DOCUMENT AND ENTITY INFORMATION - shares	9 Months Ended
DOCUMENT AND ENTITY INFORMATION - shares	Sep. 30, 2019	Oct. 22, 2019
Cover page.
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2019
Document Transition Report	false
Entity File Number	0-26224
Entity Registrant Name	INTEGRA LIFESCIENCES HOLDINGS CORP
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0317849
Entity Address	311 Enterprise Drive
Entity City	Plainsboro
Entity State	NJ
Entity Postal Zip Code	08536
City Area Code	609
Local Phone Number	275-0500
Title of 12(b) Security	COMMON STOCK
Trading Symbol	IART
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Bankruptcy Proceedings, Reporting Current	false
Entity Common Stock, Shares Outstanding (in shares)		85,865,669
Amendment Flag	false
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q3
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME / (LOSS) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Statement [Abstract]
Total revenue, net	$ 379,095	$ 365,854	$ 1,122,430	$ 1,089,126
Costs and expenses:
Cost of goods sold	142,636	143,245	415,219	425,032
Research and development	19,003	20,309	53,280	57,742
In-process research and development	59,889	0	61,566	0
Selling, general and administrative	173,098	173,355	513,345	513,518
Intangible asset amortization	5,056	5,268	21,340	15,944
Total costs and expenses	399,682	342,177	1,064,750	1,012,236
Operating income (loss)	(20,587)	23,677	57,680	76,890
Interest income	2,913	75	8,051	325
Interest expense	(13,962)	(14,478)	(40,495)	(50,750)
Other income, net	4,127	1,750	8,461	6,422
Income (loss) before income taxes	(27,509)	11,024	33,697	32,887
Provision (benefit) for income taxes	101	(2,271)	(1,185)	(2,776)
Net income (loss)	$ (27,610)	$ 13,295	$ 34,882	$ 35,663
Net income (loss) per share
Basic (in dollars per share)	$ (0.32)	$ 0.16	$ 0.41	$ 0.43
Diluted (in dollars per share)	$ (0.32)	$ 0.15	$ 0.40	$ 0.43
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	85,688	85,193	85,536	82,058
Diluted (in shares)	85,688	86,299	86,581	83,142
Comprehensive income (loss) (See Note 14)	$ (46,521)	$ 12,330	$ (7,288)	$ 33,731

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 207,981	$ 138,838
Trade accounts receivable, net of allowances of $4,006 and $3,719	281,119	265,737
Inventories, net	302,622	280,347
Prepaid expenses and other current assets	92,091	90,160
Total current assets	883,813	775,082
Property, plant and equipment, net	319,384	300,112
Right of use asset - operating leases	97,738
Intangible assets, net	1,040,350	1,079,496
Goodwill	945,282	926,475
Deferred tax assets, net	27,005	6,805
Other assets	33,008	19,917
Total assets	3,346,580	3,107,887
Current liabilities:
Current portion of borrowings under senior credit facility	45,000	22,500
Current portion of lease liability - operating leases	11,835
Accounts payable, trade	94,158	76,050
Contract liabilities	3,984	3,764
Accrued compensation	74,415	75,693
Accrued expenses and other current liabilities	73,249	84,545
Total current liabilities	302,641	262,552
Long-term borrowings under senior credit facility	1,274,049	1,210,513
Long-term borrowings under securitization facility	110,000	121,200
Lease liability - operating leases	96,820
Deferred tax liabilities	59,730	57,778
Other liabilities	118,366	80,048
Total liabilities	1,961,606	1,732,091
Commitments and contingencies (Refer to Note 16)
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; 88,689 and 88,044 issued at September 30, 2019 and December 31, 2018, respectively	886	880
Additional paid-in capital	1,208,549	1,192,601
Treasury stock, at cost; 2,869 shares and 2,881 shares at September 30, 2019 and December 31, 2018, respectively	(120,101)	(120,615)
Accumulated other comprehensive loss	(87,615)	(45,443)
Retained earnings	383,255	348,373
Total stockholders’ equity	1,384,974	1,375,796
Total liabilities and stockholders’ equity	$ 3,346,580	$ 3,107,887

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 4,006	$ 3,719
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)	88,689,000	88,044,000
Treasury stock, shares (in shares)	2,869,000	2,881,000

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
OPERATING ACTIVITIES:
Net loss	$ 34,882	$ 35,663
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	81,584	83,053
Non-cash in-process research and development expense	59,889	0
Non-cash impairment charges	5,764	4,941
Deferred income tax	(10,536)	789
Amortization of debt issuance costs	4,084	4,953
Loss on disposal of property and equipment	844	969
Change in fair value of contingent consideration and other	10	1,214
Share-based compensation	15,744	15,786
Changes in assets and liabilities, net of business acquisitions:
Accounts receivable	(17,519)	1,180
Inventories	(30,553)	(3,441)
Prepaid expenses and other current assets	(8,162)	3,432
Other non-current assets	6,650	(1,397)
Accounts payable, accrued expenses and other current liabilities	366	9,418
Contract liabilities	(1,395)	(111)
Other non-current liabilities	597	546
Net cash provided by operating activities	142,249	156,995
INVESTING ACTIVITIES:
Purchases of property and equipment	(47,343)	(52,056)
Proceeds from note receivable	752	679
Proceeds from sale of property and equipment	36	298
Cash (paid) provided for business acquisitions, net of cash acquired	(30,509)	26,704
Acquired in-process research and development	(64,995)	0
Net cash used in investing activities	(142,059)	(24,375)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	215,800	50,000
Payments on debt	(143,250)	(460,000)
Payment of debt issuance costs	0	(4,388)
Proceeds from the issuance of common stock, net of issuance costs	0	349,590
Net cash paid for financing liabilities from business acquisitions	0	(33,843)
Proceeds from exercised stock options	6,948	9,239
Cash taxes paid in net equity settlement	(6,272)	(7,415)
Net cash (used in) / provided by financing activities	73,226	(96,817)
Effect of exchange rate changes on cash and cash equivalents	(4,273)	(4,747)
Net increase in cash and cash equivalents	69,143	31,056
Cash and cash equivalents at beginning of period	138,838	174,935
Cash and cash equivalents at end of period	$ 207,981	$ 205,991

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'S EQUITY - USD ($) $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Retained Earnings
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			(2,927,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	35,663					35,663
Other comprehensive loss, net of tax	(1,931)				(2,464)	533
Issuance of common stock (in shares)		597,000
Issuance of common stock	8,677	$ 6		8,671
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)		75,000	44,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(7,414)	$ 1	$ 917	(8,332)
Equity offering (in shares)		6,038,000
Equity offering	349,598	$ 60		349,538
Share-based compensation	15,775			15,775
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)
Balance Beginning of Period, Shares (in shares) at Jun. 30, 2018		87,772,000
Balance, Beginning of Period at Jun. 30, 2018	1,341,905	$ 877	$ (120,732)	1,177,125	(25,306)	309,941
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2018			(2,890,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	13,295					13,295
Other comprehensive loss, net of tax	(965)				(965)	0
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)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2018		88,044,000
Balance, Beginning of Period at Dec. 31, 2018	$ 1,375,796	$ 880	$ (120,615)	1,192,601	(45,443)	348,373
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2018	(2,881,000)		(2,881,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	$ 34,882					34,882
Other comprehensive loss, net of tax	(42,172)				(42,172)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		645,000	12,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	677	$ 6	$ 514	157
Share-based compensation	15,791			15,791
Balance End of Period, Shares (in shares) at Sep. 30, 2019		88,689,000
Balance, End of Period at Sep. 30, 2019	$ 1,384,974	$ 886	$ (120,101)	1,208,549	(87,615)	383,255
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2019	(2,869,000)		(2,869,000)
Balance Beginning of Period, Shares (in shares) at Jun. 30, 2019		88,351,000
Balance, Beginning of Period at Jun. 30, 2019	$ 1,420,951	$ 883	$ (120,107)	1,198,010	(68,700)	410,865
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2019			(2,869,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(27,610)					(27,610)
Other comprehensive loss, net of tax	(18,915)				(18,915)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)		338,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	4,674	$ 3	$ 6	4,665
Share-based compensation	5,874			5,874
Balance End of Period, Shares (in shares) at Sep. 30, 2019		88,689,000
Balance, End of Period at Sep. 30, 2019	$ 1,384,974	$ 886	$ (120,101)	$ 1,208,549	$ (87,615)	$ 383,255
Balance, End of Period, Treasury Stock, Shares (in shares) at Sep. 30, 2019	(2,869,000)		(2,869,000)

BASIS OF PRESENTATION	9 Months Ended
BASIS OF PRESENTATION	Sep. 30, 2019
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, 2019 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, 2018 included in the Company’s Annual Report on Form 10-K. The December 31, 2018 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 period ended September 30, 2019 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with generally accepted accounting principles in the United States ("GAAP") which 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 February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) (the New Lease Standard). The New Lease Standard 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 became effective for all annual periods and interim reporting periods beginning after December 15, 2018. The Company adopted the New Lease Standard as of January 1, 2019 using a modified retrospective transition. Under this method, financial results reported in periods prior to January 1, 2019 are unchanged. The Company elected the ‘package of practical expedients’ which permits the company not to reassess the prior conclusions about lease identification, lease classification and initial direct costs under the new standard. The Company also elected the use-of-hindsight practical expedient. As most of the leases do not provide an implicit rate, the Company used our collateralized incremental borrowing rate based on the information available at the lease implementation date in determining the present value of the lease payments. The adoption of the New Lease Standard had an initial impact on the consolidated balance sheet due to the recognition of $76.4 million of lease liabilities with corresponding right-of-use assets ("ROU") of $67.3 million for operating leases. The difference between lease liabilities and right-of-use assets is primarily attributed to unamortized lease incentives which will be amortized over the term of each respective lease. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company is evaluating the impact, if any, that this pronouncement will have on the financial position and results of operations. 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. In August 2018, the FASB issued ASU No. 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under the new guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. Early application is permitted. The Company can choose to adopt the new guidance (1) prospectively to eligible costs incurred on or after the date this guidance is first applied or (2) retrospectively. The Company is evaluating the impact, if any, that this pronouncement will have on the financial position and results of operations. 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 DEVELOPMENT

9 Months Ended

Sep. 30, 2019

Business Combinations [Abstract]

BUSINESS DEVELOPMENT

Arkis BioSciences Inc.

On July 29, 2019, the Company acquired Arkis BioSciences Inc. ("Arkis") for an acquisition purchase price of $30.6 million (the "Arkis Acquisition") plus contingent consideration of up to $25.5 million, that may be payable based on the successful completion of certain development and commercial milestones. The contingent consideration had an acquisition date fair value of $13.1 million. Arkis was a privately-held company that marketed the CerebroFlo® external ventricular drainage (EVD) catheter with Endexo® technology, a permanent additive designed to reduce the potential for catheter obstruction due to thrombus formation.

Assets Acquired and Liabilities Assumed at Fair Value

The Arkis Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination to be recognized at their fair values as of the acquisition date. As of September 30, 2019, certain amounts relating to the valuation of intangible assets and tax related matters have not been finalized. The finalization of these matters may result in changes to goodwill.

The following table summarizes the preliminary fair values of the assets acquired and liabilities assumed at the acquisition date:



	Preliminary Valuation as of September 30, 2019		Weighted Average Life
	(Dollars in thousands)
Cash	$	90
Other current assets	751
Property, plant and equipment	159
Intangible assets:
CerebroFlo developed technology	20,100		15 years
Enabling technology license	1,980		14 years
Goodwill	27,297
Total assets acquired	50,377

Accounts payable, accrued expenses and other liabilities	2,908
Contingent consideration	13,100
Deferred tax liabilities, net	3,769
Net assets acquired	$	30,600

Intangible Assets

The estimated fair value of the intangible assets was determined using the income approach, which is a valuation technique that provides an estimate of the fair value of an asset based on market participant expectations of the cash flows an asset would generate over its remaining useful life. Some of the more significant assumptions inherent in the development of those asset valuations include the estimated net cash flows for each year for each asset (including net revenues, cost of sales, R&D costs, selling and marketing costs, and working capital/contributory asset charges), the appropriate discount rate to select in order to measure the risk inherent in each future cash flow stream, the assessment of each asset’s life cycle, and competitive trends impacting the asset and each cash flow stream.

The Company used a discount rate of 14.5% to arrive at the present value for the acquired intangible assets to reflect the rate of return a market participant would expect to earn and incremental commercial uncertainty in the cash flow projections. No assurances can be given that the underlying assumptions used to prepare the discounted cash flow analysis will not change. For these and other reasons, actual results may vary significantly from estimated results.

Goodwill

The Company allocated goodwill related to the Arkis Acquisition 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. One of the key factors that contributes to the recognition of goodwill, and a driver for the Company's acquisition of Arkis, is the planned expansion of the Endexo technology with the existing products within the Codman Specialty Surgical segment. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

Contingent Consideration

The Company determines the acquisition date fair value of contingent consideration obligations based on a probability-weighted income approach derived from revenue estimates and a probability assessment with respect to the likelihood of achieving contingent obligations. The fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined using the fair value concepts in ASC 820. The resultant probability-weighted cash flows are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligation will be revalued to estimated fair value and changes in fair value will be reflected as income or expense in our consolidated statement of operations. Changes in the fair value of the contingent consideration obligations may result from changes in discount periods and rates, changes in the timing and amount of revenue estimates and changes in probability assumptions with respect to the likelihood of achieving the various contingent payment obligations. Adverse changes in assumptions utilized in our contingent consideration fair value estimates could result in an increase in our contingent consideration obligation and a corresponding charge to operating results.

As part of the acquisition, the Company is required to pay the former shareholders of Arkis up to $25.5 million based on the timing of certain development milestones of $10 million and commercial sales milestones of $15.5 million, respectively. The Company used a probability weighted income approach to calculate the fair value of the contingent consideration that

considered the possible outcomes of scenarios related to each specified milestone. The Company estimated the fair value of the contingent consideration to be $13.1 million at the acquisition date.

Deferred Tax Liabilities

Deferred tax liabilities result from identifiable intangible assets’ fair value adjustments. These adjustments create excess book basis over tax basis which is tax-effected by the statutory tax rates of applicable jurisdictions.

The pro forma results are not presented for this acquisition as they are immaterial.

Rebound Therapeutics Corporation

On September 9, 2019, the Company acquired Rebound Therapeutics Corporation (“Rebound”), developers of a single-use medical device known as the AURORA Surgiscope® System ("Aurora") which enables minimally invasive access, using optics and illumination, for visualization, diagnostic and therapeutic use in neurosurgery (the “Rebound transaction”). Under the terms of the Rebound transaction, the Company made an upfront payment of $67.1 million and are committed to pay up to $35.0 million of contingent development milestones upon achievement of certain regulatory milestones. The acquisition of Rebound was primarily concentrated in one single identifiable asset and thus, for accounting purposes, the Company has concluded that the acquired assets do not meet the accounting definition of a business. The initial payment was allocated primarily to Aurora, resulting in a $59.9 million in-process research and development expense. The balance of approximately $7.2 million, which included $2.1 million of cash and cash equivalents and a net deferred tax asset of $4.2 million, was allocated to the remaining net assets acquired. The deferred tax asset primarily resulted from a federal net operating loss carry forward.

Integrated Shoulder Collaboration, Inc.

On January 4, 2019, the Company entered into a licensing agreement with Integrated Shoulder Collaboration, Inc ("ISC"). Under the terms of the agreement, the Company paid ISC $1.7 million for the exclusive, worldwide license to commercialize its short stem and stemless shoulder system. A patent related to short stem and stemless shoulder systems was issued to ISC during the first quarter of 2019. ISC is eligible to receive royalties on sales of the short stem and stemless shoulder system. The Company has the option to acquire ISC at a date four years subsequent to the first commercial sale, which becomes mandatory upon the achievement of a certain sales thresholds of the short stem and stemless shoulder system, for an amount not to exceed $80.0 million. The transaction was accounted for as an asset acquisition as the Company concluded that it acquired primarily one asset. The total upfront payment of $1.7 million was expensed as a component of in-process research and development expense and the future milestone and option payments will be recorded if the corresponding events become probable.

The pro forma results are not presented for this acquisition as they are immaterial.

REVENUES FROM CONTRACTS WITH CUSTOMERS

9 Months Ended

Sep. 30, 2019

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 for 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 product 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 thirty 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 review and authorization in advance prior to the return of product. 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 goods 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 summarizes the changes in the contract asset and liability balances for the nine months ended September 30, 2019:



Contract Asset
Contract asset, January 1, 2019	$	4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(4,193		)
Contract asset, net of transferred to trade receivables on contracts during the period	9,371
Contract asset, September 30, 2019	$	9,371

Contract Liability
Contract liability, January 1, 2019	$	12,716
Recognition of revenue included in beginning of year contract liability	(6,343		)
Contract liability, net of revenue recognized on contracts during the period	4,766
Foreign currency translation	(5		)
Contract liability, September 30, 2019	$	11,134

At September 30, 2019, the short-term portion of the contract liability of $4.0 million and the long-term portion of $7.1 million were included in accrued expenses and other current liabilities and other liabilities in the consolidated balance sheet.

As of September 30, 2019, the Company is expected to recognize approximately 42.0% of our unsatisfied (or partially unsatisfied) performance obligations as revenue through 2020, with the remaining balance to be recognized in 2021 and 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, 2019 and 2018 (amounts in thousands):



	Three Months Ended September 30, 2019		Three Months Ended September 30, 2018		Nine Months Ended September 30, 2019		Nine Months Ended September 30, 2018
	(amounts in thousands)
Neurosurgery	$	180,103	$	171,680	$	523,929	$	509,166
Precision Tools and Instruments	72,881		67,355		212,881		205,488
Total Codman Specialty Surgical	252,984		239,035		736,810		714,654

Wound Reconstruction and Care	82,213		80,472		239,458		230,809
Extremity Orthopedics	20,852		20,524		65,299		65,438
Private Label	23,046		25,823		80,863		78,225
Total Orthopedics and Tissue Technologies	126,111		126,819		385,620		374,472
Total revenue	$	379,095	$	365,854	$	1,122,430	$	1,089,126

Prior period amounts were reclassified between categories within the Orthopedics and Tissue Technologies segment to conform to the current period presentation.

See Note 15, 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 in the year of implementation 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

GOODWILL AND OTHER INTANGIBLE ASSETS

9 Months Ended

Sep. 30, 2019

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, 2019 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2018	$	625,760		$	300,715		$	926,475
Arkis Acquisition	27,297			—			27,297
Foreign currency translation	(5,843		)	(2,647		)	(8,490		)
Goodwill at September 30, 2019	$	647,214		$	298,068		$	945,282

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



	September 30, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	873,973	$	(201,067	)	$	672,906
Customer relationships	13 years	221,580		(114,498		)	107,082
Trademarks/brand names	28 years	103,463		(27,433		)	76,030
Codman tradename	Indefinite	160,841		—			160,841
Supplier relationships	27 years	34,721		(17,590		)	17,131
All other	4 years	10,727		(4,367		)	6,360
		$	1,405,305	$	(364,955	)	$	1,040,350



	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman tradename	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496

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 evaluation for some or all of its reporting units and perform a quantitative test. During the third quarter of 2019 the Company began with the qualitative evaluation, which was sufficient to find no impairment.

For intangible assets with indefinite lives, the Company elected to bypass the qualitative evaluation for its Codman tradename intangible asset and perform a quantitative test during the third quarter 2019. In performing this test, the Company utilized a discount rate of 12.5%. 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.

In April 2019, a contract manufacturing customer of the private label product line received a notification from the FDA ordering them to remove their product from the market. During the second quarter of 2019, the Company recorded an impairment charge of $5.8 million in intangible asset amortization in the consolidated statement of operations related to the customer relationship intangible asset acquired from TEI Biosciences, Inc. and TEI Medical Inc. (collectively "TEI") due to revised future projections based on a pending contract termination.

Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of product revenues) is expected to be approximately $16.6 million for the remainder of 2019, $66.6 million in 2020, $65.5 million in 2021, $62.0 million in 2022, $61.1 million in 2023, $60.3 million in 2024 and $549.0 million thereafter.

DEBT

9 Months Ended

Sep. 30, 2019

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, 2019, the Company was in compliance with all such covenants. 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.

At September 30, 2019 and December 31, 2018, there was $440.0 million and $345.0 million outstanding, respectively, under the revolving credit component of the Senior Credit Facility at weighted average interest rates of 3.4% and 4.0%, respectively. At September 30, 2019 and December 31, 2018, there was $888.8 million and $900.0 million outstanding, respectively, under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 3.4% and 3.9%, respectively. At September 30, 2019, $45.0 million of the Term Loan component of the Senior Credit Facility is classified as current on the consolidated balance sheet.

Securitization Facility

During the fourth quarter of 2018, the Company entered into an accounts receivable securitization facility (the "Securitization Facility") under which accounts receivable of certain domestic subsidiaries are sold on a non-recourse basis to a special purpose entity (“SPE”), which is a bankruptcy-remote, consolidated subsidiary of the Company. Accordingly, the assets of the SPE are not available to satisfy the obligations of the Company or any of its subsidiaries. From time to time, the SPE may

finance such accounts receivable with a revolving loan facility secured by a pledge of such accounts receivable. The amount of outstanding borrowings on the Securitization Facility at any one time is limited to $150.0 million. The Securitization Facility Agreement ("Securitization Agreement") is for an initial three-year term and may be extended. The Securitization Agreement governing the Securitization Facility contains certain covenants and termination events. An occurrence of an event of default or a termination event under this Securitization Agreement may give rise to the right of its counterparty to terminate this facility. As of September 30, 2019, the Company was in compliance with the covenants and none of the termination events had occurred. At September 30, 2019, the Company had $110.0 million of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 3.1%.

The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at September 30, 2019 were approximately $430.1 million and, $875.7 million, respectively. The fair value of the outstanding borrowing of the Securitization Facility at September 30, 2019 was approximately $109.1 million. 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, 2019 and December 31, 2018 totaled $0.8 million. There were no amounts drawn as of September 30, 2019.

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 2019	$	11,250
2020	45,000
2021	56,250
2022	67,500
2023	708,750
	$	888,750

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, 2019

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, 2019 and December 31, 2018 (amounts in thousands):



								September 30, 2019			December 31, 2018
Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value			Estimated Fair Value
								Assets (Liabilities)			Assets (Liabilities)
3-month USD LIBOR Loan	$	50,000	June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	$	—		$	410
3-month USD LIBOR Loan	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	—			415
1-month USD LIBOR Loan	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	—			418
3-month USD LIBOR Loan	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	23			619
1-month USD LIBOR Loan	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	45			1,287
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(769		)	1,246
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(3,647		)	1,491
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(3,612		)	1,460
1-month USD LIBOR Loan	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(4,463		)	418
1-month USD LIBOR Loan	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(2,268		)	162
1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(8,702		)	2,076
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(6,798		)	(2,594		)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(6,786		)	(2,551		)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(6,896		)	(2,568		)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(6,683		)	(797		)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(6,629		)	(873		)
Total interest rate derivatives designated as cash flow hedge	$	1,475,000						$	(57,185	)	$	619

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.

During the nine months ended September 30, 2019, interest rate swaps with an aggregate notional amount of $150 million matured.

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.

Cross-Currency Rate Swaps

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, 2019 (dollar amounts in thousands):



						September 30, 2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	64,710	$	1,737
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	66,667	$	1,737

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	1,327
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	1,327

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	4,050
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	4,050

Total						$	7,114

During the nine months ended September 30, 2019, the Company settled a cross-currency swap designated as a cash flow hedge of an intercompany loan with an aggregate notional amount of $33.3 million. The original maturity date was October 2, 2020, however, as the intercompany loan settlement was consummated, the cross-currency swap was settled simultaneously. As a result of the settlement, the Company recorded a loss of $0.4 million in other income, net in the consolidated statement of operations.

The Company held the following cross-currency rate swaps as of December 31, 2018 (dollar amounts in thousands):



						December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(215	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(215	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(422		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(422		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(2,193		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(2,193		)

Total						$	(2,830	)

The cross-currency swaps are carried on the consolidated balance sheet at fair value, and changes in the fair values are recorded as unrealized gains or losses in AOCI. For the three and nine months ended September 30, 2019, the Company recorded gains of $5.7 million and $3.9 million, respectively, in other income, net for the foreign currency rate translation to offset the losses recognized on the intercompany loans. For the three and nine months ended September 30, 2018, the Company recorded loss of $2.6 million and gain of $2.2 million in other income, 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, 2019, the Company recorded a gain of $9.7 million and gain of $15.4 million, respectively, in AOCI related to the change in fair value of the cross-currency swaps. 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 swaps.

For the three and nine months ended September 30, 2019, the Company recorded gains of $1.8 million and $5.5 million in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and nine months ended September 30, 2018, the Company recorded 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, 2019, an estimated gain of $6.5 million is expected to be reclassified within the next twelve months to other income, net from AOCI. As of September 30, 2019, 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.

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 from its international operations through 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.

The Company held the following cross-currency rate swaps designated as net investment hedges as of September 30, 2019 and December 31, 2018, respectively (dollar amounts in thousands):



						September 30, 2019			December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—%	EUR	70,738	$	6,141		$	1,359
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	82,000	$	6,141		$	1,359

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	4,532			(421		)
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	4,532			(421		)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	2,911			(150		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,911			(150		)

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	11,678			2,360
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	11,678			2,360

Pay CHF	October 3, 2018	September 30, 2025	—%	CHF	165,172	(6,561		)	(3,780		)
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(6,561		)	(3,780		)

Total						$	18,701		$	(632	)

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, 2019, the Company recorded gains of $17.1 million and $26.6 million in AOCI related to the change in fair value of the cross-currency swaps.

For the three and nine months ended September 30, 2019, the Company recorded gains of $2.5 million and $7.2 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated gain that is expected to be reclassified to interest income from AOCI as of September 30, 2019 within the next twelve months is $9.6 million.

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 are 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 for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of September 30, 2019 and December 31, 2018:



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2019		December 31, 2018
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap⁽²⁾	$	68	$	4,654
Cross-currency swap	6,453		7,615
Net Investment Hedges
Cross-currency swap	9,552		8,888
Other assets
Cash Flow Hedges
Interest rate swap⁽²⁾	—		5,350
Cross-currency swap	662		—
Net Investment Hedges
Cross-currency swap	18,347		1,774
Total derivatives designated as hedges — Assets	$	35,082	$	28,281

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	$	5,376	$	—
Other liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	51,878		9,385
Cross-currency swap	—		10,445
Net Investment Hedges
Cross-currency swap	9,199		11,294
Total derivatives designated as hedges — Liabilities	$	66,453	$	31,124


⁽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, 2019 and December 31, 2018, the notional amount related to the Company’s interest rate swaps were $1.3 billion and $1.5 billion, respectively.

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, 2019 and 2018:



	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, 2019
Cash Flow Hedges
Interest rate swap	$	(43,160	)	$	(13,789	)	$	237		$	(57,186	)	Interest expense
Cross-currency swap	(2,284		)	9,661			7,520			(143		)	Other income, net
Net Investment Hedges
Cross-currency swap	4,053			17,136			2,488			18,701			Interest income
	$	(41,391	)	$	13,008		$	10,245		$	(38,628	)
Three Months Ended September 30, 2018
Cash Flow Hedges
Interest rate swap	$	22,344		$	5,059		$	473		$	26,930		Interest expense
Cross-currency swap	(7,892		)	(3,067		)	(707		)	(10,252		)	Other income, net
	$	14,452		$	1,992		$	(234	)	$	16,678

	Balance in AOCI Beginning of Year			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)
Nine Months Ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(54,841	)	$	2,964		$	(57,186	)	Interest expense
Cross-currency swap	(6,190		)	15,418			9,371			(143		)	Other income, net
Net Investment Hedges
Cross-currency swap	$	(632	)	$	26,558		$	7,225		$	18,701		Interest income
	$	(6,203	)	$	(12,865	)	$	19,560		$	(38,628	)
Nine Months Ended September 30, 2018
Cash Flow Hedges
Interest rate swap	$	592		$	26,307		$	(31	)	$	26,930		Interest expense
Cross-currency swap	$	(5,104	)	$	3,000		$	8,148		$	(10,252	)	Other income, net
	$	(4,512	)	$	29,307		$	8,117		$	16,678

STOCK-BASED COMPENSATION	9 Months Ended
STOCK-BASED COMPENSATION	Sep. 30, 2019
Share-based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of September 30, 2019, 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 four years from the date of grant for officers and employees, and within one year from date of grant for directors and generally expire eight years from the grant date for employees, and from six to ten years for directors and certain executive officers. The Company values stock option grants using the binomial distribution model. 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, 2019, there were approximately $5.3 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 three years. There were 202,752 stock options granted during the nine months ended September 30, 2019. For the nine months ended September 30, 2019, the weighted average grant date fair value for stock options was $18.74 per option. 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 based on revenue goals of the Company. 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, 2019, there were approximately $28.1 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 318,410 restricted stock awards and 118,903 performance stock awards during the nine months ended September 30, 2019. For the nine months ended September 30, 2019, the weighted average grant date fair value for restricted stock awards and performance stock units was $55.19 and $55.91 per award, respectively. 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.

LEASES AND RELATED PARTY LEASES

9 Months Ended

Sep. 30, 2019

Leases [Abstract]

LEASES AND RELATED PARTY LEASES

The Company leases administrative, manufacturing, research and distribution facilities and vehicles through operating lease agreements. The Company has no finance leases as of September 30, 2019. Many of the Company's leases include both lease (e.g., fixed payments including rent) and non-lease components (e.g., common-area or other maintenance costs). For vehicles, the Company has elected the practical expedient to group lease and non-lease components.

Most facility leases include one or more options to renew. The exercise of lease renewal options is typically at the Company's sole discretion, therefore, the majority of renewals to extend the lease terms are not included in the ROU assets and lease liabilities as they are not reasonably certain of exercise. The Company regularly evaluates renewal options and when they are reasonably certain of exercise, the renewal period is included in the lease term.

As most of the Company's leases do not provide an implicit rate, the Company uses a collateralized incremental borrowing rate based on the information available at the lease commencement date in determining the present value of the lease payments.

Total operating lease expense for the nine months ended September 30, 2019 and September 30, 2018, was $14.2 million and $11.8 million respectively, which includes $0.2 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases at September 30, 2019 were as follows:



	September 30, 2019
	(In thousands, except lease term and discount rate)
ROU assets	$	97,738

Current lease liabilities	$	11,835
Non-current lease liabilities	96,820
Total lease liabilities	$	108,655

Weighted average remaining lease term (in years):
Leased facilities	12.9
Leased vehicles	2.8

Weighted average discount rate:
Leased facilities	5.4		%
Leased vehicles	3.2		%

Supplemental cash flow information related to leases was as follows for the nine months ended September 30, 2019 (in thousands):



	September 30, 2019
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	10,680

ROU assets obtained in exchange for lease liabilities:
Operating leases	41,860

Future minimum lease payments under operating leases at September 30, 2019 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	74	$	4,489	$	4,563
2020	296		13,289		13,585
2021	296		12,691		12,987
2022	296		13,641		13,937
2023	296		11,414		11,710
Thereafter	1,724		102,743		104,467
Total minimum lease payments	$	2,982	$	158,267	$	161,249
Less: Imputed interest					52,594
Total lease liabilities					108,655
Less: Current lease liabilities					11,835
Long-term lease liabilities					96,820

During 2018, the Company entered into an operating lease with a term of 18 years for a new corporate headquarters in Princeton, NJ. The lease commenced during the second quarter of 2019 and the Company recorded a ROU asset and lease liability of $35.6 million.

Future minimum lease payments under operating leases at December 31, 2018 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	296	$	16,472	$	16,768
2020	296		13,510		13,806
2021	296		12,197		12,493
2022	296		12,937		13,233
2023	296		10,707		11,003
Thereafter	1,724		100,675		102,399
Total minimum lease payments	$	3,204	$	166,498	$	169,702

Total operating lease expense for the year ended December 31, 2018 was $16.3 million and included $0.3 million, in related party lease expense.

There were no future minimum lease payments under capital leases at December 31, 2018.

Related Party Leases

The Company leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a corporation whose shareholders are trusts, whose beneficiaries include family members of the Company’s principal stockholder and former director. The term of the current lease agreement is through October 31, 2032 at an annual rate of approximately $0.3 million per year. The current lease agreement also provides (i) a 5-year renewal option for the Company to extend the lease from November 1, 2032 through October 31, 2037 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2037 through October 31, 2042 at the fair market rental rate of the premises.

INCOME TAXES

9 Months Ended

Sep. 30, 2019

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,
	2019		2018		2019		2018
Reported tax rate	(0.4	)%	(20.6	)%	(3.5	)%	(8.4	)%

The Company’s effective income tax rates for the three months ended September 30, 2019 and 2018 were (0.4)% and (20.6)%, respectively. For the three months ended September 30, 2019, the increase in the rate is primarily driven by the impact of the Rebound transaction, which resulted in a $59.9 million in–process research and development (IPR&D) expense. This amount is not deductible for tax purposes. Additionally, the Company recorded a tax expense of $1.6 million of tax reform–related adjustments, due to updates in IRS guidance.

The Company’s effective income tax rates for the nine months ended September 30, 2019 and 2018 were (3.5)% and (8.4)%, respectively. For the nine months ended September 30, 2019, the increase in the rate is primarily driven by the impact of the Rebound transaction, which resulted in a $59.9 million IPR&D expense. This amount is not deductible for tax purposes. Additionally, the Company recorded a tax expense of $1.6 million for tax reform-related adjustments due to updates in IRS guidance. This was offset by a tax benefit of $10.8 million ($0.13 per share) related to a federal tax holiday in Switzerland, which was finalized during the quarter ended March 31, 2019. The Company received a federal tax credit in Switzerland of 12 million CHF, which may be used over a seven year period, ending in 2024. The nine months ended September 30, 2018, included an additional tax benefit of $1.2 million related to share–based compensation, when compared to the same period in 2019.

As of September 30, 2019, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed indefinitely reinvested. Such taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. As such, the Company has determined the tax impact of repatriating these earnings would not be material as of September 30, 2019.

SEGMENT AND GEOGRAPHIC INFORMATION

9 Months Ended

Sep. 30, 2019

Segment Reporting [Abstract]

SEGMENT AND GEOGRAPHIC INFORMATION

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, 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 each reportable segment for the three and nine months ended September 30, 2019 and 2018 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2019			2018			2019			2018
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	252,984		$	239,035		$	736,810		$	714,654
Orthopedics and Tissue Technologies	126,111			126,819			385,620			374,472
Total revenues	$	379,095		$	365,854		$	1,122,430		$	1,089,126
Segment Profit
Codman Specialty Surgical	$	101,129		$	91,871		$	291,750		$	272,480
Orthopedics and Tissue Technologies	30,383			35,515			112,664			105,094
Segment profit	131,512			127,386			404,414			377,574
Amortization	(5,056		)	(5,268)			(21,340		)	(15,944		)
Corporate and other	(147,043		)	(98,441		)	(325,394		)	(284,740		)
Operating income	$	(20,587	)	$	23,677		$	57,680		$	76,890

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,
	2019		2018		2019		2018
	(In thousands)
United States	$	266,280	$	260,870	$	796,397	$	769,509
Europe	49,242		47,472		148,753		150,650
Asia Pacific	42,079		37,022		114,810		108,304
Rest of World	21,494		20,490		62,470		60,663
Total Revenues	$	379,095	$	365,854	$	1,122,430	$	1,089,126

COMMITMENTS AND CONTINGENCIES

9 Months Ended

Sep. 30, 2019

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

Contingent Consideration

The Company determined the fair value of contingent consideration during the nine-month period ended September 30, 2019 and 2018 to reflect the change in estimates, 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, 2019 and 2018 is as follows (in thousands):



Nine Months Ended September 30, 2019	Contingent Consideration Liability Related to Acquisition of Arkis (See Note 2)		Contingent Consideration Liability Related to Acquisition of Derma Sciences
	Long-term		Long-term
Balance as of January 1, 2019	$	—	$	230
Additions from acquisition of Arkis	13,100		—
Balance as of September 30, 2019	$	13,100	$	230



Nine months Ended September 30, 2018	Contingent Considerations Liabilities Related to Acquisition of Derma Sciences						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

Confluent Surgical

On January 15, 2014, the Company acquired all outstanding shares of Confluent Surgical, Inc., ("Confluent Surgical"). The purchase price included contingent consideration. The potential maximum undiscounted contingent consideration of $30.0 million consisted 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 fair values of contingent consideration related to the acquisition of Confluent Surgical were estimated using a discounted cash flow model using a 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 related to Confluent Surgical in October of 2018.

Derma Sciences

The Company assumed contingent consideration incurred by Derma Sciences, Inc. ("Derma Sciences") related to its acquisitions of BioD and the intellectual property related to Medihoney products. The Company accounted for the contingent liabilities by recording their fair value on the date of the acquisition based on a probability weighted income approach. The Company has paid $33.3 million related to the aforementioned contingent liabilities. One contingent liability remains which relates to net sales of Medihoney products exceeding certain amounts defined in the agreement between the Company and Derma Sciences. The potential maximum undiscounted payment amounts to $3.0 million. The estimated fair value as of September 30, 2019, December 31, 2018 and September 30, 2018 was $0.2 million.

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, the acceleration of the payment of $26.5 million by BioD. 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.

BASIS OF PRESENTATION (Policies)	9 Months Ended
BASIS OF PRESENTATION (Policies)	Sep. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Recently Issued Accounting Standards	Recently Issued Accounting Standards In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) (the New Lease Standard). The New Lease Standard 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 became effective for all annual periods and interim reporting periods beginning after December 15, 2018. The Company adopted the New Lease Standard as of January 1, 2019 using a modified retrospective transition. Under this method, financial results reported in periods prior to January 1, 2019 are unchanged. The Company elected the ‘package of practical expedients’ which permits the company not to reassess the prior conclusions about lease identification, lease classification and initial direct costs under the new standard. The Company also elected the use-of-hindsight practical expedient. As most of the leases do not provide an implicit rate, the Company used our collateralized incremental borrowing rate based on the information available at the lease implementation date in determining the present value of the lease payments. The adoption of the New Lease Standard had an initial impact on the consolidated balance sheet due to the recognition of $76.4 million of lease liabilities with corresponding right-of-use assets ("ROU") of $67.3 million for operating leases. The difference between lease liabilities and right-of-use assets is primarily attributed to unamortized lease incentives which will be amortized over the term of each respective lease. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company is evaluating the impact, if any, that this pronouncement will have on the financial position and results of operations. 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. In August 2018, the FASB issued ASU No. 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under the new guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. Early application is permitted. The Company can choose to adopt the new guidance (1) prospectively to eligible costs incurred on or after the date this guidance is first applied or (2) retrospectively. The Company is evaluating the impact, if any, that this pronouncement will have on the financial position and results of operations. 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.
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 for 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 product 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 thirty 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 review and authorization in advance prior to the return of product. 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 goods 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.

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

9 Months Ended

Sep. 30, 2019

Revenue from Contract with Customer [Abstract]

Schedule of Changes in Contract Assets and Contract Liabilities

The following table summarizes the changes in the contract asset and liability balances for the nine months ended September 30, 2019:



Contract Asset
Contract asset, January 1, 2019	$	4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(4,193		)
Contract asset, net of transferred to trade receivables on contracts during the period	9,371
Contract asset, September 30, 2019	$	9,371

Contract Liability
Contract liability, January 1, 2019	$	12,716
Recognition of revenue included in beginning of year contract liability	(6,343		)
Contract liability, net of revenue recognized on contracts during the period	4,766
Foreign currency translation	(5		)
Contract liability, September 30, 2019	$	11,134

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, 2019 and 2018 (amounts in thousands):



	Three Months Ended September 30, 2019		Three Months Ended September 30, 2018		Nine Months Ended September 30, 2019		Nine Months Ended September 30, 2018
	(amounts in thousands)
Neurosurgery	$	180,103	$	171,680	$	523,929	$	509,166
Precision Tools and Instruments	72,881		67,355		212,881		205,488
Total Codman Specialty Surgical	252,984		239,035		736,810		714,654

Wound Reconstruction and Care	82,213		80,472		239,458		230,809
Extremity Orthopedics	20,852		20,524		65,299		65,438
Private Label	23,046		25,823		80,863		78,225
Total Orthopedics and Tissue Technologies	126,111		126,819		385,620		374,472
Total revenue	$	379,095	$	365,854	$	1,122,430	$	1,089,126

Schedule of Impact on Statement of Operations

The impact of adoption in the year of implementation 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

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

9 Months Ended

Sep. 30, 2019

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, 2019 were as follows:



	Codman Specialty Surgical			Orthopedics and Tissue Technologies			Total
	(In thousands)
Goodwill at December 31, 2018	$	625,760		$	300,715		$	926,475
Arkis Acquisition	27,297			—			27,297
Foreign currency translation	(5,843		)	(2,647		)	(8,490		)
Goodwill at September 30, 2019	$	647,214		$	298,068		$	945,282

Schedule of Finite-Lived Intangible Assets

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



	September 30, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	873,973	$	(201,067	)	$	672,906
Customer relationships	13 years	221,580		(114,498		)	107,082
Trademarks/brand names	28 years	103,463		(27,433		)	76,030
Codman tradename	Indefinite	160,841		—			160,841
Supplier relationships	27 years	34,721		(17,590		)	17,131
All other	4 years	10,727		(4,367		)	6,360
		$	1,405,305	$	(364,955	)	$	1,040,350



	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman tradename	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496

Schedule of Indefinite-Lived Intangible Assets

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



	September 30, 2019
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	873,973	$	(201,067	)	$	672,906
Customer relationships	13 years	221,580		(114,498		)	107,082
Trademarks/brand names	28 years	103,463		(27,433		)	76,030
Codman tradename	Indefinite	160,841		—			160,841
Supplier relationships	27 years	34,721		(17,590		)	17,131
All other	4 years	10,727		(4,367		)	6,360
		$	1,405,305	$	(364,955	)	$	1,040,350



	December 31, 2018
	Weighted Average Life	Cost		Accumulated Amortization			Net
	(Dollars in thousands)
Completed technology	19 years	$	855,679	$	(167,384	)	$	688,295
Customer relationships	13 years	231,448		(106,859		)	124,589
Trademarks/brand names	28 years	104,061		(24,764		)	79,297
Codman tradename	Indefinite	162,054		—			162,054
Supplier relationships	27 years	34,721		(16,519		)	18,202
All other	4 years	10,958		(3,899		)	7,059
		$	1,398,921	$	(319,425	)	$	1,079,496

DEBT (Tables)

9 Months Ended

Sep. 30, 2019

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 2019	$	11,250
2020	45,000
2021	56,250
2022	67,500
2023	708,750
	$	888,750

- Definition

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

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+ Details

DERIVATIVE INSTRUMENTS (Tables)

9 Months Ended

Sep. 30, 2019

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following cross-currency rate swaps designated as net investment hedges as of September 30, 2019 and December 31, 2018, respectively (dollar amounts in thousands):



						September 30, 2019			December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2021	—%	EUR	70,738	$	6,141		$	1,359
Receive U.S.$	October 3, 2018	September 30, 2021	3.01%	$	82,000	$	6,141		$	1,359

Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	4,532			(421		)
Receive U.S.$	October 3, 2018	September 30, 2023	2.57%	$	60,000	4,532			(421		)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	2,911			(150		)
Receive U.S.$	October 3, 2018	September 30, 2025	2.19%	$	45,000	2,911			(150		)

Pay GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	11,678			2,360
Receive U.S.$	October 3, 2018	September 30, 2025	2.71%	$	167,500	11,678			2,360

Pay CHF	October 3, 2018	September 30, 2025	—%	CHF	165,172	(6,561		)	(3,780		)
Receive GBP	October 3, 2018	September 30, 2025	1.67%	GBP	128,284	(6,561		)	(3,780		)

Total						$	18,701		$	(632	)

The Company held the following cross-currency rate swaps as of December 31, 2018 (dollar amounts in thousands):



						December 31, 2018
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	97,065	$	(215	)
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	100,000	$	(215	)

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	(422		)
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	(422		)

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	(2,193		)
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	(2,193		)

Total						$	(2,830	)

The Company held the following interest rate swaps as of September 30, 2019 and December 31, 2018 (amounts in thousands):



								September 30, 2019			December 31, 2018
Hedged Item	Current Notional Amount		Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value			Estimated Fair Value
								Assets (Liabilities)			Assets (Liabilities)
3-month USD LIBOR Loan	$	50,000	June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	$	—		$	410
3-month USD LIBOR Loan	50,000		June 22, 2016	December 31, 2016	June 30, 2019	1.062	%	—			415
1-month USD LIBOR Loan	50,000		July 12, 2016	December 31, 2016	June 30, 2019	0.825	%	—			418
3-month USD LIBOR Loan	50,000		February 6, 2017	June 30, 2017	June 30, 2020	1.834	%	23			619
1-month USD LIBOR Loan	100,000		February 6, 2017	June 30, 2017	June 30, 2020	1.652	%	45			1,287
1-month USD LIBOR Loan	100,000		March 27, 2017	December 31, 2017	June 30, 2021	1.971	%	(769		)	1,246
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(3,647		)	1,491
1-month USD LIBOR Loan	150,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	(3,612		)	1,460
1-month USD LIBOR Loan	100,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(4,463		)	418
1-month USD LIBOR Loan	50,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	(2,268		)	162
1-month USD LIBOR Loan	200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	(8,702		)	2,076
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	(6,798		)	(2,594		)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	(6,786		)	(2,551		)
1-month USD LIBOR Loan	75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	(6,896		)	(2,568		)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	(6,683		)	(797		)
1-month USD LIBOR Loan	100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	(6,629		)	(873		)
Total interest rate derivatives designated as cash flow hedge	$	1,475,000						$	(57,185	)	$	619

The Company held the following cross-currency rate swaps as of September 30, 2019 (dollar amounts in thousands):



						September 30, 2019
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount		Fair Value Asset (Liability)

Pay CHF	October 2, 2017	October 2, 2020	1.75%	CHF	64,710	$	1,737
Receive U.S.$	October 2, 2017	October 2, 2020	4.38%	$	66,667	$	1,737

Pay CHF	October 2, 2017	October 2, 2021	1.85%	CHF	48,533	1,327
Receive U.S.$	October 2, 2017	October 2, 2021	4.46%	$	50,000	1,327

Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	145,598	4,050
Receive U.S.$	October 2, 2017	October 2, 2022	4.52%	$	150,000	4,050

Total						$	7,114

Schedule of Fair Value and Presentation of Derivatives

The following table summarizes the fair value for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of September 30, 2019 and December 31, 2018:



	Fair Value as of
Location on Balance Sheet ⁽¹⁾:	September 30, 2019		December 31, 2018
	(In thousands)
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap⁽²⁾	$	68	$	4,654
Cross-currency swap	6,453		7,615
Net Investment Hedges
Cross-currency swap	9,552		8,888
Other assets
Cash Flow Hedges
Interest rate swap⁽²⁾	—		5,350
Cross-currency swap	662		—
Net Investment Hedges
Cross-currency swap	18,347		1,774
Total derivatives designated as hedges — Assets	$	35,082	$	28,281

Derivatives designated as hedges — Liabilities:
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	$	5,376	$	—
Other liabilities
Cash Flow Hedges
Interest rate swap⁽²⁾	51,878		9,385
Cross-currency swap	—		10,445
Net Investment Hedges
Cross-currency swap	9,199		11,294
Total derivatives designated as hedges — Liabilities	$	66,453	$	31,124


⁽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, 2019 and December 31, 2018, the notional amount related to the Company’s interest rate swaps were $1.3 billion and $1.5 billion, respectively.

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, 2019
Cash Flow Hedges
Interest rate swap	$	(43,160	)	$	(13,789	)	$	237		$	(57,186	)	Interest expense
Cross-currency swap	(2,284		)	9,661			7,520			(143		)	Other income, net
Net Investment Hedges
Cross-currency swap	4,053			17,136			2,488			18,701			Interest income
	$	(41,391	)	$	13,008		$	10,245		$	(38,628	)
Three Months Ended September 30, 2018
Cash Flow Hedges
Interest rate swap	$	22,344		$	5,059		$	473		$	26,930		Interest expense
Cross-currency swap	(7,892		)	(3,067		)	(707		)	(10,252		)	Other income, net
	$	14,452		$	1,992		$	(234	)	$	16,678

	Balance in AOCI Beginning of Year			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)
Nine Months Ended September 30, 2019
Cash Flow Hedges
Interest rate swap	$	619		$	(54,841	)	$	2,964		$	(57,186	)	Interest expense
Cross-currency swap	(6,190		)	15,418			9,371			(143		)	Other income, net
Net Investment Hedges
Cross-currency swap	$	(632	)	$	26,558		$	7,225		$	18,701		Interest income
	$	(6,203	)	$	(12,865	)	$	19,560		$	(38,628	)
Nine Months Ended September 30, 2018
Cash Flow Hedges
Interest rate swap	$	592		$	26,307		$	(31	)	$	26,930		Interest expense
Cross-currency swap	$	(5,104	)	$	3,000		$	8,148		$	(10,252	)	Other income, net
	$	(4,512	)	$	29,307		$	8,117		$	16,678

- 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.

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+ Details

LEASES AND RELATED PARTY LEASES (Tables)

9 Months Ended

Sep. 30, 2019

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases at September 30, 2019 were as follows:



	September 30, 2019
	(In thousands, except lease term and discount rate)
ROU assets	$	97,738

Current lease liabilities	$	11,835
Non-current lease liabilities	96,820
Total lease liabilities	$	108,655

Weighted average remaining lease term (in years):
Leased facilities	12.9
Leased vehicles	2.8

Weighted average discount rate:
Leased facilities	5.4		%
Leased vehicles	3.2		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases was as follows for the nine months ended September 30, 2019 (in thousands):



	September 30, 2019
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	10,680

ROU assets obtained in exchange for lease liabilities:
Operating leases	41,860

Future Minimum Lease Payment Obligations Under Operating Leases, After Adoption of 842

Future minimum lease payments under operating leases at September 30, 2019 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	74	$	4,489	$	4,563
2020	296		13,289		13,585
2021	296		12,691		12,987
2022	296		13,641		13,937
2023	296		11,414		11,710
Thereafter	1,724		102,743		104,467
Total minimum lease payments	$	2,982	$	158,267	$	161,249
Less: Imputed interest					52,594
Total lease liabilities					108,655
Less: Current lease liabilities					11,835
Long-term lease liabilities					96,820

Future Minimum Lease Payment Obligations Under Operating Leases, Before Adoption of 842

Future minimum lease payments under operating leases at December 31, 2018 were as follows:



	Related Parties		Third Parties		Total
	(In thousands)
2019	$	296	$	16,472	$	16,768
2020	296		13,510		13,806
2021	296		12,197		12,493
2022	296		12,937		13,233
2023	296		10,707		11,003
Thereafter	1,724		100,675		102,399
Total minimum lease payments	$	3,204	$	166,498	$	169,702

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

9 Months Ended

Sep. 30, 2019

Segment Reporting [Abstract]

Total Revenue By Major Geographic Area

Net sales and profit by each reportable segment for the three and nine months ended September 30, 2019 and 2018 are as follows:



	Three Months Ended September 30,						Nine Months Ended September 30,
	2019			2018			2019			2018
	(In thousands)
Segment Net Sales
Codman Specialty Surgical	$	252,984		$	239,035		$	736,810		$	714,654
Orthopedics and Tissue Technologies	126,111			126,819			385,620			374,472
Total revenues	$	379,095		$	365,854		$	1,122,430		$	1,089,126
Segment Profit
Codman Specialty Surgical	$	101,129		$	91,871		$	291,750		$	272,480
Orthopedics and Tissue Technologies	30,383			35,515			112,664			105,094
Segment profit	131,512			127,386			404,414			377,574
Amortization	(5,056		)	(5,268)			(21,340		)	(15,944		)
Corporate and other	(147,043		)	(98,441		)	(325,394		)	(284,740		)
Operating income	$	(20,587	)	$	23,677		$	57,680		$	76,890

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,
	2019		2018		2019		2018
	(In thousands)
United States	$	266,280	$	260,870	$	796,397	$	769,509
Europe	49,242		47,472		148,753		150,650
Asia Pacific	42,079		37,022		114,810		108,304
Rest of World	21,494		20,490		62,470		60,663
Total Revenues	$	379,095	$	365,854	$	1,122,430	$	1,089,126

BASIS OF PRESENTATION - Narrative (Details) - USD ($) $ in Thousands	1 Months Ended
	May 31, 2018	Sep. 30, 2019	Jan. 01, 2019
New Accounting Pronouncement, Early Adoption [Line Items]
Lease liabilities		$ 108,655
ROU assets		$ 97,738
Accounting Standards Update 2016-02
New Accounting Pronouncement, Early Adoption [Line Items]
Lease liabilities			$ 76,400
ROU assets			$ 67,300
Public Offering
New Accounting Pronouncement, Early Adoption [Line Items]
Stock issued during the period (in shares)	6,000,000.0
Stock issued during the period, value	$ 349,600

BUSINESS DEVELOPMENT - Business Combination, Narrative (Details) - Arkis	Jul. 29, 2019 USD ($)
Business Acquisition [Line Items]
Purchase price of business combination	$ 30,600,000
Contingent consideration, liability (up to)	25,500,000
Contingent consideration, fair value	$ 13,100,000
Acquired intangible assets, discount rate	14.50%
Development Milestones
Business Acquisition [Line Items]
Contingent consideration, liability (up to)	$ 10,000,000
Commercial Sales Milestones
Business Acquisition [Line Items]
Contingent consideration, liability (up to)	$ 15,500,000

BUSINESS DEVELOPMENT - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	Jul. 29, 2019	Sep. 30, 2019	Dec. 31, 2018
Intangible assets:
Goodwill		$ 945,282	$ 926,475
Arkis
Business Acquisition [Line Items]
Cash	$ 90
Other current assets	751
Property, plant and equipment	159
Intangible assets:
Goodwill	27,297
Total assets acquired	50,377
Accounts payable, accrued expenses and other liabilities	2,908
Contingent consideration	13,100
Deferred tax liabilities, net	3,769
Net assets acquired	30,600
Arkis \| CerebroFlo developed technology
Intangible assets:
Intangible assets	$ 20,100
Weighted Average Life	15 years
Arkis \| Enabling technology license
Intangible assets:
Intangible assets	$ 1,980
Weighted Average Life	14 years

BUSINESS DEVELOPMENT - Asset Acquisition, Narrative (Details)			9 Months Ended
	Sep. 09, 2019 USD ($) asset	Jan. 04, 2019 USD ($) asset	Sep. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)
Schedule Of Asset Acquisition [Line Items]
Upfront payment, intangible assets			$ 64,995,000	$ 0
Rebound
Schedule Of Asset Acquisition [Line Items]
Upfront payment	$ 67,100,000
Contingent development milestone payments commitment (up to)	$ 35,000,000.0
Number of assets acquired \| asset	1
Remaining net assets acquired	$ 7,200,000
Rebound \| Cash and Cash Equivalents
Schedule Of Asset Acquisition [Line Items]
Remaining net assets acquired	2,100,000
Rebound \| Deferred Tax Asset
Schedule Of Asset Acquisition [Line Items]
Remaining net assets acquired	4,200,000
Rebound \| In-Process Research and Development Expense
Schedule Of Asset Acquisition [Line Items]
Upfront payment	$ 59,900,000
ISC \| Enabling technology license
Schedule Of Asset Acquisition [Line Items]
Number of assets acquired \| asset		1
Upfront payment, intangible assets		$ 1,700,000
Option to acquire, period subsequent to first commercial sale		4 years
Maximum future purchase price, if circumstances met (not to exceed)		$ 80,000,000.0

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Dec. 31, 2018	Jan. 01, 2018
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	$ 3,984	$ 3,764
Long-term portion of contract liability	$ 7,100
Product warranty period (up to)	2 years
Increase to opening retained earnings	$ 383,255	348,373
Increase to total assets	3,346,580	3,107,887
Increase to total liabilities	$ 1,961,606	$ 1,732,091
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 - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 4,193
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(4,193)
Contract asset, net of transferred to trade receivables on contracts during the period	9,371
Contract asset, End of Period	9,371
Contract Liability
Contract liability, Beginning of Period	12,716
Recognition of revenue included in beginning of year contract liability	(6,343)
Contract liability, net of revenue recognized on contracts during the period	4,766
Foreign currency translation	(5)
Contract liability, End of Period	$ 11,134

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Disaggregation of Revenue [Line Items]
Total Revenues	$ 379,095	$ 365,854	$ 1,122,430	$ 1,089,126
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	252,984	239,035	736,810	714,654
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	180,103	171,680	523,929	509,166
Codman Specialty Surgical \| Precision Tools and Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	72,881	67,355	212,881	205,488
Orthopedics and Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	126,111	126,819	385,620	374,472
Orthopedics and Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	82,213	80,472	239,458	230,809
Orthopedics and Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total Revenues	20,852	20,524	65,299	65,438
Orthopedics and Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 23,046	$ 25,823	$ 80,863	$ 78,225

REVENUES FROM CONTRACTS WITH CUSTOMERS - Impact of Adoption on Statement of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Statement of Operations
Total revenue, net	$ 379,095	$ 365,854	$ 1,122,430	$ 1,089,126
Cost of goods sold	142,636	143,245	415,219	425,032
Income tax benefit	101	(2,271)	(1,185)	(2,776)
Net loss	$ (27,610)	13,295	$ 34,882	35,663
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 loss		$ 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, 2019	Dec. 31, 2018
Inventory, Net [Abstract]
Finished goods	$ 191,250	$ 179,885
Work in process	51,438	47,715
Raw materials	59,934	52,747
Inventories, net	$ 302,622	$ 280,347

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019 USD ($)
Goodwill [Roll Forward]
Beginning of Period	$ 926,475
Foreign currency translation	(8,490)
End of Period	945,282
Arkis
Goodwill [Roll Forward]
Arkis Acquisition	27,297
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of Period	625,760
Foreign currency translation	(5,843)
End of Period	647,214
Codman Specialty Surgical \| Arkis
Goodwill [Roll Forward]
Arkis Acquisition	27,297
Orthopedics and Tissue Technologies
Goodwill [Roll Forward]
Beginning of Period	300,715
Foreign currency translation	(2,647)
End of Period	298,068
Orthopedics and Tissue Technologies \| Arkis
Goodwill [Roll Forward]
Arkis Acquisition	$ 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, 2019	Dec. 31, 2018
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,405,305	$ 1,398,921
Accumulated Amortization	(364,955)	(319,425)
Net	1,040,350	1,079,496
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	160,841	162,054
Net	$ 160,841	$ 162,054
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	19 years	19 years
Cost	$ 873,973	$ 855,679
Accumulated Amortization	(201,067)	(167,384)
Net	$ 672,906	$ 688,295
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	13 years	13 years
Cost	$ 221,580	$ 231,448
Accumulated Amortization	(114,498)	(106,859)
Net	$ 107,082	$ 124,589
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 103,463	$ 104,061
Accumulated Amortization	(27,433)	(24,764)
Net	$ 76,030	$ 79,297
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	27 years
Cost	$ 34,721	$ 34,721
Accumulated Amortization	(17,590)	(16,519)
Net	$ 17,131	$ 18,202
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	4 years	4 years
Cost	$ 10,727	$ 10,958
Accumulated Amortization	(4,367)	(3,899)
Net	$ 6,360	$ 7,059

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Goodwill [Line Items]
Goodwill, impairment	$ 0
Intangible assets, indefinite life, discount rate percentage	12.50%			12.50%
Intangible asset amortization				$ 5,764,000	$ 4,941,000
Expected annual amortization expense, remainder of 2019	$ 16,600,000			16,600,000
Expected annual amortization expense, in 2020	66,600,000			66,600,000
Expected annual amortization expense, in 2021	65,500,000			65,500,000
Expected annual amortization expense, in 2022	62,000,000.0			62,000,000.0
Expected annual amortization expense, in 2023	61,100,000			61,100,000
Expected annual amortization expense, in 2024	60,300,000			60,300,000
Expected annual amortization expense, thereafter	$ 549,000,000.0			$ 549,000,000.0
Contract Manufacturing Customer, Notified By FDA To Remove Product From Market \| Private Label \| Customer Relationships
Goodwill [Line Items]
Intangible asset amortization		$ 5,800,000
Metasurg \| Orthopedics and Tissue Technologies
Goodwill [Line Items]
Intangible asset amortization			$ 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

DEBT - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
DEBT - Narrative (Details) - USD ($)	Dec. 31, 2018	Jun. 30, 2018	Sep. 30, 2019	May 03, 2018
Debt Instrument [Line Items]
Maximum borrowing capacity				$ 2,200,000,000
Securitization program outstanding borrowings, maximum limit	$ 150,000,000.0
Securitization program, term	3 years
Long-term borrowings under securitization facility	$ 121,200,000		$ 110,000,000
Weighted average interest rate, accounts receivable securitization revolving loan facility			3.10%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value			$ 109,100,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity				1,300,000,000
Line of credit facility outstanding	$ 345,000,000.0		$ 440,000,000.0
Weighted average interest rate on debt	4.00%		3.40%
Revolving Credit Facility \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding			$ 430,100,000
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity				60,000,000.0
Swingline Loans
Debt Instrument [Line Items]
Maximum borrowing capacity				60,000,000.0
Senior Credit Facility
Debt Instrument [Line Items]
Incremental financing costs capitalized		$ 4,200,000
Previously capitalized financing costs, written-off		$ 800,000
Senior Credit Facility \| Federal Funds
Debt Instrument [Line Items]
Interest rates available			0.50%
Senior Credit Facility \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available			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			1.00%
Senior Credit Facility \| Minimum \| Federal Funds
Debt Instrument [Line Items]
Interest rates available			0.00%
Senior Credit Facility \| Minimum \| Prime Rate
Debt Instrument [Line Items]
Interest rates available			0.00%
Senior Credit Facility \| Minimum \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available			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			1.75%
Senior Credit Facility \| Maximum \| Federal Funds
Debt Instrument [Line Items]
Interest rates available			0.75%
Senior Credit Facility \| Maximum \| Prime Rate
Debt Instrument [Line Items]
Interest rates available			0.75%
Senior Credit Facility \| Maximum \| One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available			0.75%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding			$ 0
Letters of credit outstanding	$ 800,000		800,000
Term Loan A \| Secured Debt
Debt Instrument [Line Items]
Line of credit facility outstanding	$ 900,000,000.0		$ 888,800,000
Weighted average interest rate on debt	3.90%		3.40%
Term Loan A \| Secured Debt \| Secured Debt, Current
Debt Instrument [Line Items]
Line of credit facility outstanding			$ 45,000,000.0
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity				$ 900,000,000.0
Term Loan Facility \| Secured Debt \| Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding			$ 875,700,000

DEBT - Contractual Maturity Table (Details) $ in Thousands	Sep. 30, 2019 USD ($)
Debt Disclosure [Abstract]
Remainder of 2019	$ 11,250
2020	45,000
2021	56,250
2022	67,500
2023	708,750
Principal Repayment	$ 888,750

DERIVATIVE INSTRUMENTS - Schedule of Derivatives (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Derivative [Line Items]
Current Notional Amount	$ 1,475,000,000
Estimated Fair Value, Assets (Liabilities)	(57,185,000)	$ 619,000
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)	$ 0	410,000
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)	$ 0	415,000
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)	$ 23,000	619,000
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)	$ 0	418,000
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)	$ 45,000	1,287,000
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)	$ (769,000)	1,246,000
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)	$ (3,647,000)	1,491,000
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)	$ (3,612,000)	1,460,000
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)	$ (4,463,000)	418,000
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)	$ (2,268,000)	162,000
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)	$ (8,702,000)	2,076,000
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 75,000,000
Fixed Interest Rate	3.22%
Estimated Fair Value, Assets (Liabilities)	$ (6,798,000)	(2,594,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 75,000,000
Fixed Interest Rate	3.199%
Estimated Fair Value, Assets (Liabilities)	$ (6,786,000)	(2,551,000)
1-Month USD LIBOR \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Current Notional Amount	$ 75,000,000
Fixed Interest Rate	3.209%
Estimated Fair Value, Assets (Liabilities)	$ (6,896,000)	(2,568,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Current Notional Amount	$ 100,000,000
Fixed Interest Rate	2.885%
Estimated Fair Value, Assets (Liabilities)	$ (6,683,000)	(797,000)
1-Month USD LIBOR \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Current Notional Amount	$ 100,000,000
Fixed Interest Rate	2.867%
Estimated Fair Value, Assets (Liabilities)	$ (6,629,000)	$ (873,000)

DERIVATIVE INSTRUMENTS - Narrative (Details)	3 Months Ended		9 Months Ended
DERIVATIVE INSTRUMENTS - Narrative (Details)	Sep. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)	Sep. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)	Oct. 02, 2017 CHF (SFr)	Oct. 02, 2017 USD ($)
Derivative [Line Items]
Derivative, notional amount matured	$ 150,000,000		$ 150,000,000
Designated as Hedging Instrument \| Cash Flow Hedges
Derivative [Line Items]
Current notional amount	1,475,000,000		1,475,000,000
Cross-currency swap \| Codman
Derivative [Line Items]
Gain (loss), reclassification from AOCI, foreign currency rate translation, intercompany loan	5,700,000	$ (2,600,000)	3,900,000	$ 2,200,000
Gain reclassified into other income	1,800,000	1,900,000	5,500,000	5,900,000
Gain expected to be reclassified to earnings in the next twelve months	6,500,000		6,500,000
Cross-currency swap \| Codman \| Other income, net
Derivative [Line Items]
Gain (loss) recorded to AOCI	9,700,000	$ (3,100,000)	15,400,000	$ 3,000,000.0
Cross-currency swap \| Short \| Codman
Derivative [Line Items]
Current notional amount						$ 300,000,000.0
Cross-currency swap \| Long \| Codman
Derivative [Line Items]
Current notional amount \| SFr					SFr 291,200,000
Cross-currency swap \| Designated as Hedging Instrument
Derivative [Line Items]
Gain recorded in AOCI, change in fair value	17,100,000		26,600,000
Cross-currency swap \| Designated as Hedging Instrument \| Net Investment Hedges
Derivative [Line Items]
Gain reclassified into other income	2,500,000		7,200,000
Gain expected to be reclassified to earnings in the next twelve months	9,600,000		9,600,000
Cross-currency swap \| Designated as Hedging Instrument \| Codman \| Cash Flow Hedges
Derivative [Line Items]
Current notional amount	$ 33,300,000		33,300,000
Loss recorded in other income, net			$ 400,000

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details)	Sep. 30, 2019 CHF (SFr)	Sep. 30, 2019 USD ($)	Dec. 31, 2018 CHF (SFr)	Dec. 31, 2018 USD ($)	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
Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Aggregate Notional Amount						$ 300,000,000.0
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount		$ 1,475,000,000
Fair Value Asset (Liability)		(57,185,000)		$ 619,000
Cash Flow Hedges \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount		33,300,000
Fair Value Asset (Liability)		7,114,000		(2,830,000)
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ 1,737,000		$ (215,000)
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.75%	1.75%	1.75%	1.75%
Aggregate Notional Amount \| SFr	SFr 64,710,000		SFr 97,065,000
Cash Flow Hedges \| Swap One \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.38%	4.38%	4.38%	4.38%
Aggregate Notional Amount		$ 66,667,000		$ 100,000,000
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ 1,327,000		$ (422,000)
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%	1.85%	1.85%
Aggregate Notional Amount \| SFr	SFr 48,533,000		SFr 48,533,000
Cash Flow Hedges \| Swap Two \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%	4.46%	4.46%
Aggregate Notional Amount		$ 50,000,000		$ 50,000,000
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)		$ 4,050,000		$ (2,193,000)
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%	1.95%	1.95%
Aggregate Notional Amount \| SFr	SFr 145,598,000		SFr 145,598,000
Cash Flow Hedges \| Swap Three \| Designated as Hedging Instrument \| Codman \| Cross-currency swap \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%	4.52%	4.52%
Aggregate Notional Amount		$ 150,000,000		$ 150,000,000

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) - Designated as Hedging Instrument - Net Investment Hedges € in Thousands, £ in Thousands, SFr in Thousands, $ in Thousands	Sep. 30, 2019 GBP (£)	Sep. 30, 2019 CHF (SFr)	Sep. 30, 2019 EUR (€)	Sep. 30, 2019 USD ($)	Dec. 31, 2018 USD ($)
Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)				$ 6,141	$ 1,359
Cross Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 70,738
Cross Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	3.01%	3.01%	3.01%	3.01%
Aggregate Notional Amount				$ 82,000
Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)				$ 4,532	(421)
Cross Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 51,760
Cross Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	2.57%	2.57%	2.57%	2.57%
Aggregate Notional Amount				$ 60,000
Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)				$ 2,911	(150)
Cross Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 38,820
Cross Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Rate	2.19%	2.19%	2.19%	2.19%
Aggregate Notional Amount				$ 45,000
Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)				$ 11,678	2,360
Cross Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Rate	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £	£ 128,284
Cross Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Rate	2.71%	2.71%	2.71%	2.71%
Aggregate Notional Amount				$ 167,500
Cross Currency Interest Rate Swap Five
Derivative [Line Items]
Fair Value Asset (Liability)				$ (6,561)	(3,780)
Cross Currency Interest Rate Swap Five \| Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr		SFr 165,172
Cross Currency Interest Rate Swap Five \| Short
Derivative [Line Items]
Fixed Rate	1.67%	1.67%	1.67%	1.67%
Aggregate Notional Amount \| £	£ 128,284
Cross Currency Interest Rate Swap
Derivative [Line Items]
Fair Value Asset (Liability)				$ 18,701	$ (632)

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) - USD ($)	Sep. 30, 2019	Dec. 31, 2018
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	$ 35,082,000	$ 28,281,000
Derivatives designated as hedges — Liabilities	66,453,000	31,124,000
Interest Rate Swap
Derivatives, Fair Value [Line Items]
Current notional amount	1,300,000,000	1,500,000,000
Interest Rate Swap \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	68,000	4,654,000
Interest Rate Swap \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	0	5,350,000
Interest Rate Swap \| Designated as Hedging Instrument \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	5,376,000	0
Interest Rate Swap \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	51,878,000	9,385,000
Cross-currency swap \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	6,453,000	7,615,000
Cross-currency swap \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	662,000	0
Cross-currency swap \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	0	10,445,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	9,552,000	8,888,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other assets
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Assets	18,347,000	1,774,000
Cross-currency swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Other liabilities
Derivatives, Fair Value [Line Items]
Derivatives designated as hedges — Liabilities	$ 9,199,000	$ 11,294,000

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, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,420,951	$ 1,341,905	$ 1,375,796	$ 962,306
Balance, End of Period	1,384,974	1,365,081	1,384,974	1,365,081
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(68,700)	(25,306)	(45,443)	(23,807)
Balance, End of Period	(87,615)	(26,271)	(87,615)	(26,271)
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	13,008	1,992	(12,865)	29,307
Amount of Gain (Loss) Reclassified from AOCI into Earnings	10,245	(234)	19,560	8,117
Designated as Hedging Instrument \| Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(41,391)	14,452	(6,203)	(4,512)
Balance, End of Period	(38,628)	16,678	(38,628)	16,678
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(43,160)	22,344	619	592
Amount of Gain (Loss) Recognized in AOCI	(13,789)	5,059	(54,841)	26,307
Amount of Gain (Loss) Reclassified from AOCI into Earnings	237	473	2,964	(31)
Balance, End of Period	(57,186)	26,930	(57,186)	26,930
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(2,284)	(7,892)	(6,190)	(5,104)
Amount of Gain (Loss) Recognized in AOCI	9,661	(3,067)	15,418	3,000
Amount of Gain (Loss) Reclassified from AOCI into Earnings	7,520	(707)	9,371	8,148
Balance, End of Period	(143)	$ (10,252)	(143)	$ (10,252)
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	4,053		(632)
Amount of Gain (Loss) Recognized in AOCI	17,136		26,558
Amount of Gain (Loss) Reclassified from AOCI into Earnings	2,488		7,225
Balance, End of Period	$ 18,701		$ 18,701

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2019 USD ($) plan $ / shares 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) \| shares	202,752
Options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 18.74
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs \| $	$ 5.3
Weighted-average period for cost recognition	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	6 years
Stock options \| Directors and Certain Executive Officers \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	10 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 \| $	$ 28.1
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares) \| shares	318,410
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 55.19
Performance stock and Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Requisite service periods of awards	3 years
Performance shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards granted during the period (in shares) \| shares	118,903
Other than options, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 55.91

DEFINED BENEFIT PLANS - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018
Retirement Benefits [Abstract]
Net periodic benefit costs	$ 1.0	$ 0.5	$ 2.1	$ 1.7
Service cost component	0.7	$ 0.7	2.0	$ 1.4
Estimated fair value of plan assets	$ 28.6		$ 28.6		$ 31.1

LEASES AND RELATED PARTY LEASES - Narrative (Details)	9 Months Ended		12 Months Ended
LEASES AND RELATED PARTY LEASES - Narrative (Details)	Sep. 30, 2019 USD ($) renewal_option	Sep. 30, 2018 USD ($)	Dec. 31, 2018 USD ($)	Jun. 30, 2019 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewal_option	1
Operating lease expense	$ 14,200,000	$ 11,800,000
Right of use asset - operating leases	97,738,000
Operating lease liability	108,655,000
Operating lease expense, Topic 840			$ 16,300,000
Future minimum lease payments, capital leases			$ 0
NEW JERSEY
Operating Leased Assets [Line Items]
Operating lease, term			18 years
Right of use asset - operating leases				$ 35,600,000
Operating lease liability				$ 35,600,000
Related Parties
Operating Leased Assets [Line Items]
Operating lease expense	$ 200,000	$ 200,000
Operating lease expense, Topic 840			$ 300,000
Percent of manufacturing facility owned by corporation whose shareholders are trusts whose beneficiaries include family members of company's former director	50.00%
Annual rate of lease agreement	$ 300,000
Related Parties \| Five Year Option Lease From November 1, 2032 Through October 31, 2037
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2032 through October 31, 2037
Related Parties \| Five Year Option Lease From November 1, 2037 Through October 31, 2042
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2037 through October 31, 2042

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) $ in Thousands	Sep. 30, 2019 USD ($)
Lessee, Lease, Description [Line Items]
ROU assets	$ 97,738
Current lease liabilities	11,835
Non-current lease liabilities	96,820
Total lease liabilities	$ 108,655
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	12 years 10 months 24 days
Weighted average discount rate	5.40%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 9 months 18 days
Weighted average discount rate	3.20%

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases, After Adoption of 842 (Details) $ in Thousands	Sep. 30, 2019 USD ($)
Operating Leased Assets [Line Items]
2019	$ 4,563
2020	13,585
2021	12,987
2022	13,937
2023	11,710
Thereafter	104,467
Total minimum lease payments	161,249
Less: Imputed interest	52,594
Total lease liabilities	108,655
Less: Current lease liabilities	11,835
Long-term lease liabilities	96,820
Related Parties
Operating Leased Assets [Line Items]
2019	74
2020	296
2021	296
2022	296
2023	296
Thereafter	1,724
Total minimum lease payments	2,982
Third Parties
Operating Leased Assets [Line Items]
2019	4,489
2020	13,289
2021	12,691
2022	13,641
2023	11,414
Thereafter	102,743
Total minimum lease payments	$ 158,267

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases, Before Adoption of 842 (Details) $ in Thousands	Dec. 31, 2018 USD ($)
Operating Leased Assets [Line Items]
2019	$ 16,768
2020	13,806
2021	12,493
2022	13,233
2023	11,003
Thereafter	102,399
Total minimum lease payments	169,702
Related Parties
Operating Leased Assets [Line Items]
2019	296
2020	296
2021	296
2022	296
2023	296
Thereafter	1,724
Total minimum lease payments	3,204
Third Parties
Operating Leased Assets [Line Items]
2019	16,472
2020	13,510
2021	12,197
2022	12,937
2023	10,707
Thereafter	100,675
Total minimum lease payments	$ 166,498

TREASURY STOCK - Narrative (Details) - USD ($)	9 Months Ended		12 Months Ended
TREASURY STOCK - Narrative (Details) - USD ($)	Sep. 30, 2019	Sep. 30, 2018	Dec. 31, 2018	Dec. 11, 2018	Dec. 10, 2018
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
Treasury stock (in shares)	2,900,000		2,900,000
Treasury stock	$ 120,100,000		$ 120,600,000
Treasury stock, average cost per share (in dollars per share)	$ 41.87		$ 41.87
Stock repurchase program, authorized amount (up to)				$ 225,000,000.0	$ 150,000,000.0
Amount available for share repurchase under this latest authorization	$ 225,000,000.0
Stock repurchased during period (in shares)	0	0

INCOME TAXES - Narrative (Details) $ / shares in Units, SFr in Millions, $ in Millions	3 Months Ended			9 Months Ended
	Sep. 30, 2019 USD ($)	Mar. 31, 2019 USD ($) $ / shares	Sep. 30, 2018	Sep. 30, 2019 CHF (SFr)	Sep. 30, 2019 USD ($)	Sep. 30, 2018 USD ($)
Income Tax Contingency [Line Items]
Effective income tax rate	(0.40%)		(20.60%)	(3.50%)	(3.50%)	(8.40%)
Tax expense, tax reform-related adjustments, due to clarification in IRS guidance	$ 1.6				$ 1.6
Tax benefit from Switzerland tax holiday		$ 10.8
Tax benefit from Switzerland tax holiday (in dollars per share) \| $ / shares		$ 0.13
Tax benefit, related to share-based compensation						$ 1.2
Foreign Tax Authority \| Swiss Federal Tax Administration (FTA)
Income Tax Contingency [Line Items]
Federal tax credit \| SFr				SFr 12
Federal tax credit, term				7 years	7 years
Rebound
Income Tax Contingency [Line Items]
In-process research and development (IPR&D) expense	$ 59.9				$ 59.9

NET INCOME (LOSS) 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, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Basic net income per share:
Net income (loss)	$ (27,610)	$ 13,295	$ 34,882	$ 35,663
Weighted average common shares outstanding - Basic (in shares)	85,688	85,193	85,536	82,058
Basic net income (loss) per common share (in dollars per share)	$ (0.32)	$ 0.16	$ 0.41	$ 0.43
Diluted net income per share:
Net income (loss)	$ (27,610)	$ 13,295	$ 34,882	$ 35,663
Weighted average common shares outstanding - Basic (in shares)	85,688	85,193	85,536	82,058
Effect of dilutive securities:
Stock options and restricted stock (in shares)	0	1,106	1,045	1,084
Weighted average common shares for diluted earnings per share (in shares)	85,688	86,299	86,581	83,142
Diluted net income (loss) per common share (in dollars per share)	$ (0.32)	$ 0.15	$ 0.40	$ 0.43

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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+ Details

- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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-Subparagraph (SX 210.5-03(21))
-URI http://asc.fasb.org/extlink&oid=116634182&loc=SL114868664-224227

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 260
-SubTopic 10
-Section 45
-Paragraph 60B
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=117326831&loc=SL5780133-109256

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(19))
-URI http://asc.fasb.org/extlink&oid=116637232&loc=SL114874131-224263

+ Details

- Definition

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

+ References + Details

COMPREHENSIVE INCOME (LOSS) - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Equity [Abstract]
Net income (loss)	$ (27,610)	$ 13,295	$ 34,882	$ 35,663
Foreign currency translation adjustment	(18,651)	(2,353)	(17,960)	(16,359)
Change in unrealized gain (loss) on derivatives, net of tax	(775)	1,386	(24,714)	14,419
Pension liability adjustment, net of tax	515	2	504	8
Comprehensive income (loss), net	$ (46,521)	$ 12,330	$ (7,288)	$ 33,731

- Definition

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

+ References + Details

COMPREHENSIVE INCOME (LOSS) - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,420,951	$ 1,341,905	$ 1,375,796	$ 962,306
Other comprehensive loss			(27,728)
Amounts reclassified from accumulated other comprehensive loss			14,444
Net current-period other comprehensive income (loss)	(18,915)	(965)	(42,172)	(1,931)
Balance, End of Period	1,384,974	1,365,081	1,384,974	1,365,081
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(4,813)
Other comprehensive loss			(9,763)
Amounts reclassified from accumulated other comprehensive loss			14,950
Net current-period other comprehensive income (loss)			(24,713)
Balance, End of Period	(29,526)		(29,526)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(736)
Other comprehensive loss			(2)
Amounts reclassified from accumulated other comprehensive loss			(506)
Net current-period other comprehensive income (loss)			504
Balance, End of Period	(232)		(232)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period			(39,894)
Other comprehensive loss			(17,963)
Amounts reclassified from accumulated other comprehensive loss			0
Net current-period other comprehensive income (loss)			(17,963)
Balance, End of Period	(57,857)		(57,857)
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(68,700)	(25,306)	(45,443)	(23,807)
Net current-period other comprehensive income (loss)	(18,915)	(965)	(42,172)	(2,464)
Balance, End of Period	$ (87,615)	$ (26,271)	$ (87,615)	$ (26,271)

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Segment Net Sales
Total Revenues	$ 379,095	$ 365,854	$ 1,122,430	$ 1,089,126
Segment Profit
Operating income	(20,587)	23,677	57,680	76,890
Amortization	(5,056)	(5,268)	(21,340)	(15,944)
Operating Segments
Segment Profit
Operating income	131,512	127,386	404,414	377,574
Segment Reconciling Items
Segment Profit
Amortization	(5,056)	(5,268)	(21,340)	(15,944)
Corporate and other
Segment Profit
Operating income	(147,043)	(98,441)	(325,394)	(284,740)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	252,984	239,035	736,810	714,654
Codman Specialty Surgical \| Operating Segments
Segment Profit
Operating income	101,129	91,871	291,750	272,480
Orthopedics and Tissue Technologies
Segment Net Sales
Total Revenues	126,111	126,819	385,620	374,472
Orthopedics and Tissue Technologies \| Operating Segments
Segment Profit
Operating income	$ 30,383	$ 35,515	$ 112,664	$ 105,094

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Other Long-term Liabilities - Fair Value, Inputs, Level 3 $ in Thousands	9 Months Ended
	Sep. 30, 2019 USD ($)
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 0
Additions from acquisition of Arkis	13,100
Balance, End of Period	13,100
Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230
Balance, End of Period	$ 230

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 $ in Thousands	9 Months Ended
	Sep. 30, 2018 USD ($)
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
Transfers from long-term to current portion	1,387
Payments	(2,000)
Balance, End of Period	0
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]
Loss from change in fair value of contingent consideration liabilities	298
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
Transfers from long-term to current portion	(1,387)
Payments	0
Balance, End of Period	230
Derma Sciences \| Other Long-term Liabilities \| Selling, general and administrative
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Loss from change in fair value of contingent consideration liabilities	230
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
Transfers from long-term to current portion	0
Payments	(19,000)
Balance, End of Period	5,000
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]
Loss from change in fair value of contingent consideration liabilities	$ 1,522

COMMITMENTS AND CONTINGENCIES - Narrative (Details)	1 Months Ended	9 Months Ended
COMMITMENTS AND CONTINGENCIES - Narrative (Details)	Oct. 31, 2018 USD ($)	Sep. 30, 2019 USD ($) liability	Dec. 31, 2018 USD ($)	Sep. 30, 2018 USD ($)	Mar. 31, 2018 USD ($)	Feb. 24, 2017 USD ($)	Jan. 15, 2014 USD ($)
Confluent Surgical, Inc.
Loss Contingencies [Line Items]
Maximum contingent consideration							$ 30,000,000.0
Contingent consideration, liability					$ 19,000,000.0
Payment for contingent consideration	$ 5,000,000.0
Confluent Surgical, Inc. \| Contingent Consideration Liability \| Measurement Input, Discount Rate
Loss Contingencies [Line Items]
Discounted cash flow model, measurement input							0.022
Confluent Surgical, Inc. \| U.S. Contingent Consideration
Loss Contingencies [Line Items]
Maximum contingent consideration							$ 25,000,000.0
Confluent Surgical, Inc. \| European Contingent Consideration
Loss Contingencies [Line Items]
Maximum contingent consideration							$ 5,000,000.0
Derma Sciences
Loss Contingencies [Line Items]
Maximum contingent consideration		$ 3,000,000.0				$ 26,500,000
Contingent consideration, liability		$ 200,000	$ 200,000	$ 200,000
Number of contingent liabilities remaining \| liability		1
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 33,300,000

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2019-10-01	Sep. 30, 2019
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation through 2020, percentage	42.00%
Performance obligations expected to be satisfied, expected timing	15 months

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	9 Months Ended
	Sep. 30, 2019 Segment product
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

DEFINED BENEFIT PLANS	9 Months Ended
DEFINED BENEFIT PLANS	Sep. 30, 2019
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, 2019 were $1.0 million and $2.1 million, respectively. The components of the net periodic benefit costs other than the service cost component of $0.7 million and $2.0 million for the three and nine months ended September 30, 2019, respectively, are included in other income, net in the consolidated statements of operations. 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 $1.4 million for the three and nine months ended September 30, 2018, respectively, are included in other income, net in the consolidated statements of operations. The estimated fair values of plan assets were $28.6 million and $31.1 million as of September 30, 2019 and December 31, 2018, respectively. The net plan assets of the pension plans are invested in common trusts as of September 30, 2019 and December 31, 2018. 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, 2019
Treasury Stock Transactions, Excluding Value of Shares Reissued [Abstract]
TREASURY STOCK	TREASURY STOCK As of September 30, 2019 and December 31, 2018, there were 2.9 million shares of treasury stock outstanding with a cost of $120.1 million and $120.6 million, respectively, at a weighted average cost per share of $41.87. On December 11, 2018, the Board of Directors (the "Board") authorized the Company to repurchase up to $225.0 million of the Company’s common stock. The program allows the Company to repurchase its shares opportunistically from time to time. The repurchase authorization expires in December 2020. Purchases may be affected through one or more open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, or a combination of the foregoing. As of September 30, 2019, there remained $225.0 million available for repurchase under this authorization. This stock repurchase authorization replaces the previous $150.0 million stock repurchase authorization, approved by the Board in 2016. There were no cash treasury stock repurchases during the nine months ended September 30, 2019 and 2018.

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2019 USD ($)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 10,680
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 41,860

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		9 Months Ended
INCOME TAXES - Summary of Effective Tax Rate (Details)	Sep. 30, 2019	Sep. 30, 2018	Sep. 30, 2019	Sep. 30, 2018
Income Tax Disclosure [Abstract]
Reported tax rate	(0.40%)	(20.60%)	(3.50%)	(8.40%)

Label	Element	Value
Accounting Standards Update 2014-09 [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 1,854,000
Accounting Standards Update 2014-09 [Member] \| Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 1,854,000