reported tax rate	(20.60%)	2.30%	(8.40%)	(27.60%)

INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Effective income tax rate	(20.60%)	2.30%	(8.40%)	(27.60%)
Excess tax benefit from share-based compensation		$ 2.1		$ 1.9
Foreign tax credit	$ 1.1		$ 1.1
Provisional income tax expense, Tax Cuts and Jobs Act of 2017	$ 0.8				$ 5.5
GILTI foreign tax credit			$ 2.2
Income tax expense, to be paid within one year, Tax Cuts and Jobs Act of 2017					4.6
Tax benefit, re-measurement of net deferred tax liabilities, Tax Cuts and Jobs Act of 2017					$ 43.4

NET INCOME PER SHARE - Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2017
Basic net income per share:
Net income	$ 13,295	$ 11,376	$ 10,992	$ 3,159	$ 10,835	$ 6,394	$ 35,663	$ 20,388
Weighted average common shares outstanding - Basic (in shares)	85,193			78,186			82,058	76,387
Basic net income per common share (in dollars per share)	$ 0.16			$ 0.04			$ 0.43	$ 0.27
Diluted net income per share:
Net income	$ 13,295	$ 11,376	$ 10,992	$ 3,159	$ 10,835	$ 6,394	$ 35,663	$ 20,388
Weighted average common shares outstanding - Basic (in shares)	85,193			78,186			82,058	76,387
Effect of dilutive securities:
Warrants (in shares)	0			158			0	1,295
Stock options and restricted stock (in shares)	1,106			1,111			1,084	1,291
Weighted average common shares for diluted earnings per share (in shares)	86,299			79,455			83,142	78,973
Diluted net income per common share (in dollars per share)	$ 0.15			$ 0.04			$ 0.43	$ 0.26

NET INCOME PER SHARE - Narrative (Details) - shares	9 Months Ended		12 Months Ended
NET INCOME PER SHARE - Narrative (Details) - shares	Sep. 30, 2018	Sep. 30, 2017	Dec. 31, 2017	Dec. 15, 2016
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares excluded from computation as their effect would be anti-dilutive (in shares)	200,000	300,000
Vested Restricted Units and Vested Performance Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Weighted average number of shares outstanding, basic and diluted (in shares)	500,000
Convertible Debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Warrants exercised (in shares)			8,707,202
Common stock from the exercise of warrants (in shares)			2,839,743
Warrants outstanding (in shares)	0
2016 Senior Convertible Notes \| Convertible Debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Interest rate on debt				1.625%

COMPREHENSIVE INCOME - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Sep. 30, 2018	Sep. 30, 2017
Equity [Abstract]
Net income	$ 13,295	$ 11,376	$ 10,992	$ 3,159	$ 10,835	$ 6,394	$ 35,663	$ 20,388
Foreign currency translation adjustment	(2,353)			10,175			(16,359)	33,724
Change in unrealized gain (loss) on derivatives, net of tax	1,386			207			14,419	(331)
Pension liability adjustment, net of tax	2			(7)			8	(22)
Comprehensive income, net	$ 12,330			$ 13,534			$ 33,731	$ 53,759

- Definition

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

+ References + Details

COMPREHENSIVE INCOME - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands		3 Months Ended						9 Months Ended
	Jan. 01, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Sep. 30, 2018
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 962,306	$ 1,341,905	$ 998,440	$ 962,306	$ 894,554	$ 852,491	$ 839,667	$ 962,306
Reclassification of stranded tax effect	(532)
Other comprehensive income (loss)								4,310
Amounts reclassified from accumulated other comprehensive income								6,242
Net current-period other comprehensive income (loss)		(965)	(22,578)	21,612	10,375	17,295	5,701	(1,932)
Balance, End of Period		1,365,081	1,341,905	998,440	913,116	894,554	852,491	1,365,081
Cash Flow Hedges
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(2,979)			(2,979)				(2,979)
Reclassification of stranded tax effect	(532)
Other comprehensive income (loss)								20,661
Amounts reclassified from accumulated other comprehensive income								6,242
Net current-period other comprehensive income (loss)								14,419
Balance, End of Period	(3,511)	10,908						10,908
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(93)			(93)				(93)
Reclassification of stranded tax effect	0
Other comprehensive income (loss)								8
Amounts reclassified from accumulated other comprehensive income								0
Net current-period other comprehensive income (loss)								8
Balance, End of Period	(93)	(85)						(85)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(20,735)			(20,735)				(20,735)
Reclassification of stranded tax effect	0
Other comprehensive income (loss)								(16,359)
Amounts reclassified from accumulated other comprehensive income								0
Net current-period other comprehensive income (loss)								(16,359)
Balance, End of Period	(20,735)	(37,094)						(37,094)
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(23,807)	(25,306)	(1,663)	(23,807)	(34,158)	(51,453)	(57,154)	(23,807)
Net current-period other comprehensive income (loss)		(965)	(23,643)	22,144	10,375	17,295	5,701
Balance, End of Period	$ (24,339)	$ (26,271)	$ (25,306)	$ (1,663)	$ (23,783)	$ (34,158)	$ (51,453)	$ (26,271)

COMPREHENSIVE INCOME - Narrative (Details) $ in Thousands	9 Months Ended
COMPREHENSIVE INCOME - Narrative (Details) $ in Thousands	Sep. 30, 2018 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain reclassified from accumulated other comprehensive income	$ 6,242
Other Expense \| Accumulated Net Investment Gain (Loss) Attributable to Parent
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain reclassified from accumulated other comprehensive income	$ 6,200

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	9 Months Ended
	Sep. 30, 2018 product Segment
Segment Reporting Information [Line Items]
Number of reportable segments \| Segment	2
Codman Specialty Surgical
Segment Reporting Information [Line Items]
Number of products offered (more than) \| product	60,000

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Segment Net Sales
Total Revenues	$ 365,854	$ 278,834	$ 1,089,126	$ 819,634
Segment Profit
Operating income	23,677	10,642	76,890	37,586
Amortization	(5,268)	(5,456)	(15,944)	(14,976)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	239,035	164,760	714,654	480,907
Orthopedics and Tissue Technologies
Segment Net Sales
Total Revenues	126,819	114,074	374,472	338,727
Operating Segments
Segment Profit
Operating income	127,386	98,700	377,574	286,742
Operating Segments \| Codman Specialty Surgical
Segment Profit
Operating income	91,871	68,289	272,480	198,242
Operating Segments \| Orthopedics and Tissue Technologies
Segment Profit
Operating income	35,515	30,411	105,094	88,500
Segment Reconciling Items
Segment Profit
Amortization	(5,268)	(5,456)	(15,944)	(14,976)
Corporate and other
Segment Profit
Operating income	$ (98,441)	$ (82,602)	$ (284,740)	$ (234,180)

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017	Sep. 30, 2018	Sep. 30, 2017
Segment Reporting Information [Line Items]
Total Revenues	$ 365,854	$ 278,834	$ 1,089,126	$ 819,634
United States
Segment Reporting Information [Line Items]
Total Revenues	260,870	213,685	769,509	634,047
Europe
Segment Reporting Information [Line Items]
Total Revenues	47,472	32,609	150,650	93,924
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	37,022	16,887	108,304	48,540
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 20,490	$ 15,653	$ 60,663	$ 43,123

COMMITMENTS AND CONTINGENCIES - Narrative (Details)		1 Months Ended		3 Months Ended	9 Months Ended	38 Months Ended
COMMITMENTS AND CONTINGENCIES - Narrative (Details)	Jul. 17, 2015 USD ($)	Oct. 31, 2018 USD ($)	Aug. 31, 2017 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2018 USD ($)	Oct. 11, 2018 case	Mar. 31, 2018 USD ($)	Dec. 31, 2017 USD ($)	Feb. 24, 2017 USD ($)	Jan. 15, 2014 USD ($)
Loss Contingencies [Line Items]
Payment for contingent consideration					$ 15,900,000
Measurement Input, Discount Rate \| Supply Commitment, Current, Long-Term, and Above Market
Loss Contingencies [Line Items]
Discounted cash flow model, measurement input				0.120	0.120	0.120
TEI
Loss Contingencies [Line Items]
Indemnification policy in place	$ 3,000,000.0
TEI \| Indemnification period - up to fifteen months after close
Loss Contingencies [Line Items]
Maximum indemnification from acquisition	$ 30,000,000
Period of indemnification	15 months
Indemnification payments received						$ 0
Indemnification payments owed				$ 0	$ 0	$ 0
TEI \| Indemnification period - up to 3 years after close
Loss Contingencies [Line Items]
Maximum indemnification from acquisition	$ 30,000,000
Period of indemnification	3 years
Minimum indemnification from acquisition	$ 20,000,000
TEI \| Third Party Insurer
Loss Contingencies [Line Items]
Indemnification policy in place	$ 3,000,000.0
TEI \| Subsequent Event
Loss Contingencies [Line Items]
Number of active cases \| case							1
Confluent Surgical, Inc.
Loss Contingencies [Line Items]
Maximum contingent consideration											$ 30,000,000
Minimum contingent consideration (up to)											$ 19,000,000
Contingent consideration, liability								$ 19,000,000
Confluent Surgical, Inc. \| Measurement Input, Discount Rate \| Contingent Consideration Liability
Loss Contingencies [Line Items]
Discounted cash flow model, measurement input											0.022
Confluent Surgical, Inc. \| Cash Consideration One
Loss Contingencies [Line Items]
Maximum contingent consideration											$ 25,000,000
Confluent Surgical, Inc. \| Cash Consideration Two
Loss Contingencies [Line Items]
Maximum contingent consideration											$ 5,000,000
Confluent Surgical, Inc. \| Subsequent Event
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 5,000,000
Derma Sciences \| BioD Earnout Payments
Loss Contingencies [Line Items]
Maximum contingent consideration										$ 26,500,000
Contingent consideration, liability									$ 300,000	$ 9,100,000
Payment for contingent consideration			$ 4,800,000	$ 0
Derma Sciences \| BioD Earnout Payments \| Measurement Input, Discount Rate
Loss Contingencies [Line Items]
Discounted cash flow model, measurement input										0.030

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Derma Sciences \| Accrued expenses and other short-term liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 315	$ 0
Additions from acquisition of Derma Sciences		33,707
Transfers from long-term to current portion	1,387	2,193
Payments	(2,000)	(31,346)
Balance, End of Period	0	2,133
Derma Sciences \| Accrued expenses and other short-term liabilities \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/Loss from change in fair value of contingent consideration liabilities	298	(2,421)
Derma Sciences \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	1,387	0
Additions from acquisition of Derma Sciences		3,467
Transfers from long-term to current portion	(1,387)	(2,193)
Payments	0	0
Balance, End of Period	230	1,356
Derma Sciences \| Other Long-term Liabilities \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/Loss from change in fair value of contingent consideration liabilities	230	82
Confluent Surgical, Inc. \| Accrued expenses and other short-term liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	22,478	0
Additions from acquisition of Derma Sciences		0
Transfers from long-term to current portion	0	21,312
Payments	(19,000)	0
Balance, End of Period	5,000	21,312
Confluent Surgical, Inc. \| Accrued expenses and other short-term liabilities \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/Loss from change in fair value of contingent consideration liabilities	$ 1,522	0
Confluent Surgical, Inc. \| Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period		22,036
Additions from acquisition of Derma Sciences		0
Transfers from long-term to current portion		(21,312)
Payments		0
Balance, End of Period		872
Confluent Surgical, Inc. \| Other Long-term Liabilities \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/Loss from change in fair value of contingent consideration liabilities		$ 148

COMMITTMENTS AND CONTINGENCIES - Fair Value Supply Agreement (Details) - Supply Commitments - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Accrued expenses and other short-term liabilities \| Supply Agreement Liability - Short-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period		$ 166
Payments		(166)
Transfer from long-term to current portion		0
Balance, End of Period		0
Accrued expenses and other short-term liabilities \| Supply Agreement Liability - Short-term \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/loss from change in fair value		0
Accrued expenses and other short-term liabilities \| Above Market Supply Agreement Liability - Short- Term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 2,641	0
Payments	(1,546)	0
Transfer from long-term to current portion		3,216
Transfer to accounts payable	(164)
Balance, End of Period	303	2,864
Accrued expenses and other short-term liabilities \| Above Market Supply Agreement Liability - Short- Term \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/loss from change in fair value	$ (628)	(352)
Other Long-term Liabilities \| Above Market Supply Agreement Liability - Long-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period		2,648
Payments		(415)
Transfer from long-term to current portion		(3,216)
Balance, End of Period		57
Other Long-term Liabilities \| Above Market Supply Agreement Liability - Long-term \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
(Gain)/loss from change in fair value		$ 1,040