0000917520-23-000015 | 10-K | XBRL Viewer | Integra Lifesciences Holdings Corp

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TREASURY STOCK	12 Months Ended
TREASURY STOCK	Dec. 31, 2022
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of December 31, 2022 and 2021, there were 6.8 million and 4.9 million shares of treasury stock outstanding with a cost of $362.9 million and $234.4 million, respectively, at a weighted average cost per share of $53.18 and $47.86, respectively. On January 26, 2023, the Company entered into a $150 million accelerated share repurchase ("2023 ASR") and received 2.1 million shares of the Company common stock at inception of the 2023 ASR, which represented approximately 80% of the expected total shares of under the 2023 SAR. The remaining repurchase transactions are expected to be completed in the first half of 2023. On April 26 2022, the Board of Directors authorized the Company to repurchase up to $225 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 2024. This stock repurchase authorization replaces the previous $225 million stock repurchase authorization, of which $100 million remained authorized at the time of its replacement, and which was otherwise set to expire on December 31, 2022. 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. On January 12, 2022, the Company entered into a $125 million accelerated share repurchase ("2022 ASR") and received 1.48 million shares of Company common stock at inception of the 2022 ASR, which represented approximately 80% of the expected total shares under the 2022 ASR. In March 24, 2022, the early exercise provision was exercised by the 2022 ASR counterparty. Upon settlement on March 24, 2022, the Company received an additional 0.46 million shares determined using the volume-weighted average price of the Company's common stock during the term of the 2022 ASR. For the year ended December 31, 2021, there were no repurchases of the Company’s common stock as part of the share repurchase authorization. On August 16, 2022, the Inflation Reduction Act of 2022 (the “Act”) was signed into law. The Act implements a new excise tax of 1% on the net share repurchases made by the company effective for share repurchases performed January 1, 2023, or after.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Basis Of Presentation

BASIS OF PRESENTATION These financial statements and the accompanying notes are prepared in accordance with accounting principles generally accepted in the United States of America and conform to Regulation S-X under the Securities Exchange Act of 1934, as amended.

Principles Of Consolidation

PRINCIPLES OF CONSOLIDATION

The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. Intercompany accounts and transactions have been eliminated in consolidation. See Note 4, Acquisitions and Divestitures, for details of new subsidiaries included in the consolidation.

Use Of Estimates

USE OF ESTIMATES 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 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.

Cash And Cash Equivalents

CASH AND CASH EQUIVALENTS

The Company considers all short-term, highly liquid investments purchased with original maturities of three months or less to be cash equivalents. These investments are carried at cost, which approximates fair value.

Trade Accounts Receivable And Allowances For Doubtful Accounts Receivable

TRADE ACCOUNTS RECEIVABLE AND ALLOWANCES FOR DOUBTFUL ACCOUNTS RECEIVABLE

Trade accounts receivable are recorded at the invoiced amount and do not bear interest. The Company grants credit to customers in the normal course of business, but generally does not require collateral or any other security to support its receivables.

The Company evaluates the collectability of accounts receivable based on a combination of factors. The Company recognizes a provision for doubtful accounts that reflects the Company’s estimate of expected credit losses for trade accounts receivable. In circumstances where a specific customer is unable to meet its financial obligations to the Company, a provision to the allowances for doubtful accounts is recorded against amounts due to reduce the net recognized receivable to the amount that is reasonably expected to be collected. For all other customers, the Company evaluates measurement of all expected credit losses for trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts.

In June 2016, the FASB issued ASU 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020 was not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the COVID-19 pandemic and recent variants of the virus, and other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact due to customer and governmental responses to the COVID-19 pandemic.Provisions to the allowances for doubtful accounts are recorded to selling, general and administrative expenses. Account balances are charged off against the allowance when it is probable that the receivable will not be recovered.

Inventories

INVENTORIES

Inventories, consisting of purchased materials, direct labor and manufacturing overhead, are stated at the lower of cost, the value determined by the first-in, first-out method, or net realizable value. Inventories consisted of the following:


	December 31,
Dollars in thousands	2022		2021
Finished goods	172,088		$	162,528
Work in process	70,598		65,323
Raw materials	81,897		89,535
Total inventories, net	$	324,583	$	317,386

At each balance sheet date, the Company evaluates inventories for excess quantities, obsolescence or shelf life expiration. This evaluation includes analysis of historical sales levels by product, projections of future demand, the risk of technological or competitive obsolescence for products, general market conditions, a review of the shelf life expiration dates for products, as well as the feasibility of reworking or using excess or obsolete products or components in the production or assembly of other products that are not obsolete or for which there are not excess quantities in inventory. To the extent that management determines there are excess or obsolete inventory or quantities with a shelf life that is too near its expiration for the Company to reasonably expect that it can sell those products prior to their expiration, the Company adjusts the carrying value to estimated net realizable value.

The Company capitalizes inventory costs associated with certain products prior to regulatory approval, based on management's judgment of probable economic benefit. The Company could be required to expense previously capitalized costs related to pre-approval inventory upon a change in such judgment, due to, among other potential factors, a denial or delay of approval by necessary regulatory bodies or a decision by management to discontinue the related development program.

Property, Plant And Equipment

PROPERTY, PLANT AND EQUIPMENT

Property, plant and equipment are stated at historical cost less accumulated depreciation and any impairment charges. The Company provides for depreciation using the straight-line method over the estimated useful lives of the assets. Leasehold improvements are amortized over the lesser of the lease term or the useful life. The cost of major additions and improvements is capitalized, while maintenance and repair costs that do not improve or extend the lives of the respective assets are charged to operations as incurred. The cost of computer software developed or obtained for internal use is accounted for in accordance with the Accounting Standards Codification 350-40, Internal-Use Software.

Capitalized Interest

CAPITALIZED INTERESTThe interest cost on capital projects, including facilities build-out and internal use software, is capitalized and included in the cost of the project. Capitalization commences with the first expenditure for the project and continues until the project is substantially complete and ready for its intended use. When no debt is incurred specifically for a project, interest is capitalized on project expenditures using the weighted average cost of the Company's outstanding borrowings.

Acquisitions

ACQUISITIONS

Results of operations of acquired companies are included in the Company’s results of operations as of the respective acquisition dates. The Company accounts for the acquisition of a business in accordance with ASC 805, Business Combinations ("ASC Topic 805"). Amounts paid to acquire a business are allocated to the assets acquired and liabilities assumed based on their fair values at the date of acquisition. Any excess of the purchase price over the fair value of the net assets acquired is recorded as goodwill. Transaction costs and costs to restructure the acquired company are expensed as incurred.

Contingent consideration is recorded at fair value as measured on the date of acquisition. The value recorded is based on estimates of future financial projections under various potential scenarios using either a Monte Carlo simulation or the probability-weighted income approach derived from revenue estimates and probability assessment with respect to the likelihood of achieving contingent obligations. Contingent payments related to acquisitions consist of development, regulatory, and commercial milestone payments, in addition to sales-based payments, and are valued using discounted cash flow techniques. Each quarter until such contingent amounts are earned, the fair value of the liability is remeasured at each reporting period and adjusted as a component of operating expenses based on changes to the underlying assumptions. The change in the fair value of sales-based payments is based upon future revenue estimates and increases or decreases as revenue estimates or expectation of timing of payment charges. The estimates used to determine the fair value of the contingent consideration liability are subject to significant judgment and actual results are likely to differ from the amounts originally recorded.

The Company determines the fair value of acquired intangible assets based on detailed valuations that use certain information and assumptions provided by management. The Company allocates any excess purchase price over the fair value of the net tangible and intangible assets acquired to goodwill. Determining the fair value of these intangible assets acquired as part of a business combination requires the Company to make significant estimates. These estimates include the amount and timing of projected future cash flows, the discount rate used to discount those cash flows to present value, the assessment of the asset’s life cycle, and the consideration of legal, technical, regulatory, economic, and competitive risks. The fair value assigned to other intangible assets is determined by estimating the future cash flows of each project or technology and discounting the net cash flows back to their present values. The discount rate used is determined at the time of measurement in accordance with accepted valuation methodologies.

Acquired IPR&D is recognized at fair value and initially characterized as an indefinite-lived intangible asset, irrespective of whether the acquired IPR&D has an alternative future use. The Company uses the income approach to determine the fair value of developed technology and IPR&D acquired in a business combination. This approach determines fair value by estimating the after-tax cash flows attributable to the respective asset over its useful life and then discounting these after-tax cash flows back to a present value. 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 product including net revenues, cost of sales, R&D costs, selling and marketing costs, 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 also uses the income approach, as described above, to determine the estimated fair value of certain other identifiable intangible assets including customer relationships, trade names and business licenses. Customer relationships represent established relationships with customers, which provide a ready channel for the sale of additional products and services. Trade names represent acquired company and product names.

IPR&D acquired in a business combination is capitalized as an indefinite-lived intangible asset. Development costs incurred after the acquisition are expensed as incurred. Upon receipt of regulatory approval, the indefinite-lived intangible asset is then accounted for as a finite-lived intangible asset and amortized on a straight-line basis or accelerated basis, as appropriate, over its estimated useful life. If the research and development project is subsequently abandoned, the indefinite-lived intangible asset is charged to expense. IPR&D acquired outside of a business combination is expensed immediately.

Due to the uncertainty associated with research and development projects, there is risk that actual results will differ materially from the original cash flow projections and that the research and development project will result in a successful commercial product. The risks associated with achieving commercialization include, but are not limited to, delay or failure to obtain regulatory approvals to conduct clinical trials, delay or failure to obtain required market clearances, delays or issues with patent

issuance, or validity and litigation.

If the acquired net assets do not constitute a business under the acquisition method of accounting, the transaction is accounted for as an asset acquisition and no goodwill is recognized. In an asset acquisition, the amount allocated to acquired IPR&D with no alternative future use is charged to expense at the acquisition date. Payments that would be recognized as contingent consideration in a business combination are expensed when probable in an asset acquisition.

Goodwill And Other Intangible Assets

GOODWILL AND OTHER INTANGIBLE ASSETS

The excess of the cost over the fair value of net assets of acquired businesses is recorded as goodwill. Goodwill is not subject to amortization but is reviewed for impairment at the reporting unit level annually, or more frequently if impairment indicators arise. The Company's assessment of the recoverability of goodwill is based upon a comparison of the carrying value of goodwill with its estimated fair value. The Company reviews goodwill for impairment in the third quarter every year in accordance with ASC Topic 350, Intangibles - Goodwill and Other ("ASC Topic 350") and whenever events or changes in circumstances indicate the carrying value of goodwill may not be recoverable. Refer to Note 7, Goodwill and Other Intangibles for more information.

The Company has two reportable segments with three underlying reporting units. Refer to Note 16, Segment and Geographic Information for more information on reportable segments.

Other intangible assets include patents, trademarks, purchased technology, and supplier and customer relationships. Identifiable intangible assets are initially recorded at fair market value at the time of acquisition generally using an income or cost approach. The Company capitalizes costs incurred to renew or extend the term of recognized intangible assets and amortizes those costs

over their expected useful lives.

The Company tests 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 an indefinite lived intangible asset below its carrying amount. The Company tests for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including 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 the intangible asset is less than its carrying amount. The Company may elect to bypass this qualitative evaluation and perform a quantitative test.

Product rights and other definite-lived intangible assets are tested periodically for impairment in accordance with ASC 350 Topic 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 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.

Long-Lived Assets

LONG-LIVED ASSETS Long-lived assets held and used by the Company, including property, plant and equipment, intangible assets, and leases are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. For purposes of evaluating the recoverability of long-lived assets to be held and used, a recoverability test is performed using projected undiscounted net cash flows applicable to the long-lived assets. If an impairment exists, the amount of such impairment is calculated based on the estimated fair value of the asset. Impairments to long-lived assets to be disposed of are recorded based upon the difference between the carrying value and the fair value of the applicable assets.

Integra Foundation

INTEGRA FOUNDATION The Company may periodically make contributions to the Integra Foundation, Inc. The Integra Foundation was incorporated in 2002 exclusively for charitable, educational, and scientific purposes and qualifies under IRC 501(c)(3) as an exempt private foundation. Under its charter, the Integra Foundation engages in activities that promote health, the diagnosis and treatment of disease, and the development of medical science through grants, contributions and other appropriate means. The Integra Foundation is a separate legal entity and is not a subsidiary of the Company; therefore, its results are not included in these consolidated financial statements.

Derivatives

DERIVATIVES

The Company develops, manufactures, and sells medical devices globally and its earnings and cash flows are exposed to market risk from changes in interest rates and currency exchange rates. The Company addresses these risks through a risk management program that includes the use of derivative financial instruments and operates the program pursuant to documented corporate risk management policies. All derivative financial instruments are recognized in the financial statements at fair value in accordance with the authoritative guidance. Under the guidance, for those instruments that are designated and qualify as hedging instruments, the hedging instrument must be designated as a fair value hedge, cash flow hedge, or a hedge of a net investment in a foreign operation, based on the exposure being hedged. The accounting for changes in the fair value of a derivative instrument depends on whether it has been designated and qualifies as part of a hedging relationship and, further, on the type of hedging relationship. The Company's derivative instruments do not subject its earnings or cash flows to material risk, and gains and losses on these derivatives generally offset losses and gains on the item being hedged. The Company has not entered into derivative transactions for speculative purposes. From time to time, the Company may enter into derivatives that are not designated as hedging instruments in order to protect itself from currency volatility due to intercompany balances.

All derivative instruments are recognized at the fair values as either assets or liabilities on the balance sheet. The Company determines the fair value of its derivative instruments using the framework prescribed by the authoritative guidance, by considering the estimated amount the Company would receive to sell or transfer these instruments at the reporting date and by taking into account expected forward interest rates, currency exchange rates, the creditworthiness of the counterparty for assets, and its creditworthiness for liabilities. In certain instances, the Company utilizes a discounted cash flow model to measure fair value. Generally, the Company uses inputs that include quoted prices for similar assets or liabilities in active markets, other observable inputs for the asset or liability and inputs derived principally from, or corroborated by, observable market data by correlation or other means. The Company has classified all of its derivative assets and liabilities within Level 2 of the fair value hierarchy because observable inputs are available for substantially the full term of its derivative instruments. The Company classifies derivatives designated as hedges in the same category as the item being hedged for cash flow presentation purposes.

The Company entered into foreign currency forward and foreign currency swap contracts that are not designated as hedging instruments for accounting purposes. These contracts are recorded at fair value, with the changes in fair value recognized into other income, net, on the consolidated financial statements.

Foreign Currency

FOREIGN CURRENCY All assets and liabilities of foreign subsidiaries which have a functional currency other than the U.S. dollar are translated at the rate of exchange at year-end, while elements of the income statement are translated at the average exchange rates in effect during the year. The net effect of these translation adjustments is shown as a component of accumulated other comprehensive income (loss). These currency translation adjustments are not currently adjusted for income taxes as they relate to permanent investments in non-U.S. subsidiaries.

Income Taxes

INCOME TAXES

Income taxes are accounted for by using the asset and liability method. Deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. A valuation allowance is provided when it is more likely than not that some portion or all of the deferred tax assets will not be realized. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period when the change is enacted.

The Company recognizes a tax benefit from an uncertain tax position only if it is more likely than not to be sustained upon examination based on the technical merits of the position. Reserves are established for positions that don't meet this recognition threshold. The reserve is measured as the largest amount of benefit determined on a cumulative probability basis that the Company believes is more likely than not to be realized upon ultimate settlement of the position. These reserves are classified as long-term liabilities in the consolidated balance sheets of the Company, unless the reserves are expected to be paid in cash during the next twelve months, in which case they are classified as current liabilities. The Company also records interest and penalties accrued in relation to uncertain tax benefits as a component of income tax expense.

While the Company believes it has identified all reasonable exposures and the reserve it has established is appropriate under the circumstances, it is possible that additional exposures exist and that exposures may be settled at amounts different than the amounts reserved. It is also possible that changes in facts and circumstances could cause the Company to either materially increase or reduce the carrying amount of its tax reserve.

The Company continues to indefinitely reinvest substantially all of its foreign earnings unless there is a manner under which to remit the earnings without a material tax cost. The current provisional analysis indicates that the Company has sufficient U.S. liquidity, including borrowing capacity, to fund foreseeable U.S. cash needs without requiring the repatriation of foreign cash. One time or unusual items that may impact the ability or intent to keep the foreign earnings and cash indefinitely reinvested include significant U.S. acquisitions, loans from a foreign subsidiary and changes in tax laws.

Revenue Recognition

REVENUE RECOGNITION

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

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

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

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

Revenues from sale of products and services are evidenced by either a contract with the customer or a valid purchase order and an invoice which includes all relevant terms of sale. For product sales, invoices are generally issued upon the transfer of control (or upon the completion of the manufacturing in the case of the private label transactions recognized over time) and are typically payable 30 days after the invoice date. The Company performs a review of each specific customer's creditworthiness and ability to pay prior to acceptance as a customer. Further, the Company performs periodic reviews of its customers' creditworthiness prospectively. Refer to Note 3, Revenue From Contracts With Customers for more information. The Company also maintains a provision for estimated returns and allowances in the same period that the related revenue is recorded. This reserve is based upon an analysis of actual credit memos issued for pricing issues or returned goods over an extended period, as well as assumptions about outstanding accounts receivable and judgment in interpreting the data.

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 90 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. Upon invoicing to the customer, the balance is recorded in trade receivable, net 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 FeesThe 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.

Research And Development

RESEARCH AND DEVELOPMENT Research and development costs, including salaries, depreciation, consultant and other external fees, and facility costs directly attributable to research and development activities, are expensed in the period in which they are incurred.

Employee Termination Benefits

EMPLOYEE TERMINATION BENEFITS

The Company does not have a written severance plan, and it does not offer similar termination benefits to affected employees in all restructuring initiatives. Accordingly, in situations where minimum statutory termination benefits must be paid to the affected employees, the Company records employee severance costs associated with these restructuring activities in accordance with the authoritative guidance for non-retirement post-employment benefits. Charges associated with these activities are recorded when the payment of benefits is probable and can be reasonably estimated. In all other situations where the Company pays out termination benefits, including supplemental benefits paid in excess of statutory minimum amounts and benefits offered to affected employees based on management's discretion, the Company records these termination costs in accordance with the authoritative guidance for ASC Topic 712 Compensation - Nonretirement Benefits and ASC Topic 420 One-time Employee Termination Benefits.

The timing of the recognition of charges for employee severance costs other than minimum statutory benefits depends on whether the affected employees are required to render service beyond their legal notification period in order to receive the benefits. If affected employees are required to render service beyond their legal notification period, charges are recognized over the future service period. Otherwise, charges are recognized when management has approved a specific plan and employee communication requirements have been met.

Stock-Based Compensation

STOCK-BASED COMPENSATION Relevant authoritative guidance requires companies to recognize the expense related to the fair value of their stock-based compensation awards. Stock-based compensation expense for stock option awards are based on the grant date fair value using the binomial distribution model. The Company recognizes compensation expense for stock option awards, restricted stock awards, performance stock awards and contract stock awards over the requisite service period of the award. All excess tax benefits and taxes and tax deficiencies from stock-based compensation are included in provision for income taxes in the consolidated statement of operations.

Pension Benefits

PENSION BENEFITS

The Company maintains defined benefit pension plans that cover certain employees in France, Japan, Germany and Switzerland. Various factors are considered in determining the pension liability, including the number of employees expected to be paid their salary levels and years of service, the expected return on plan assets, the discount rate used to determine the benefit obligations, the timing of benefit payments and other actuarial assumptions.

Retirement benefit plan assumptions are reassessed on an annual basis or more frequently if changes in circumstances indicate a re-evaluation of assumptions are required. The key benefit plan assumptions are the discount rate and expected rate of return on plan assets. The discount rate is based on average rates on bonds that matched the expected cash outflows of the benefit plans. The expected rate of return is based on historical and expected returns on the various categories of plan assets.

The Company uses the corridor approach in measuring the amount of net periodic benefit pension cost to recognize each period. The corridor approach defers all actuarial gains and losses resulting from variances between actual results and actuarial assumptions. Those unrecognized gains and losses are amortized when the net gains and losses exceed 10% of the greater of the market-related value of plan assets or the projected benefit obligation at the beginning of the year. The amount in excess of the corridor is amortized over the average remaining service period to retirement date of active plan participants.

Deferred Compensation Plan

The Company maintains a deferred compensation plan in which certain employees of the Company may defer the payment and taxation of up to 75% of their base salary and up to 100% of bonus amounts and other eligible cash compensation.

This deferred compensation is invested in funds offered under the Plan and is valued based on Level 1 measurements in the fair value hierarchy. The purpose of the plan is to retain key employees by providing them with an opportunity to defer a portion of their compensation as elected by the participant in accordance with the plan. Any amounts set aside to defray the liabilities assumed by the Company will remain the general assets of the Company until such amounts are distributed to the participants. Assets of the Company's deferred compensation plan are included in Other current assets and recorded at fair value based on their quoted market prices.

Concentration Of Credit Risk

CONCENTRATION OF CREDIT RISK

Financial instruments, which potentially subject the Company to concentrations of credit risk, consist principally of cash and cash equivalents, which are held at major financial institutions, investment-grade marketable debt securities and trade receivables.

The Company's products are sold on an uncollateralized basis and on credit terms based upon a credit risk assessment of each customer. A portion of the Company's trade receivables to customers outside the United States includes sales to foreign distributors, who then sell to government owned or supported healthcare systems.

Recent Accounting Pronouncements

RECENT ACCOUNTING PRONOUNCEMENTS

In December 2019, the FASB issued ASU 2019-12, Income Taxes: Simplifying the Accounting for Income Taxes, intended to simplify the accounting for income taxes by eliminating certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplifies aspects of the accounting for franchise taxes and enacted changes in tax laws or rates and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The standard is effective for annual periods beginning after December 15, 2020 and interim periods within, with early adoption permitted. The Company adopted ASU 2019-12 as of January 1, 2021. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures.

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848), and subsequent amendment to the initial guidance: ASU 2021-01, Reference Rate Reform (Topic 848): Scope (collectively, “Topic 848”). Topic 848 provides optional expedients and exceptions for applying GAAP to contracts, hedging relationships, and other transactions affected by reference rate reform if certain criteria are met. The amendments apply only to contracts, hedging relationships, and other transactions that reference London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued because of reference rate reform. The guidance generally can be applied from March 12, 2020 through December 31, 2022. On October 5, 2022, the FASB approved an extension of the sunset date of the reference rate reform from December 31, 2022 to December 31, 2024, past LIBOR’s end date. The Company currently has contracts that are indexed to LIBOR and are continuing to evaluate the scope of impacted contracts and potential risk. The Company expects all LIBOR-based contracts to be replaced by the Secured Overnight Financing Rate (“SOFR”), which is calculated based on overnight transactions under repurchase agreements backed by Treasury securities. The Alternative Reference Rates Committee, a group of private-market participants convened by the U.S. Federal Reserve Board and the New York Federal Reserve, has recommended the use of SOFR as a more robust reference rate alternative to LIBOR. The use of SOFR as a substitute for LIBOR is, however, voluntary and may not be suitable for all market participants. There can be no assurance that the replacement rate will be economically equivalent to LIBOR, which could result in higher interest rates for us under our debt facilities. There is no guarantee that a transition from LIBOR to SOFR will not result in financial market disruptions, significant increases in benchmark rates, or our borrowing costs, any of which could have an adverse effect on our business, results of operations and financial condition.

In August 2020, the FASB issued ASU 2020-06, Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity's Own Equity (Subtopic 815-40):Accounting for Convertible Instruments and Contracts in an Entity's Own Equity. The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will be effective for annual and interim periods beginning after December 15, 2021, and early adoption is permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years using either the modified retrospective or full retrospective method.

As detailed in Note 5, Debt, on February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes are subject to the guidance included in ASU 2020-06. The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts:

ADJUSTMENT

CONSOLIDATED BALANCE SHEET CLASSIFICATION

AMOUNT
(in millions)

Deferred tax impact of cumulative-effect adjustment

Deferred tax liabilities

(20.6)

Debt discount reclassification

Long-term convertible securities

89.1

Equity issuance costs reclassification

Long-term convertible securities

(2.5)

Debt discount amortization and equity costs reclassification, net of tax

Retained Earnings

(2.8)

Net impact of cumulative-effect adjustment

Additional paid-in capital

(63.3)

On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its 2025 Notes to be settled in cash and any excess in shares. Following the irrevocable notice, only the amounts settled in excess of the principal will be considered in diluted earnings per share under the “if-converted” method. Upon adoption of ASU 2020-06, the Company’s 2025 Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount.

In October 2020, the FASB issued ASU 2020-10, Codification Improvements, which updates various codification topics by clarifying or improving disclosure requirements to align with the regulations of the U.S. Securities and Exchange Commission (the "SEC") . The ASU has been effective for the Company for annual and interim periods beginning after January 1, 2021. The Company adopted this standard on the January 1, 2021. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures.

In May 2021, the FASB issued ASU 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options which provides guidance to clarify and reduce diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options (for example, warrants) that remain equity classified after modification or exchange. The amendments in this ASU No. 2021-04 are effective for all entities for fiscal years beginning after December 15, 2021, and interim periods within those fiscal years, with early adoption permitted, including interim periods within those fiscal years. The amendment currently has no impact to the Company as the effect will largely depend on the terms of written call options or financings issued or modified in the future.

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.

Revenue Recognition and Shipping and Handling Fees

REVENUE RECOGNITION

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

Performance Obligations

Significant Judgments

Contract Asset and Liability

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 CustomersThe 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.

GOODWILL AND OTHER INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

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

The qualitative evaluation is an assessment of factors including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass the qualitative assessment for its three reporting units and perform a quantitative test. The assumptions used in evaluating goodwill for impairment are subject to change and are tracked against historical results by management.

The quantitative test estimates the fair value of the three reporting units using a discounted cash flow model, which incorporates significant estimates and assumptions made by management which, by their nature, are characterized by uncertainty. Inputs used to fair value the Company's reporting units are considered inputs of the fair value hierarchy. For Level 3 measurements, significant increases or decreases in long-term growth rates or discount rates in isolation or in combination could result in a significantly lower or higher fair value measurement. The key assumptions impacting the valuation included the following:

•The reporting unit's financial projections, which are based on management's assessment of regional and macroeconomic variables, industry trends and market opportunities, and the Company's strategic objectives and future growth plans.

•The projected terminal value for the reporting unit, which represents the present value of projected cash flows beyond the last period in the discounted cash flow analysis. The terminal value reflects the Company's assumptions related to long-term growth rates and profitability, which are based on several factors, including local and macroeconomic variables, market opportunities, and future growth plans.

•The discount rate used to measure the present value of the projected future cash flows is set using a weighted-average cost of capital method that considers market and industry data as well as the Company's specific risk factors that are likely to be considered by a market participant. The weighted-average cost of capital is the Company's estimate of the overall after-tax rate of return required by equity and debt holders of a business enterprise.

During the third quarter of 2022, the Company elected to perform a qualitative analysis for its three reporting units. The Company determined, after performing the qualitative analysis, that there was no evidence that it is more likely than not that the fair value was less that the carrying amounts, therefore, it was not necessary to perform a quantitative impairment test.

Changes in the carrying amount of goodwill in 2022 and 2021 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at January 1, 2021	$	671,975	$	260,392	$	932,367
ACell Acquisition	—		94,147		94,147
Foreign currency translation	(8,547)		(4,509)		(13,056)
Balance at December 31, 2021	$	663,428	$	350,030	$	1,013,458
Sale of non-core traditional wound care business	—		(5,019)		(5,019)
SIA Acquisition	—		41,855		41,855
Foreign currency translation	(7,209)		(4,204)		(11,413)
Balance at December 31, 2022	$	656,219	$	382,662	$	1,038,881

Other Intangible Assets

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


	December 31, 2022
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,204,325	$	(370,968)	$	833,357
Customer relationships	12 years	193,081		(144,040)		49,041
Trademarks/brand names	28 years	97,265		(34,674)		62,591
Codman trade name	Indefinite	166,693		—		166,693
Supplier relationships	30 years	30,211		(17,170)		13,041
All other	11 years	5,957		(4,071)		1,886
		$	1,697,532	$	(570,923)	$	1,126,609


	December 31, 2021
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,132,954	$	(307,013)	$	825,941
Customer relationships	12 years	211,344		(142,755)		68,589
Trademarks/brand names	28 years	98,367		(31,468)		66,899
Codman trade name	Indefinite	167,758		—		167,758
Supplier relationships	30 years	30,211		(16,192)		14,019
All other	11 years	6,258		(3,891)		2,367
		$	1,646,892	$	(501,319)	$	1,145,573

Intangible Assets with Indefinite Lives

The Company tests 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 indefinite lived intangible asset below its carrying amount. The Company tests for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including 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 the intangible asset is less than its carrying amount. The Company may elect to bypass this qualitative evaluation and perform a quantitative test.

During the third quarter of 2022, the Company elected to perform a qualitative analysis for its intangible asset with indefinite lives. The Company determined, after performing the qualitative analysis, that there was no evidence that it is more likely than not that the fair value was less that the carrying amounts, therefore, it was not necessary to perform a quantitative impairment test.

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 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.

Amortization expense (including amounts reported in cost of product revenues) for the years ended December 31, 2022, 2021 and 2020 was $78.3 million, $83.3 million and $74.5 million, respectively.

Annual amortization expense is expected to approximate $82.3 million in 2023, $81.7 million in 2024, $81.7 million in 2025, $81.5 million in 2026, $79.6 million in 2027 and $551.6 million thereafter. Amortization of product technology based intangible assets totaled $64.4 million, $66.5 million and $46.7 million for the years ended December 31, 2022, 2021 and 2020, respectively, and is presented by the Company within cost of goods sold.

INCOME TAXES (Tax Valuation Allowance) (Details) - SEC Schedule, 12-09, Valuation Allowance, Deferred Tax Asset - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Valuation Allowance [Line Items]
Balance at Beginning of Period	$ 15,258	$ 13,825	$ 12,069
Charged to Costs and Expenses		(515)	1,444	$ 1,617
Other			89	0
Deductions		(71)	(100)	139
Balance at End of Period	$ 14,672	$ 15,258	$ 13,825	$ 12,069

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Schedule of Accumulated Other Comprehensive Income (Loss)) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,684,804	$ 1,514,867	$ 1,416,736
Other comprehensive gain (loss)	69,957
Less: Amounts reclassified from accumulated other comprehensive income, net	14,537
Total other comprehensive gain (loss), net of tax	55,420	28,904	2,343
Balance, End of Period	1,804,403	1,684,804	1,514,867
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(45,155)	(74,059)	(76,402)
Total other comprehensive gain (loss), net of tax	55,420	28,904	2,343
Balance, End of Period	10,265	(45,155)	$ (74,059)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(42,981)
Other comprehensive gain (loss)	80,335
Less: Amounts reclassified from accumulated other comprehensive income, net	14,537
Total other comprehensive gain (loss), net of tax	65,798
Balance, End of Period	22,817	(42,981)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	1,893
Other comprehensive gain (loss)	7,429
Less: Amounts reclassified from accumulated other comprehensive income, net	0
Total other comprehensive gain (loss), net of tax	7,429
Balance, End of Period	9,322	1,893
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(4,067)
Other comprehensive gain (loss)	(17,807)
Less: Amounts reclassified from accumulated other comprehensive income, net	0
Total other comprehensive gain (loss), net of tax	(17,807)
Balance, End of Period	$ (21,874)	$ (4,067)

- Definition

Total of all stockholders' equity (deficit) items, net of receivables from officers, directors, owners, and affiliates of the entity which are attributable to the parent. The amount of the economic entity's stockholders' equity attributable to the parent excludes the amount of stockholders' equity which is allocable to that ownership interest in subsidiary equity which is not attributable to the parent (noncontrolling interest, minority interest). This excludes temporary equity and is sometimes called permanent equity.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS

12 Months Ended

Dec. 31, 2022

Revenue from Contract with Customer [Abstract]

REVENUES FROM CONTRACTS WITH CUSTOMERS

Summary of Accounting Policies on Revenue Recognition

Performance Obligations

Significant Judgments

Contract Asset and Liability

The following table summarized the changes in the contract asset and liability balances for the year ended December 31, 2022:


Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2022	$	11,412
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(11,412)
Contract asset, net of transferred to trade receivables on contracts during the period	10,122
Contract asset, December 31, 2022	$	10,122

Contract Liability
Contract liability, January 1, 2022	$	11,946
Recognition of revenue included in beginning of year contract liability	(5,349)
Contract liability, net of revenue recognized on contracts during the period	9,596
Foreign currency translation	(66)
Contract liability, December 31, 2022	$	16,127

At December 31, 2022, the short-term portion of the contract liability of $7.3 million and the long-term portion of $8.8 million is included in current liabilities and other liabilities, respectively, in the consolidated balance sheet.

As of December 31, 2022, the Company is expected to recognize revenue of approximately $7.3 million in 2023, $4.2 million in 2024, $2.7 million in 2025, $1.1 million in 2026, $0.7 million in 2027, and $0.1 million thereafter.

Shipping and Handling Fees

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

Product Warranties

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 years-ended December 31, 2022, 2021 and 2020 (dollar amounts in thousands):


	Year Ended December 31, 2022		Year Ended December 31, 2021		Year Ended December 31, 2020
Neurosurgery	$	794,017	$	802,959	$	716,339
Instruments	225,547		222,273		178,492
Total Codman Specialty Surgical	1,019,564		1,025,232		894,831

Wound Reconstruction and Care(2)(3)	406,689		392,463		293,038
Extremity Orthopedics(1)	—		—		78,316
Private Label	131,413		124,753		105,683
Total Tissue Technologies	538,102		517,216		477,037
Total revenue	$	1,557,666	$	1,542,448	$	1,371,868

(1) On January 4, 2021, the Company completed its sale of its Extremity Orthopedics business. See Note 4, Acquisitions and Divestitures, for details

(2) See Note 4. Acquisitions and Divestitures, for details around the ACell acquisition.

(3) On August 31, 2022, the Company completed the sale of its non-core traditional wound care ("TWC") business. See Note 4, Acquisitions and Divestitures

See Note 16, Segment and Geographical Information, for details of revenues based on the location of the customer.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

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+ Details

DERIVATIVE INSTRUMENTS- (Schedule of Gains and (Loss) of Derivative Instruments) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 1,258	$ 455
Foreign Currency Forward Contract
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	0	(174)
Currency Swap
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 1,258	$ 629

NET INCOME PER SHARE (Basic and Diluted Net Income Per Share) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Basic net income per share:
Net income	$ 180,550	$ 169,075	$ 133,892
Weighted average common shares outstanding - Basic (in shares)	82,997	84,698	84,650
Basic net income per common share (in dollars per share)	$ 2.18	$ 2.00	$ 1.58
Diluted net income per share:
Net income	$ 180,550	$ 169,075	$ 133,892
Weighted average common shares outstanding - Basic (in shares)	82,997	84,698	84,650
Effect of dilutive securities:
Stock options and restricted stock (in shares)	519	787	577
Weighted average common shares for diluted earnings per share (in shares)	83,516	85,485	85,228
Diluted net income per common share (in dollars per share)	$ 2.16	$ 1.98	$ 1.57

- Definition

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

+ References

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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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+ Details

INCOME TAXES (Schedule of Provision for Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Current:
Federal	$ 24,201	$ 31,938	$ 6,184
State	3,835	11,377	5,029
Foreign	9,893	5,042	12,553
Total current	37,929	48,357	23,766
Deferred:
Federal	(11,591)	(12,830)	(5,079)
State	(2,316)	(3,688)	(1,760)
Foreign	9,322	13,763	(57,299)
Total deferred	(4,585)	(2,755)	(64,138)
Provision for income taxes	$ 33,344	$ 45,602	$ (40,372)

DEBT

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

DEBT

Amendment to the Sixth Amended and Restated Senior Credit Agreement

On February 3, 2020, the Company entered into the sixth amendment and restatement (the "February 2020 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 February 2020 Amendment extended the maturity date to February 3, 2025. The Company continues to have the aggregate principal amount of up to approximately $2.2 billion available to it through the following facilities: (i) a $877.5 million Term Loan facility, and (ii) a $1.3 billion revolving credit facility, which includes a $60 million sublimit for the issuance of standby letters of credit and a $60 million sublimit for swingline loans.

The Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) is the following:


Fiscal Quarter						Maximum Consolidated Total Leverage Ratio


September 30, 2022 through June 30, 2023						4.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter						4.00 to 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 amendment and restatement) in effect from time to time plus the applicable rate (ranging from 1.00% to 2.25%), 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%

2.the prime lending rate of Bank of America, N.A. or

3.the one-month Eurodollar Rate plus 1.00%

The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness as of such date less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA (as defined by the July 2020 amendment), for the period of four consecutive fiscal quarters ending on such date).

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 December 31, 2022, the Company was in compliance with all such covenants. In connection with the February 2020 Amendment, the Company capitalized $4.6 million of financing costs in connection with modification of the Senior Credit Facility and wrote off $1.2 million of previously capitalized financing costs during the first quarter of 2020. In connection with the July 2020 amendment, the Company expensed $3.3 million of incremental financing costs in connection with the modification of the Senior Credit Facility during the third quarter of 2020.

There was no balance outstanding at December 31, 2022 under the revolving portion of the Senior Credit Facility and as of December 31, 2021, there was $31.3 million, outstanding under the revolving portion of the Senior Credit Facility at weighted average interest rate of 1.4%. At December 31, 2022 and 2021, there was $771.3 million and $843.8 million, respectively, outstanding, under the Term Loan component of the Senior Credit Facility at weighted average interest rate of 5.6% and 1.4%, respectively. At December 31, 2022 and 2021, there was $38.1 million and $45.0 million, respectively, of the Term Loan component of the Senior Credit Facility was classified as current on the consolidated balance sheets.

The fair value of outstanding borrowings of the Senior Credit Facility's Term Loan components at December 31, 2022 was $800.8 million. This 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 December 31, 2022 and 2021 totaled $1.6 million. There were no amounts drawn as of December 31, 2022.

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


Year-ended December 31, 2022	Principal Repayment
Dollars in thousands
2023	$	38,125
2024	$	67,500
2025	$	669,375
	$	775,000

Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $42.7 million in 2023, $39.1 million in 2024, and $3.6 million in 2025. Interest is calculated on the term loan portion of the Senior Credit Facility based on LIBOR plus the spread paid by the Company. As the revolving credit facility and Securitization Facility can be repaid at any time, no interest has been included in the calculation.

The outstanding balance of the revolving credit component of the Senior Credit Facility is due on February 3, 2025.

Convertible Senior Notes

On February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes will mature on August 15, 2025 and bear interest at a rate of 0.5% per annum payable semi-annually in arrears, unless earlier converted, repurchased or redeemed in accordance with the terms of the 2025 Notes. The portion of debt proceeds that was classified as equity at the time of the offering was $104.5 million. The effective interest rate implicit in the liability component was 4.2%. In connection with this offering, the Company capitalized $13.2 million of financing fees.

The 2025 Notes are senior, unsecured obligations of the Company, and are convertible into cash and shares of its common stock based on initial conversion rate, subject to adjustment of 13.5739 shares per $1,000 principal amounts of the 2025 Notes (which represents an initial conversion price of $73.67 per share). The 2025 Notes convert only in the following circumstances: (1) if the closing price of the Company's common stock has been at least 130% of the conversion price during the period; (2) if the average trading price per $1,000 principal amount of the 2025 Notes is less than or equal to 98% of the average conversion value of the 2025 Notes during a period as defined in the indenture; (3) at any time on or after February 20, 2023; or (4) if specified corporate transactions occur. As of December 31, 2022, none of these conditions existed with respect to the 2025 Notes and as a result the 2025 Notes are classified as long term.

On December 9, 2020, the Company entered into the First Supplemental Indenture to the original agreement dated as of February 4, 2020 between the Company and Citibank, N.A., as trustee, governing the Company’s outstanding 2025 Notes. The Company irrevocably elected (1) to eliminate the Company’s option to choose physical settlement on any conversion of the 2025 Notes that occurs on or after the date of the First Supplemental Indenture and (2) with respect to any Combination Settlement for a conversion of the 2025 Notes, the Specified Dollar Amount that will be settled in cash per $1,000 principal amount of the 2025 Notes shall be no lower than $1,000.

Holders of the Notes will have the right to require the Company to repurchase for cash all or a portion of their Notes at 100% of their principal amount, plus any accrued and unpaid interest, upon the occurrence of a fundamental change (as defined in the indenture relating to the Notes). The Company will also be required to increase the conversion rate for holders who convert their Notes in connection with certain fundamental changes occurring prior to the maturity date or following delivery by the Company of a notice of redemption.

In connection with the issuance of the 2025 Notes, the Company entered into call transactions and warrant transactions, primarily with affiliates of the initial purchasers of the 2025 Notes (the “hedge participants”). The cost of the call transactions was $104.2 million for the 2025 Notes. The Company received $44.5 million of proceeds from the warrant transactions for the 2025 Notes. The call transactions involved purchasing call options from the hedge participants, and the warrant transactions involved selling call options to the hedge participants with a higher strike price than the purchased call options. The initial strike price of the call transactions was $73.67, subject to anti-dilution adjustments substantially similar to those in the 2025 Notes. The initial strike price of the warrant transactions was $113.34 for the 2025 Notes, subject to customary anti-dilution adjustments.

At December 31, 2022, the carrying amount of the liability was $575.0 million. The fair value of the 2025 Notes at December 31, 2022 was $560.5 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quote. The level of the 2025 Notes is considered as Level 1.

As a result of the adoption of ASU 2020-06, for both the years ended December 31, 2022 and 2021, the Company recognized only cash interest related to the contractual interest coupon on the 2025 Notes of $2.9 million.

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") 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 December 31, 2022, the Company was in compliance with the covenants and none of the termination events had occurred.

On May 28, 2021, the Company entered into an amendment (the "May 2021 Amendment") of the Securitization Facility which extended the maturity date from December 21, 2021 to May 28, 2024. The May 2021 Amendment does not increase the Company’s total indebtedness.

At December 31, 2022 and 2021, the Company had $104.7 million and $112.5 million, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 5.0% and 1.1%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at December 31, 2022 was $104.9 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.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI https://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

DEBT (Schedule of Debt Maturity) (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
2023	$ 38,125
2024	67,500
2025	669,375
Principal Repayment	$ 775,000

- Definition

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

+ References + Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Schedule of Inventories

Inventories consisted of the following:


	December 31,
Dollars in thousands	2022		2021
Finished goods	172,088		$	162,528
Work in process	70,598		65,323
Raw materials	81,897		89,535
Total inventories, net	$	324,583	$	317,386

Schedule of Property, Plant and Equipment Balances and Corresponding Lives

Property, plant and equipment balances and corresponding lives were as follows:


	December 31,
Dollars in thousands	2022		2021		Useful Lives
Land	$	966	$	1,512
Buildings and building improvements	14,710		19,032		5-40 years
Leasehold improvements	164,292		155,495		1-20 years
Machinery and production equipment	181,780		183,270		3-20 years
Demonstration equipment	3,792		2,791		4-5 years
Information systems and hardware	151,330		148,706		1-7 years
Furniture, fixtures, and office equipment	20,286		20,921		1-15 years
Construction-in-progress	103,875		94,850
Total	641,031		626,577
Less: Accumulated depreciation	(329,729)		(314,874)
Property, plant and equipment, net	$	311,302	$	311,703

Schedule of Impact on Statement of Operations

The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts:

ADJUSTMENT

CONSOLIDATED BALANCE SHEET CLASSIFICATION

AMOUNT
(in millions)

Deferred tax impact of cumulative-effect adjustment

Deferred tax liabilities

(20.6)

Debt discount reclassification

Long-term convertible securities

89.1

Equity issuance costs reclassification

Long-term convertible securities

(2.5)

Debt discount amortization and equity costs reclassification, net of tax

Retained Earnings

(2.8)

Net impact of cumulative-effect adjustment

Additional paid-in capital

(63.3)

Summary of Valuation Allowance

The valuation allowance at December 31, 2022 and 2021 primarily remained unchanged from respective prior periods; decreasing by an immaterial amount in both periods.


	Balance at Beginning of Period	Charged to Costs and Expenses	Other	Deductions	Balance at End of Period
Description
Dollars in thousands
Year ended December 31, 2022
Deferred tax assets valuation allowance	15,258	(515)		(71)	14,672
Year ended December 31, 2021
Deferred tax assets valuation allowance	13,825	1,444	89	(100)	15,258
Year ended December 31, 2020
Deferred tax assets valuation allowance	12,069	1,617	—	139	13,825

Restructuring and Related Costs

The following table summarizes our restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the year ended December 31, 2022 and 2021.


	Years Ended December 31,
(Dollars in thousands)	2022		2021
Balance, beginning of the year	$	10,226	$	6,372
Charges:
Cost of Goods Sold	$	1,494	$	3,436
Research and development	72		288
Selling, general and administrative	$	5,582	$	466
Payments and other adjustments	$	(12,267)	$	(336)
Balance, end of the year	$	5,107	$	10,226

Accounts Receivable, Allowance for Credit Loss

The below table shows the rollforward of the allowance for doubtful accounts for the years ended December 31, 2022, 2021 and 2020:


	Balance at Beginning of Period		Charged to Costs and Expenses	Other	Deductions	Balance at End of Period
Dollars in thousands
Year Ended:
December 31, 2022	$	4,735	238	—	(669)	$	4,304
December 31, 2021	$	6,439	(1,059)	341	(986)	$	4,735
December 31, 2020	$	4,303	3,635	—	(1,499)	$	6,439

(1)Deductions primarily relates to allowance for doubtful accounts written off during the year, net of recoveries and other adjustments.

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative, Revenue Remaining Performance Obligation) (Details) $ in Millions	Dec. 31, 2022 USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 7.3
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 4.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 2.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 1.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 0.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 0.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year

NET INCOME PER SHARE

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

NET INCOME PER SHARE

Basic and diluted net income per share was as follows:


	Years Ended December 31,
Dollars in thousands, except per share amounts	2022		2021		2020
Basic net income per share:
Net income	$	180,550	$	169,075	$	133,892
Weighted average common shares outstanding	82,997		84,698		84,650
Basic net income per common share	$	2.18	$	2.00	$	1.58

Diluted net income per share:
Net income	$	180,550	$	169,075	$	133,892

Weighted average common shares outstanding — Basic	82,997		84,698		84,650
Effect of dilutive securities:
Stock options and restricted stock	519		787		577
Weighted average common shares for diluted earnings per share	83,516		85,485		85,228
Diluted net income per common share	$	2.16	$	1.98	$	1.57

Common stock of approximately 0.3 million and 0.1 million shares at December 31, 2022, and 2021 that are issuable through exercise of dilutive securities, respectively, and were not included in the computation of diluted net income per share because their effect would have been anti-dilutive.

Based on the adoption of ASU 2020-06, as the principal amount of the 2025 Notes will be paid in cash and only the conversion spread is settled in shares, the Company will be utilizing the if-converted method and only includes the net number of incremental shares that would be issued upon conversion.

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Trade accounts receivable, allowances	$ 4,304	$ 4,735
Preferred stock, par value (in dollars per share)	$ 0	$ 0
Preferred stock, authorized shares (in shares)	15,000,000	15,000,000
Preferred stock, outstanding (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 (in shares)	90,477,000	89,600,000
Treasury stock, at cost; shares (in shares)	6,823,000	4,899,000

RETIREMENT BENEFIT PLANS (Schedule of Change in Benefit Obligations and Plan Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$ 65,184	$ 72,869
Interest cost	194	100
Service cost	2,419	2,741
Actuarial (gain) loss	(14,822)	(5,044)
Plan amendments	(390)	(586)
Plan settlements	(20)	(655)
Employee contribution	999	917
Premiums paid	(391)	(373)
Benefit payment	(999)	(2,128)
Effect of foreign currency exchange rates	(1,810)	(2,657)
Projected benefit obligations, end of year	50,364	65,184
Change In Plan Assets
Plan assets at fair value, beginning of year	39,914	37,825
Actual return on plan assets	(2,863)	3,371
Employer contributions	2,356	2,254
Employee contributions	999	917
Plan settlements	0	(633)
Benefits paid	(998)	(2,128)
Premiums paid	(391)	(373)
Effect of foreign currency exchange rates	(964)	(1,319)
Plan assets at fair value, end of year	$ 38,053	$ 39,914

RETIREMENT BENEFIT PLANS (Schedule of Assumptions Used Periodic Benefit Cost and Actuarial Present Value) (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Discount rate	2.44%	0.37%
Expected return on plan assets	3.61%	3.59%
Rate of compensation increase	1.97%	2.10%
Interest crediting rate for cash balance plans	1.00%	1.00%

COMMITMENTS AND CONTINGENCIES

12 Months Ended

Dec. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

COMMITMENTS AND CONTINGENCIES

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

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

Company's results of operations, financial position and cash flows in a particular period could be materially affected by these contingencies.

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

Contingent Consideration

The Company determined the fair value of contingent consideration during the twelve-month period ended December 31, 2022 and 2021 to reflect the change in estimate, additions, payments, transfers and the time value of money during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the years ended December 31, 2022 and 2021 is as follows (in thousands):


Year ended December 31, 2022	Contingent Consideration Liability Related to Acquisition of:
	Arkis (See Note 4)				Location in Financial Statements	Derma Sciences		ACell Inc. (See Note 4)				SIA				Location in Financial Statements
	Short-term		Long-term			Long-term		Short-term		Long-term		Long-term
Balance as of January 1, 2022	$	3,691	$	11,408		$	230	$	—	$	21,800	$	—
Additions	—		—			—				—		57,607
Transfers from long-term to current portion	—		—			—		4,885		(4,885)		—
Change in fair value of contingent consideration liabilities	(846)		(1,358)		Research and development	—		(4,885)		(13,215)		—				Selling, general and administrative
Balance as of December 31, 2022	$	2,845	$	10,050		$	230	$	—	$	3,700	$	57,607	$	—


Year ended December 31, 2021	Contingent Consideration Liability Related to Acquisition of:
	Arkis (See Note 4)				Location in Financial Statements	Derma Sciences		ACell Inc. (See Note 4)		Location in Financial Statements
	Short-term		Long-term			Long-term		Long-term
Balance as of January 1, 2021	$	3,415	$	11,746		$	230	$	—
Additions	—		—			—		23,900
Transfers from long-term to current portion	276		(276)			—		—
Change in fair value of contingent consideration liabilities	—		$	(62)	Research and development	—		(2,100)		Selling, general and administrative
Balance as of December 31, 2021	$	3,691	$	11,408		$	230	$	21,800

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 already paid $33.3 million related to the aforementioned contingent liabilities. One contingent milestone 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 December 31, 2022 and 2021 was $0.2 million.

Arkis BioSciences, Inc.

As part of the acquisition of Arkis BioSciences, Inc. ("Arkis"), 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. The estimated the fair value as of December 31, 2022 was $12.9 million. The Company recorded $2.8 million in accrued expenses and other current liabilities and $10.1 million in other liabilities at December 31, 2022 in the consolidated balance sheets of the Company.

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Number of days from shipment to issue a credit on returned goods	90 days
Short-term portion of contract liability	$ 7,253	$ 5,295
Long-term portion of contract liability	$ 8,800
Product warranty period (up to)	2 years

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions			12 Months Ended
	Jan. 26, 2023	Jan. 12, 2022	Dec. 31, 2022	Dec. 31, 2021	Apr. 26, 2022	Mar. 24, 2022
Equity, Class of Treasury Stock [Line Items]
Treasury stock outstanding (in shares)			6,800	4,900
Treasury stock			$ 362.9	$ 234.4
Treasury stock, average cost per share (in dollars per share)			$ 53.18	$ 47.86
Stock repurchase program, authorized amount (up to)					$ 225.0
Accelerated share repurchase program, receipt (payment)		$ 125.0
Accelerated share repurchases, shares received at inception		1,480
Accelerated share repurchases, percentage of expected total repurchased		80.00%
Remaining amount under share repurchase					$ 100.0
Accelerated share repurchases, additional shares received						460
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, authorized amount (up to)	$ 150.0
Accelerated share repurchases, shares received at inception	2,100
Accelerated share repurchases, percentage of expected total repurchased	80.00%

RETIREMENT BENEFIT PLANS (Tables)

12 Months Ended

Dec. 31, 2022

Retirement Benefits [Abstract]

Schedule of Net Periodic Benefit Costs

Net periodic benefit costs for the Company’s defined benefit pension plans for the years ended December 31, 2022 and 2021 included the following (amounts in thousands):


	Year ended December 31,
	2022		2021
Service cost	$	2,419	$	2,741
Interest cost	194		100
Expected return on plan assets	(1,381)		(893)
Amortization of prior service cost (credit)	(326)		(281)
Recognized actuarial losses	9		186
Settlements	—		51
Net period benefit cost	$	915	$	1,904

Schedule of Weighted Average Assumptions Used

The following weighted average assumptions were used to develop net periodic pension benefit costs and the actuarial present values of projected pension benefit obligations for the years ended December 31, 2022 and 2021, respectively:


	As of December 31,
	2022		2021
Discount rate	2.44	%	0.37	%
Expected return on plan assets	3.61	%	3.59	%
Rate of compensation increase	1.97	%	2.10	%
Interest crediting rate for cash balance plans	1.00	%	1.00	%

Schedule of Benefit Obligations and Plan Assets

The following sets forth the change in projected benefit obligations and the change in plan assets for the years ended December 31, 2022 and 2021 and a reconciliation of the funded status at December 31, 2022 and 2021, respectively (amounts in thousands):


	Year ended December 31,
	2022		2021
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	65,184	$	72,869
Interest cost	194		100
Service cost	2,419		2,741
Actuarial (gain) loss	(14,822)		(5,044)
Plan amendments	(390)		(586)
Plan settlements	(20)		(655)
Employee contribution	999		917
Premiums paid	(391)		(373)
Benefit payment	(999)		(2,128)
Effect of foreign currency exchange rates	(1,810)		(2,657)
Projected benefit obligations, end of year	$	50,364	$	65,184

	Year ended December 31,
	2022		2021
Change In Plan Assets
Plan assets at fair value, beginning of year	$	39,914	$	37,825
Actual return on plan assets	(2,863)		3,371
Employer contributions	2,356		2,254
Employee contributions	999		917
Plan settlements	—		(633)
Benefits paid	(998)		(2,128)
Premiums paid	(391)		(373)
Effect of foreign currency exchange rates	(964)		(1,319)
Plan assets at fair value, end of year	$	38,053	$	39,914

Schedule of Funded Status


	Year ended December 31,
	2022		2021
Reconciliation Of Funded Status
Fair value of plan assets	$	38,053	$	39,914
Benefit obligations	50,364		65,184
Unfunded benefit obligations	$	12,311	$	25,270

Schedule of Expected Benefit Payments

The following table is the summary of expected future benefit payments (in thousands):




2023	$	2,211
2024	$	2,045
2025	$	2,050
2026	$	1,929
2027	$	1,868
Next five years	$	11,068

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Tables)

12 Months Ended

Dec. 31, 2022

Stockholders' Equity Note [Abstract]

Schedule of Changes in Accumulated Other Comprehensive Loss

Changes in accumulated other comprehensive loss by component between December 31, 2022 and 2021 are presented in the table below, net of tax:


Dollars in thousands	Gains and Losses on Derivatives		Defined Benefit Pension Items		Foreign Currency Items		Total
Balance at December 31, 2021	$	(42,981)	$	1,893	$	(4,067)	$	(45,155)
Other comprehensive gain (loss)	80,335		7,429		(17,807)		69,957
Less: Amounts reclassified from accumulated other comprehensive income, net	14,537		—		—		14,537
Net current-period other comprehensive gain (loss)	65,798		7,429		(17,807)		55,420
Balance at December 31, 2022	$	22,817	$	9,322	$	(21,874)	$	10,265

INCOME TAXES (Schedule of Effective Tax Rate Reconciliation) (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%	21.00%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	0.10%	1.90%	1.20%
Foreign operations	(3.90%)	(4.00%)	(7.90%)
Excess tax benefits from stock compensation	(2.40%)	(1.20%)	(1.00%)
Intercompany profit in inventory	0.30%	(0.20%)	1.20%
Nondeductible facilitative costs	0.20%	0.30%	1.10%
Contingent Consideration	(2.00%)	(0.20%)	0.20%
Research and development credit	(1.40%)	(1.20%)	(1.60%)
Return to provision	(0.50%)	(0.70%)	(2.30%)
Global intangible low-taxed income ("GILTI")	2.80%	0.70%	2.50%
Nondeductible executive compensation	1.80%	0.90%	2.40%
Fair market value step up on intra-entity transfer of intellectual property	0.00%	0.00%	(63.30%)
Gain from sale of business - book to tax differences	0.00%	3.90%	2.80%
Other	(0.40%)	0.00%	0.50%
Effective tax rate	15.60%	21.20%	(43.20%)

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

12 Months Ended

Dec. 31, 2022

Segment Reporting [Abstract]

Schedule of Net Sales and Profit, by Segment

Net sales and profit by reportable segment for the years ended December 31, 2022, 2021 and 2020 are as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Segment Net Sales
Codman Specialty Surgical	$	1,019,564	$	1,025,232	$	894,831
Tissue Technologies	538,102		517,216		477,037
Total revenues	$	1,557,666	$	1,542,448	$	1,371,868
Segment Profit
Codman Specialty Surgical	$	417,873	$	439,471	$	356,657
Tissue Technologies	233,802		228,199		159,630
Segment profit	651,675		667,670		516,287
Amortization	(13,882)		(16,914)		(27,757)
Corporate and other	(398,873)		(453,526)		(337,160)
Operating income	$	238,920	$	197,230	$	151,370

Schedule of Geographic Revenue, by Area

Total revenue, net and long-lived assets (tangible) by major geographic area are summarized below:


Dollars in thousands	United States(1)		Europe		Asia Pacific		Rest of the World		Consolidated
Total revenue, net:
2022	$	1,126,810	$	170,903	$	176,477	$	83,476	$	1,557,666
2021	1,089,526		191,327		182,034		79,561		1,542,448
2020	971,975		172,689		157,174		70,030		1,371,868
Total long-lived assets:
2022	$	440,223	$	60,857	$	12,975	$	2,721	$	516,776
2021	339,535		55,026		11,289		6,836		412,686

RETIREMENT BENEFIT PLANS

12 Months Ended

Dec. 31, 2022

Retirement Benefits [Abstract]

RETIREMENT BENEFIT PLANS

DEFINED BENEFIT PLANS

The Company has various defined benefit plans which covers certain employees in France, Japan, Germany and Switzerland.

Net periodic benefit costs for the Company’s defined benefit pension plans for the years ended December 31, 2022 and 2021 included the following (amounts in thousands):


	Year ended December 31,
	2022		2021
Service cost	$	2,419	$	2,741
Interest cost	194		100
Expected return on plan assets	(1,381)		(893)
Amortization of prior service cost (credit)	(326)		(281)
Recognized actuarial losses	9		186
Settlements	—		51
Net period benefit cost	$	915	$	1,904


	As of December 31,
	2022		2021
Discount rate	2.44	%	0.37	%
Expected return on plan assets	3.61	%	3.59	%
Rate of compensation increase	1.97	%	2.10	%
Interest crediting rate for cash balance plans	1.00	%	1.00	%

The Company’s discount rates are determined by considering current yield curves representing high quality, long-term fixed income instruments. The resulting discount rates are consistent with the duration of plan liabilities. In 2022 and 2021, the discount rates were prescribed as the current yield on corporate bonds with an average rating of AA or AAA of equivalent currency and term to the liabilities. The expected returns on plan assets represent the average rate of return expected to be earned on plan assets over the period the benefits included in the benefit obligation are to be paid. In developing the expected rates of return, the Company considers returns of historical market data as well as actual returns on the plan assets. Using this reference information, the long-term return expectations for each asset category are developed according to the allocation among those investment categories.

The assessment is determined using projections from external financial sources, long-term historical averages, actual returns by asset class and the various asset class allocations by market.


	Year ended December 31,
	2022		2021
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	65,184	$	72,869
Interest cost	194		100
Service cost	2,419		2,741
Actuarial (gain) loss	(14,822)		(5,044)
Plan amendments	(390)		(586)
Plan settlements	(20)		(655)
Employee contribution	999		917
Premiums paid	(391)		(373)
Benefit payment	(999)		(2,128)
Effect of foreign currency exchange rates	(1,810)		(2,657)
Projected benefit obligations, end of year	$	50,364	$	65,184

	Year ended December 31,
	2022		2021
Change In Plan Assets
Plan assets at fair value, beginning of year	$	39,914	$	37,825
Actual return on plan assets	(2,863)		3,371
Employer contributions	2,356		2,254
Employee contributions	999		917
Plan settlements	—		(633)
Benefits paid	(998)		(2,128)
Premiums paid	(391)		(373)
Effect of foreign currency exchange rates	(964)		(1,319)
Plan assets at fair value, end of year	$	38,053	$	39,914


	Year ended December 31,
	2022		2021
Reconciliation Of Funded Status
Fair value of plan assets	$	38,053	$	39,914
Benefit obligations	50,364		65,184
Unfunded benefit obligations	$	12,311	$	25,270

The unfunded benefit obligations are included in other liabilities in the consolidated balance sheets at December 31, 2022 and 2021, respectively.

During the periods ended December 31, 2022 and 2021, the Company had a net gain of $7.4 million and $7.0 million, respectively, recognized within accumulated other comprehensive loss that has not been recognized as a component of net periodic benefit cost. The gain recognized during the period ended December 31, 2021, is primarily attributed to a change in the discount rate used to estimate the projected benefit obligation for defined benefit plans which cover certain employees in Switzerland. The combined accumulated benefit obligations for the defined benefit plans was $46.4 million and $60.3 million as of December 31, 2022 and 2021, respectively.

Unrecognized gains and losses are amortized over the average remaining future service for each plan. For plans with no active employees, they are amortized over the average life expectancy. The amortization of gains and losses is determined by using a 10% corridor of the greater of the market value of assets or the accumulated benefit obligation. Total unamortized gains and losses in excess of the corridor are amortized over the average remaining future service.

Prior service costs/benefits for the pension plans are amortized over the average remaining future service of plan participants at the time of the plan amendment.

The net plan assets of the pension plans are invested in common trusts. Common trusts are classified as Level 2 in fair value hierarchy. The fair value of common trusts is valued at 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 appropriate risk profile.

The benefit plans in France and Germany had no assets at December 31, 2022.

As of December 31, 2022, no plan assets are expected to be returned to the Company in the next twelve months.

The following table is the summary of expected future benefit payments (in thousands):




2023	$	2,211
2024	$	2,045
2025	$	2,050
2026	$	1,929
2027	$	1,868
Next five years	$	11,068

As of December 31, 2022, contributions expected to be paid to the plan in 2022 is $2.6 million.

DEFINED CONTRIBUTION PLANS

The Company also has various defined contribution savings plans that cover substantially all employees in the United States, Belgium, Canada, France, Japan, Netherlands, the U.K. and Puerto Rico. The Company matches a certain percentage of each employee’s contributions as per the provisions of the plans. Total contributions by the Company to the plans were $9.8 million, $8.8 million and $6.7 million for the years ended December 31, 2022, 2021 and 2020, respectively.

DEFERRED COMPENSATION PLAN

The Company maintains a Deferred Compensation Plan in which certain employees of the Company may defer the payment and taxation of up to 75% of their base salary and up to 100% of bonus amounts and other eligible cash compensation.

This deferred compensation is invested in funds offered under this plan and is valued based on Level 1 measurements in the fair value hierarchy. Assets of the Company's deferred compensation plan are included in Other current assets and recorded at fair value based on their quoted market prices. The fair value of these assets at December 31, 2022 and 2021 was $4.7 million and $3.8 million. Offsetting liabilities relating to the deferred compensation plan are included in Other liabilities.

- Definition

The entire disclosure for retirement benefits.

+ References

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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

BASIS OF PRESENTATION

These financial statements and the accompanying notes are prepared in accordance with accounting principles generally accepted in the United States of America and conform to Regulation S-X under the Securities Exchange Act of 1934, as amended.

PRINCIPLES OF CONSOLIDATION

USE OF ESTIMATES

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 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. As the Company continues to navigate the novel coronavirus ("COVID-19") pandemic and recent variants of the virus as well as the adverse impacts to global economic conditions, supply chain and the operations, there may be impact to future estimates including, but not limited to, inventory valuations, fair value measurements, goodwill and long-lived asset impairments, the effectiveness of the Company’s hedging instruments, deferred tax valuation allowances, and allowances for doubtful accounts receivable.

CASH AND CASH EQUIVALENTS

TRADE ACCOUNTS RECEIVABLE AND ALLOWANCES FOR DOUBTFUL ACCOUNTS RECEIVABLE

Provisions to the allowances for doubtful accounts are recorded to selling, general and administrative expenses. Account balances are charged off against the allowance when it is probable that the receivable will not be recovered. Provision for doubtful accounts, net of recoveries, associated with accounts receivable, included in selling, general and administrative expense, was charges of $0.2 million for the year ended December 31, 2022, recoveries of $1.1 million, and charges of $3.6 million for the years ended December 31, 2021 and 2020, respectively.

The below table shows the rollforward of the allowance for doubtful accounts for the years ended December 31, 2022, 2021 and 2020:


	Balance at Beginning of Period		Charged to Costs and Expenses	Other	Deductions	Balance at End of Period
Dollars in thousands
Year Ended:
December 31, 2022	$	4,735	238	—	(669)	$	4,304
December 31, 2021	$	6,439	(1,059)	341	(986)	$	4,735
December 31, 2020	$	4,303	3,635	—	(1,499)	$	6,439

(1)Deductions primarily relates to allowance for doubtful accounts written off during the year, net of recoveries and other adjustments.

INVENTORIES


	December 31,
Dollars in thousands	2022		2021
Finished goods	172,088		$	162,528
Work in process	70,598		65,323
Raw materials	81,897		89,535
Total inventories, net	$	324,583	$	317,386

PROPERTY, PLANT AND EQUIPMENT

Property, plant and equipment balances and corresponding lives were as follows:


	December 31,
Dollars in thousands	2022		2021		Useful Lives
Land	$	966	$	1,512
Buildings and building improvements	14,710		19,032		5-40 years
Leasehold improvements	164,292		155,495		1-20 years
Machinery and production equipment	181,780		183,270		3-20 years
Demonstration equipment	3,792		2,791		4-5 years
Information systems and hardware	151,330		148,706		1-7 years
Furniture, fixtures, and office equipment	20,286		20,921		1-15 years
Construction-in-progress	103,875		94,850
Total	641,031		626,577
Less: Accumulated depreciation	(329,729)		(314,874)
Property, plant and equipment, net	$	311,302	$	311,703

Depreciation expense associated with property, plant and equipment was $40.1 million, $39.4 million, and $42.1 million for the years ended December 31, 2022, 2021 and 2020, respectively.

CAPITALIZED INTEREST

The interest cost on capital projects, including facilities build-out and internal use software, is capitalized and included in the cost of the project. Capitalization commences with the first expenditure for the project and continues until the project is substantially complete and ready for its intended use. When no debt is incurred specifically for a project, interest is capitalized on project expenditures using the weighted average cost of the Company's outstanding borrowings. For the years ended December 31, 2022 and 2021, respectively, the Company capitalized $1.4 million and $1.2 million of interest expense into property, plant and equipment.

ACQUISITIONS

issuance, or validity and litigation.

GOODWILL AND OTHER INTANGIBLE ASSETS

The Company has two reportable segments with three underlying reporting units. Refer to Note 16, Segment and Geographic Information for more information on reportable segments.

over their expected useful lives.

LONG-LIVED ASSETS

Long-lived assets held and used by the Company, including property, plant and equipment, intangible assets, and leases are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. For purposes of evaluating the recoverability of long-lived assets to be held and used, a recoverability test is performed using projected undiscounted net cash flows applicable to the long-lived assets. If an impairment exists, the amount of such impairment is calculated based on the estimated fair value of the asset. Impairments to long-lived assets to be disposed of are recorded based upon the difference between the carrying value and the fair value of the applicable assets.

INTEGRA FOUNDATION

The Company may periodically make contributions to the Integra Foundation, Inc. The Integra Foundation was incorporated in 2002 exclusively for charitable, educational, and scientific purposes and qualifies under IRC 501(c)(3) as an exempt private foundation. Under its charter, the Integra Foundation engages in activities that promote health, the diagnosis and treatment of disease, and the development of medical science through grants, contributions and other appropriate means. The Integra Foundation is a separate legal entity and is not a subsidiary of the Company; therefore, its results are not included in these consolidated financial statements. The Company contributed $0.0 million, $1.2 million and $0.8 million to the Integra Foundation during the years ended December 31, 2022, 2021 and 2020, respectively. These contributions were recorded in selling, general, and administrative expense.

DERIVATIVES

FOREIGN CURRENCY

All assets and liabilities of foreign subsidiaries which have a functional currency other than the U.S. dollar are translated at the rate of exchange at year-end, while elements of the income statement are translated at the average exchange rates in effect during the year. The net effect of these translation adjustments is shown as a component of accumulated other comprehensive income (loss). These currency translation adjustments are not currently adjusted for income taxes as they relate to permanent investments in non-U.S. subsidiaries. Foreign currency transaction net losses of $3.3 million, net gains of less than $0.1 million, and net losses $1.6 million are reported in other income, net in the statements of operations, for the year ended December 31, 2022, 2021 and 2020, respectively.

INCOME TAXES

REVENUE RECOGNITION

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

RESEARCH AND DEVELOPMENT

Research and development costs, including salaries, depreciation, consultant and other external fees, and facility costs directly attributable to research and development activities, are expensed in the period in which they are incurred.

EMPLOYEE TERMINATION BENEFITS

The Company incurred employee termination costs on restructuring activities associated with a closure of a manufacturing facility in France and other reorganization projects in the consolidated statement of operations for the year ended December 31, 2022. In 2021, the Company incurred employee termination costs on restructuring activities associated with the closure of a manufacturing facility in France. The following table summarizes our restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the year ended December 31, 2022 and 2021.


	Years Ended December 31,
(Dollars in thousands)	2022		2021
Balance, beginning of the year	$	10,226	$	6,372
Charges:
Cost of Goods Sold	$	1,494	$	3,436
Research and development	72		288
Selling, general and administrative	$	5,582	$	466
Payments and other adjustments	$	(12,267)	$	(336)
Balance, end of the year	$	5,107	$	10,226

Included in the accrual balance as of December 31, 2022 is $2.0 million related to the closure of a manufacturing facility located in France, and other reorganization projects of $3.1M. Included in the accrual balance as of December 31, 2021 is $10.2 million related to the closure of the manufacturing facility located in France.

STOCK-BASED COMPENSATION

Relevant authoritative guidance requires companies to recognize the expense related to the fair value of their stock-based compensation awards. Stock-based compensation expense for stock option awards are based on the grant date fair value using the binomial distribution model. The Company recognizes compensation expense for stock option awards, restricted stock awards, performance stock awards and contract stock awards over the requisite service period of the award. All excess tax benefits and taxes and tax deficiencies from stock-based compensation are included in provision for income taxes in the consolidated statement of operations. Refer to Note 9, Stock-based Compensation for more information.

PENSION BENEFITS

Deferred Compensation Plan

CONCENTRATION OF CREDIT RISK

None of the Company's customers accounted for 10% or more of the consolidated net sales during the years ended December 31, 2022, 2021 and 2020.

RECENT ACCOUNTING PRONOUNCEMENTS

ADJUSTMENT

CONSOLIDATED BALANCE SHEET CLASSIFICATION

AMOUNT
(in millions)

Deferred tax impact of cumulative-effect adjustment

Deferred tax liabilities

(20.6)

Debt discount reclassification

Long-term convertible securities

89.1

Equity issuance costs reclassification

Long-term convertible securities

(2.5)

Debt discount amortization and equity costs reclassification, net of tax

Retained Earnings

(2.8)

Net impact of cumulative-effect adjustment

Additional paid-in capital

(63.3)

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.

SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION

Cash paid for interest during the years ended December 31, 2022, 2021 and 2020 was $42.2 million (net of $1.4 million that was capitalized into construction in progress), $43.2 million (net of $1.2 million that was capitalized into construction in progress) and $47.3 million (net of $2.3 million that was capitalized into construction in progress), respectively.

Cash paid for income taxes, net of refunds, for the years ended December 31, 2022, 2021 and 2020 was $35.9 million, $49.5 million and $29.8 million, respectively.

NON-CASH INVESTING AND FINANCING ACTIVITIES

Property and equipment purchases included in liabilities at December 31, 2022, 2021 and 2020 were $10.5 million, $4.7 million and $1.6 million, respectively.

During the fourth quarter of 2021, the Company achieved its final developmental milestone which triggered a $5.0 million obligation to be paid to former shareholders of Rebound Therapeutics Corporation ("Rebound"). The Company recorded $5.0 million as an intangible asset in the consolidated balance sheet upon achieving the milestone. The remaining obligation was included in accrued liabilities at December 31, 2021 in the consolidated balance sheets. The milestone was fully paid in 2022.

During the fourth quarter of 2020, the Company achieved another developmental milestone which triggered a $20.0 million obligation to be paid to the former shareholders of Rebound. The Company recorded $20.0 million as an intangible asset in the consolidated balance sheet upon achieving the milestone. The milestone was paid during the fourth quarter of 2020.

COMMITMENTS AND CONTINGENCIES - Narrative (Details)	12 Months Ended
COMMITMENTS AND CONTINGENCIES - Narrative (Details)	Dec. 31, 2022 USD ($) liability	Dec. 31, 2021 USD ($)	Jul. 29, 2019 USD ($)
Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Number of liabilities \| liability	1
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	$ 3,000,000
Derma Sciences \| BioD Earnout Payments and Medihoney Earnout Payments
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Payment for contingent consideration	33,300,000
Derma Sciences \| Level 3
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, liability	200,000	$ 200,000
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, liability	12,900,000		$ 25,500,000
Business combination, contingent consideration, liability, current	2,800,000
Business combination, contingent consideration, liability, noncurrent	$ 10,100,000
Contingent consideration			13,100,000
Arkis \| Milestone Payment One
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, liability			10,000,000
Arkis \| Milestone Payment Two
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, liability			$ 15,500,000

STOCK-BASED COMPENSATION

12 Months Ended

Dec. 31, 2022

Share-Based Payment Arrangement [Abstract]

STOCK-BASED COMPENSATION

Stock-based compensation expense - all related to employees and members of the Board of Directors - recognized under the authoritative guidance was as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Cost of goods sold	549		470		344
Research and development	1,739		1,644		1,471
Selling, general and administrative	$	25,437	$	34,096	$	17,776
Total stock-based compensation expense	27,725		36,210		19,591
Total estimated tax benefit related to stock-based compensation expense	10,574		13,804		6,221
Net effect on net income	$	17,151	$	22,406	$	13,370

EMPLOYEE STOCK PURCHASE PLAN

The purpose of the Employee Stock Purchase Plan (the “ESPP”) is to provide eligible employees of the Company 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. Under the ESPP, a total of 3.0 million shares of common stock are reserved for issuance. These shares will be made available either from the Company’s authorized but unissued shares of common stock or from shares of common stock reacquired by the Company as treasury stock. At December 31, 2022, 2.0 million shares remain available for purchase under the ESPP. During the years ended December 31, 2022, 2021 and 2020, the Company issued 20,780 shares, 16,948 shares and 18,284 shares under the ESPP for $1.1 million, $1.1 million and $1.1 million, respectively.

EQUITY AWARD PLANS

As of December 31, 2022, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under the Integra LifeSciences Holdings Corporation Fifth Amended and Restated 2003 Equity Incentive Plan (the “2003 Plan”). The 2000 and 2001 Equity Incentive Plans were terminated as of February 19, 2021, and no further awards may be issued under the plans.

In May 2010 and May 2017, the stockholders of the Company approved amendments to the 2003 Plan to increase by 3.5 million and 1.7 million, respectively, the number of shares of common stock that may be issued under the 2003 Plan. The Company has reserved 4.0 million shares under each of the 2000 Plan and the 2001 Plan, and 14.7 million shares under the 2003 Plan. The Plans permit the Company to grant incentive and non-qualified stock options, stock appreciation rights, restricted stock, contract stock, performance stock, or dividend equivalent rights to designated directors, officers, employees and associates of the Company.

Stock options issued under the 2003 Plan became exercisable over specified periods, generally within four years from the date of grant for officers and employees, and within one year from the date of the grant for members of the Board of Directors. The awards generally expire eight years from the grant date for employees and from six to ten for directors and certain executive officers, except in certain instances that result in accelerated vesting due to death, disability, retirement age or change in control provisions within their grant agreements. Restricted stock issued under the 2003 Plan vests ratably over specified periods, generally three years after the date of grant. The vesting of performance stock issued under the 2003 Plan is subject to service and performance conditions.

Stock Options

The Company values stock option grants using the binomial distribution model. Management believes that the binomial distribution model is preferable to the Black-Scholes model because it is a more flexible model that gives consideration to the impact of non-transferability and vesting provisions in valuing employee stock options.

In determining the value of stock options granted, the Company considered that it has never paid cash dividends and does not currently intend to pay cash dividends, and thus has assumed a 0% dividend yield. Expected volatilities are based on the historical volatility of the Company’s stock price. The expected life of stock options is estimated based on historical data on exercise of stock options, post-vesting forfeitures and other factors to estimate the expected term of the stock options granted. The risk-free interest rates are derived from the U.S. Treasury yield curve in effect on the date of grant for instruments with a remaining term similar to the expected life of the options. The Company accounts for forfeitures as they occur.

The following weighted-average assumptions were used in the calculation of fair value:


	Years Ended December 31,
	2022	2021	2020
Dividend yield	0%	0%	0%
Expected volatility	30%	29%	27%
Risk free interest rate	2.01%	1.30%	0.89%
Expected life of option from grant date	7 years	7 years	7 years
Weighted average grant date fair value of options granted	$23.15	$22.59	$13.03

The following table summarizes the Company’s stock option activity.


	Shares	Weighted Average Exercise Price		Weighted Average Contractual Term in Years	Aggregate Intrinsic Value
Stock Options	(In thousands)				(In thousands)
Outstanding at January 1, 2022	1,225	$	45.11	4.30	$26,970
Granted	146	65.11		—	—
Exercised	(155)	28.32		—	—
Forfeited or Expired	(14)	50.68		—	—
Outstanding at December 31, 2022	1,202	$	49.63	4.14	$	10,772
Exercisable at December 31, 2022	871	$	45.82	3.30	$	9,635

The Company recognized $3.5 million, $5.0 million and $3.2 million in expense related to stock options during the years ended December 31, 2022, 2021 and 2020, respectively. The intrinsic value of options exercised for the years ended December 31, 2022, 2021 and 2020 were $4.0 million, $11.1 million and $8.7 million, respectively. Cash received from option exercises and employee stock purchase plan was $5.5 million, $6.8 million and $5.2 million, for the years ended December 31, 2022, 2021 and 2020, respectively. The realized tax benefit from options exercised were $0.6 million, $2.2 million and $1.7 million for the years ended December 31, 2022, 2021 and 2020, respectively.

As of December 31, 2022, there was approximately $3.5 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately two years.

Awards of Restricted Stock, Performance Stock and Contract Stock

The following table summarizes the Company’s awards of restricted stock, performance stock and contract stock for the year ended December 31, 2022.


	Restricted Stock Awards			Performance Stock and Contract Stock Awards
	Shares	Weighted Average Grant Date Fair Value Per Share		Shares	Weighted Average Grant Date Fair Value Per Share
	(In thousands)			(In thousands)
Unvested, January 1, 2022	422	$	58.78	442	60.62
Granted	334	62.88		245	62.89
Adjustments for performance achievement related to award target	—	—		(18)	60.76
Cancellations	(34)	62.29		(10)	59.88
Released	(239)	58.27		(252)	59.38
Unvested, December 31, 2022	483	$	61.63	407	62.88

The Company recognized $24.3 million, $31.2 million and $16.4 million in expense related to such awards during the years ended December 31, 2022, 2021 and 2020, respectively. The total fair market value of shares vested and released in 2022, 2021 and 2020 was $65.0 million, $15.7 million and $17.3 million, respectively. Vested awards include shares that have been fully earned but had not been delivered as of December 31, 2022.

Performance stock awards have performance features associated with them. Performance stock, restricted stock and contract stock awards generally have requisite service periods of three years. The fair value of these awards is being expensed on a straight-line basis over the vesting period. As of December 31, 2022, there were 129,399 performance stock units ("PSU's") subject to vest and be released based on 2022 performance achievement.

As of December 31, 2022, there was approximately $29.7 million of total unrecognized compensation costs related to unvested restricted stock, performance stock and contract stock awards. These costs are expected to be recognized over a weighted-average period of approximately two years.

At December 31, 2022, there were approximately 3.1 million shares available for grant under the 2003 Plan.

The Company capitalized into inventory, share based compensation costs of $0.6 million, $0.5 million and $0.4 million for the years ended December 31, 2022, 2021 and 2020, respectively. Such share-based compensation was recognized as cost of goods sold when related inventory was sold.

NET INCOME PER SHARE (Narrative) (Details) - shares shares in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Abstract]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.3	0.1

DERIVATIVE INSTRUMENTS (Schedule of Cross-Currency Swap Derivatives) (Details) SFr in Thousands	Dec. 31, 2022 USD ($)	Dec. 31, 2022 CHF (SFr)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Dec. 31, 2021 CHF (SFr)	Oct. 04, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount								$ 471,600,000	SFr 420,100
Cross-Currency Interest Rate Swap \| Long
Derivative [Line Items]
Aggregate Notional Amount \| SFr											SFr 291,200
Cross-Currency Interest Rate Swap \| Short
Derivative [Line Items]
Aggregate Notional Amount										$ 300,000,000
Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount			$ 300,000,000	SFr 288,000
Cash Flow Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	$ 1,475,000,000				$ 1,775,000,000
Fair Value Asset (Liability)	56,712,000				(43,956,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (3,528,000)				0
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract One \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount \| SFr		SFr 48,532				SFr 0
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract One \| Short
Derivative [Line Items]
Fixed Rate	5.32%	5.32%
Aggregate Notional Amount	$ 49,142,000				0
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 0				(8,283,000)
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Two \| Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount \| SFr		SFr 0				145,598
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Two \| Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount	$ 0				150,000,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ (4,241,000)				41,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Three \| Long
Derivative [Line Items]
Fixed Rate	3.00%	3.00%
Aggregate Notional Amount \| SFr		SFr 374,137				SFr 397,137
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross Currency Interest Rate Swap, Contract Three \| Short
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 420,001,000				445,821,000
Cash Flow Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount							$ 50,000,000
Fair Value Asset (Liability)	$ (7,769,000)				$ (8,242,000)

LEASES AND RELATED PARTY LEASES (Tables)

12 Months Ended

Dec. 31, 2022

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases at December 31, 2022 were as follows:


	December 31, 2022			December 31, 2021
	(In thousands, except lease term and discount rate)

ROU assets	$	148,284		$	84,543

Current lease liabilities	14,624			14,775
Non-current lease liabilities	157,420			90,329
Total lease liabilities	$	172,044		$	105,104

Weighted average remaining lease term (in years):

Leased facilities	16.9 years			10.4 years
Leased vehicles	2.0 years			2.1 years

Weighted average discount rate:
Leased facilities	5.4		%	5.1		%
Leased vehicles	2.7		%	2.6		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases was as follows:


	December 31, 2022		December 31, 2021
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	17,442	$	15,077

ROU assets obtained in exchange for lease liabilities:
Operating leases	72,169		12,610

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at December 31, 2022 were as follows:


	Related Parties		Third Parties		Total
	(In thousands)
2023	296		20,024		20,320
2024	296		20,869		21,165
2025	296		19,198		19,494
2026	296		16,830		17,126
2027	296		15,886		16,182
Thereafter	542		164,622		165,164
Total minimum lease payments	$	2,022	$	257,429	$	259,451
Less: Imputed interest					$	87,407
Total lease liabilities					172,044
Less: Current lease liabilities					14,624
Long-term lease liabilities					157,420

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Lessee, Lease, Description [Line Items]
ROU assets	$ 148,284	$ 84,543
Current lease liabilities	14,624	14,775
Non-current lease liabilities	157,420	90,329
Total lease liabilities	$ 172,044	$ 105,104
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	16 years 10 months 24 days	10 years 4 months 24 days
Weighted average discount rate	5.40%	5.10%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years	2 years 1 month 6 days
Weighted average discount rate	2.70%	2.60%

INCOME TAXES (Schedule of Income Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
United States operations	$ 92,642	$ 91,150	$ 15,082
Foreign operations	121,252	123,527	78,438
Income before income taxes	$ 213,894	$ 214,677	$ 93,520

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases Current Period (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating Leased Assets [Line Items]
2023	$ 20,320
2024	21,165
2025	19,494
2026	17,126
2027	16,182
Thereafter	165,164
Total minimum lease payments	259,451
Less: Imputed interest	87,407
Total lease liabilities	172,044	$ 105,104
Less: Current lease liabilities	14,624	14,775
Long-term lease liabilities	157,420	$ 90,329
Related Parties
Operating Leased Assets [Line Items]
2023	296
2024	296
2025	296
2026	296
2027	296
Thereafter	542
Total minimum lease payments	2,022
Third Parties
Operating Leased Assets [Line Items]
2023	20,024
2024	20,869
2025	19,198
2026	16,830
2027	15,886
Thereafter	164,622
Total minimum lease payments	$ 257,429

NET INCOME PER SHARE (Tables)

12 Months Ended

Dec. 31, 2022

Earnings Per Share [Abstract]

Basic And Diluted Net Income Per Share

Basic and diluted net income per share was as follows:


	Years Ended December 31,
Dollars in thousands, except per share amounts	2022		2021		2020
Basic net income per share:
Net income	$	180,550	$	169,075	$	133,892
Weighted average common shares outstanding	82,997		84,698		84,650
Basic net income per common share	$	2.18	$	2.00	$	1.58

Diluted net income per share:
Net income	$	180,550	$	169,075	$	133,892

Weighted average common shares outstanding — Basic	82,997		84,698		84,650
Effect of dilutive securities:
Stock options and restricted stock	519		787		577
Weighted average common shares for diluted earnings per share	83,516		85,485		85,228
Diluted net income per common share	$	2.16	$	1.98	$	1.57

STOCK-BASED COMPENSATION (Summary of Stock Option Activity) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Outstanding at beginning of year (in shares)	1,225
Granted (in shares)	146
Exercised (in shares)	(155)
Forfeited or Expired (in shares)	(14)
Outstanding at end of year (in shares)	1,202	1,225
Exercisable at end of year (in shares)	871
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Roll Forward]
Weighted Average Exercise Price, Outstanding at beginning of year (in dollars per share)	$ 45.11
Weighted Average Exercise Price, Granted (in dollars per share)	65.11
Weighted Average Exercise Price, Exercised (in dollars per share)	28.32
Weighted Average Exercise Price, Forfeited or Expired (in dollars per share)	50.68
Weighted Average Exercise Price, Outstanding at end of year (in dollars per share)	49.63	$ 45.11
Weighted Average Exercise Price, Exercisable at end of year (in dollars per share)	$ 45.82
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures
Weighted Average Contractual Term in Years, Outstanding at end of year	4 years 1 month 20 days	4 years 3 months 18 days
Weighted Average Contractual Term in Years, Exercisable at end of year	3 years 3 months 18 days
Aggregate Intrinsic Value, Outstanding	$ 10,772	$ 26,970
Aggregate Intrinsic Value, Exercisable at end of year	$ 9,635

STOCK-BASED COMPENSATION (Summary of Vested and Unvested Restricted Stock, Performance Stock, and Contract Stock) (Details) shares in Thousands	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Restricted Stock Awards
Shares
Unvested at beginning of year (in shares) \| shares	422
Granted (in shares) \| shares	334
Adjustments for performance achievement related to award target (in shares) \| shares	0
Cancellations (in shares) \| shares	(34)
Released (in shares) \| shares	(239)
Unvested at end of year (in shares) \| shares	483
Weighted Average Grant Date Fair Value Per Share
Unvested at beginning of year (in dollars per share) \| $ / shares	$ 58.78
Granted (in dollars per share) \| $ / shares	62.88
Adjustments for performance achievement related to award target (in dollars per share) \| $ / shares	0
Cancellations (in dollars per share) \| $ / shares	62.29
Released (in dollars per share) \| $ / shares	58.27
Unvested at end of year (in dollars per share) \| $ / shares	$ 61.63
Performance Stock and Contract Stock Awards
Shares
Unvested at beginning of year (in shares) \| shares	442
Granted (in shares) \| shares	245
Adjustments for performance achievement related to award target (in shares) \| shares	(18)
Cancellations (in shares) \| shares	(10)
Released (in shares) \| shares	(252)
Unvested at end of year (in shares) \| shares	407
Weighted Average Grant Date Fair Value Per Share
Unvested at beginning of year (in dollars per share) \| $ / shares	$ 60.62
Granted (in dollars per share) \| $ / shares	62.89
Adjustments for performance achievement related to award target (in dollars per share) \| $ / shares	60.76
Cancellations (in dollars per share) \| $ / shares	59.88
Released (in dollars per share) \| $ / shares	59.38
Unvested at end of year (in dollars per share) \| $ / shares	$ 62.88

DERIVATIVE INSTRUMENTS (Tables)

12 Months Ended

Dec. 31, 2022

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following interest rate swaps as of December 31, 2022 and 2021 (dollar amounts in thousands):


	December 31, 2022		December 31, 2021							December 31, 2022		December 31, 2021
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month USD LIBOR Loan	—		300,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	$	—	$	(5,268)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	5,012		(5,520)
1-month USD LIBOR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	8,380		(7,421)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,831		(5,512)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,905		(5,464)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,970		(5,494)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,252		(6,886)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,153		(6,764)
1-month USD LIBOR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	23,742		3,552
1-month USD LIBOR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	5,467		821
	$	1,475,000	$	1,775,000						$	56,712	$	(43,956)

The Company held the following cross-currency rate swaps as of December 31, 2022 and 2021 (dollar amounts in thousands):


					December 31, 2022	December 31, 2021	December 31, 2022		December 31, 2021
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)










Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	—	145,598	—		(8,283)
Receive U.S.$			4.52%	$	—	150,000

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	374,137	397,137	(4,241)		41
Receive U.S.$			3.98%	$	420,001	445,821

Pay CHF	September 28, 2022	September 29, 2023	1.95%	CHF	48,532	—	(3,528)		—
Receive U.S.$			5.32%	$	49,142	—

Total							$	(7,769)	$	(8,242)

The Company held the following cross-currency rate swaps designated as net investment hedges as of December 31, 2022 and 2021 (dollar amounts in thousands):


					December 31, 2022	December 31, 2021	December 31, 2022		December 31, 2021
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)


Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	51,760	4,713		2,503
Receive U.S.$			2.57%	$	60,000	60,000

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	4,307		2,147
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	December 16, 2020	December 16, 2027	—%	CHF	—	222,300	—		(792)
Receive USD			1.10%	$	—	250,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	—	(14,663)		—
Receive U.S.$			1.94%	$	300,000	—

Total							$	(5,643)	$	3,858

Summary of Fair Value in Balance Sheet for Derivatives Designated as Hedging Instruments

The following table summarizes the fair value for derivatives designated as hedging instruments in the consolidated balance sheets as of December 31, 2022 and 2021:


	Fair Value as of December 31,
Dollars in thousands	2022		2021
Location on Balance Sheet (1):
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Cross-currency swap	4,497		4,900
Interest rate swap(2)	16,682		—
Net Investment Hedges
Cross-currency swap	11,653		5,120
Other assets
Cash Flow Hedges
Interest rate swap(2)	40,030		4,373
Net Investment Hedges
Cross-currency swap	3,311		2,104
Total derivatives designated as hedges — Assets	$	76,173	$	16,497

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	—	$	18,187
Cross-currency swap	3,528		8,283
Net Investment Hedges
Cross-currency swap	—		—
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	—		30,143
Cross-currency swap	8,738		4,859
Net Investment Hedges
Cross-currency swap	20,608		3,366
Total derivatives designated as hedges — Liabilities	32,874		64,838

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

(2)At December 31, 2022 and 2021, the total notional amounts related to the Company’s interest rate swaps were $1.5 billion and $1.8 billion respectively.

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

The following presents the effect of derivative instruments designated as cash flow hedges and net investment hedges on the accompanying consolidated statement of operations during the years ended December 31, 2022 and 2021:


Dollars in thousands	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 Year		Location in Statements of Operations
Year Ended December 31, 2022
Cash Flow Hedges
Interest rate swap	$	(43,956)	$	93,308	$	(7,360)	$	56,712	Interest expense
Cross-currency swap	(9,688)		8,847		19,430		(20,271)		Other income, net
Net Investment Hedges
Cross-currency swap	(2,321)		2,196		6,789		(6,914)		Interest income
	$	(55,965)	$	104,351	$	18,859	$	29,527
Year Ended December 31, 2021
Cash Flow Hedges
Interest rate swap	$	(93,769)	$	27,402	$	(22,411)	$	(43,956)	Interest expense
Cross-currency swap	(1,073)		24,275		32,890		(9,688)		Other income, net
Net Investment Hedges
Cross-currency swap	(12,291)		16,515		6,545		(2,321)		Interest income
	$	(107,133)	$	68,192	$	17,024	$	(55,965)

Derivatives Not Designated as Hedging Instruments

The following table summarizes the gains (losses) of derivative instruments not designated as hedges on the condensed consolidated statements of income, which was included in other income:


Dollars in thousands	December 31,
	2022		2021
Foreign currency forward contracts	$	—	$	(174)
Foreign currency swaps	1,258		629
Total	$	1,258	$	455

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 10
-Section 50
-Paragraph 4B
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Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
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Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org/extlink&oid=125515794&loc=SL5579240-113959

+ Details

RETIREMENT BENEFIT PLANS (Narrative) (Details) - USD ($)	1 Months Ended	12 Months Ended
	May 31, 2019	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Defined Benefit Plan Disclosure [Line Items]
Gain (loss) recognized within accumulated other comprehensive loss		$ 7,400,000	$ 7,000,000
Accumulated benefit obligation		46,400,000	60,300,000
Benefit plans, assets		38,053,000	39,914,000	$ 37,825,000
Plan assets expected to be returned next twelve months		0
Contributions expected to be paid to plan		2,600,000
Total contributions made		$ 9,800,000	$ 8,800,000	6,700,000
Defer payment and taxation, base salary, percentage (up to)	75.00%	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%	100.00%
Deferred compensation plan, fair value of assets		$ 4,700,000		$ 3,800,000
FRANCE
Defined Benefit Plan Disclosure [Line Items]
Benefit plans, assets		0
GERMANY
Defined Benefit Plan Disclosure [Line Items]
Benefit plans, assets		$ 0

ACQUISITIONS AND DIVESTITURES - Fair Value Acquisition ACell (Details) - USD ($) $ in Thousands	Jan. 20, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Goodwill		$ 1,038,881	$ 1,013,458	$ 932,367
ACell, Inc.
Business Acquisition [Line Items]
Cash	$ 2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaid expenses and other current assets	1,498
Total current assets	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000
Goodwill	94,147
Right of use asset - operating leases	9,259
Deferred tax assets	7,465
Other assets	148
Total assets acquired	408,780
Accounts payable	718
Accrued expenses	5,966
Current portion of lease liability - operating leases	1,673
Total current liabilities	8,357
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	61,724
Contingent consideration	23,900
Total liabilities assumed	101,842
Net assets acquired	$ 306,938
ACell, Inc. \| Minimum
Business Acquisition [Line Items]
Weighted Average Life	13 years
ACell, Inc. \| Maximum
Business Acquisition [Line Items]
Weighted Average Life	14 years

ACQUISITIONS AND DIVESTITURES

12 Months Ended

Dec. 31, 2022

Business Combination and Asset Acquisition [Abstract]

ACQUISITIONS AND DIVESTITURES

Surgical Innovation Associates, Inc. Acquisition

On December 6, 2022, the Company completed its acquisition of Surgical Innovation Associates, Inc. ("SIA") for an acquisition purchase price of $51.5 million. In addition to the purchase price, the acquisition includes two separate contingent considerations payments, which are dependent on 1) achieving certain revenue-based performance milestones in 2023, 2024, and 2025 (up to $50.0 million in additional payments), as well as 2) the approval by the FDA of the Premarket Approval (“PMA”) Application for DuraSorb for certain uses by certain timing targets (up to $40.0 million in additional payments). SIA's core technology, DuraSorb, is a fully resorbable scaffold of a globally accepted polymer, which is cleared for use in hernia repair, abdominal wall, and other soft tissue reinforcement. DuraSorb sales will be reported within Integra’s Tissue Technologies segment as part of its Wound Reconstruction and Care franchise.

Assets Acquired and Liabilities Assumed at Fair Value

The SIA 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.

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


Dollars in thousands	Valuation as of December 6, 2022		Weighted Average Life
Current assets:
Cash	$	4,438
Trade accounts receivable, net	1,551
Inventories, net	2,900
Prepaid expenses and other current assets	1,654
Total current assets	$	10,543
Intangible assets	75,000		14 years
Goodwill	41,854
Total assets acquired	$	127,397

Current liabilities:
Accounts payable and accrued expenses	$	2,044
Total current liabilities	$	2,044
Deferred Tax Liability	11,799
Contingent consideration	57,607
Total liabilities assumed	71,450

Net assets acquired	$	55,947

Developed Technology

The estimated fair value of the developed technology was determined using the multi-period excess earnings method of the income approach, which estimates value based on the present value of future economic benefits. 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 product including net revenues, cost of sales, R&D costs, selling and marketing costs, working capital, and 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 the asset’s life cycle, and competitive trends impacting the asset and the cash flow stream.

The Company used a discount rate of 18% 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 SIA Acquisition to the Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected revenue and cost synergies of the combined company and assembled workforce. A key factor that contributes to the recognition of goodwill, and a driver for the Company’s acquisition of SIA, is the attractive growth opportunities presented by the surgical matrix business in the breast reconstruction market. 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 resulting most likely payouts 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 the consolidated statement of operations. Changes in the fair value of the contingent considerations may result from changes in discount periods and rates and changes in the timing and amount of revenue estimates. Changes in assumptions utilized in the contingent consideration fair value estimates could result in an increase in the contingent consideration obligation and a corresponding charge to operating results.

As part of the acquisition, the Company is required to pay to the shareholder of SIA up to $90.0 million for two separate payments, which are dependent on 1) achieving certain revenue-based performance milestones in 2023, 2024, and 2025 (up to $50.0 million in additional payments), as well as 2) the approval by the FDA of the PMA for DuraSorb for certain uses by

certain timing targets (up to $40.0 million in additional payments). The Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration for the revenue-based milestone that considered the possible outcomes of scenarios related to each specific milestone for the revenue based performance milestone. The Company used probabilities of achieving the conditions to calculate the fair value of the contingent consideration for the PMA approval milestone. The Company estimated the fair value of the contingent consideration for the revenue based milestone to be $32.6 million at the acquisition date and $25.0 million for the PMA approval milestone.

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.

Sale of non-core traditional wound care business

On August 31, 2022, the Company completed its sale of its non-core traditional wound care ("TWC") business to Gentell, LLC ("Gentell") for $28.8 million, which consists of $27.8 million in cash plus $1.0 million in contingent consideration which may be received upon achieving certain revenue-based performance milestones two years after the closing date. The proceeds from the sale of the TWC business of $27.8 million is presented in the consolidated statement of cash flows net of cash transferred of $3.5 million and other transaction fees. The transaction included the sale of the Company's TWC products, such as sponges, gauze and conforming bandages, and certain advanced wound care dressings, such as supportive, calcium alginate, hydrogel, and foam dressings.

The divestiture did not represent a strategic shift that had a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method of the TWC business to the Company's Tissue Technologies reportable business segment. In connection with the sale, the Company recognized $0.6 million as a gain from the sale of the business in the consolidated statement of operations for the year ended December 31, 2022. The transaction is subject to final working capital adjustments.

In addition to the purchase and sale agreement, the Company also entered into a contract manufacturing agreement with Gentell. Under the terms of the agreement, Gentell received inventory, equipment, and tooling to manufacture certain MediHoney® and TCC-EZ® products on behalf of the Company. On the close date of this transaction, the Company transferred all inventory associated with these products to Gentell and recognized an asset of $11.1 million, as a form of a deposit for the inventory transferred, which based on the expected timing of inventory purchases, was primarily included within prepaid expenses and other current assets in the consolidated balance sheet. This deposit will be utilized by the Company on future orders placed to Gentell for such products. As of December 31, 2022, the Company had a deposit remaining of $8.3 million which is included in prepaid assets and recognized a payable due to Gentell of $2.7 million, which is included in the consolidated balance sheet within accrued expenses and other current liabilities.

Sale of Extremity Orthopedics Business

On January 4, 2021, the Company completed the sale of its Extremity Orthopedics business to Smith & Nephew USD Limited ("Smith & Nephew"). The transaction included the sale of the Company's upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. The Company received an aggregate purchase price of $240.0 million from Smith & Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO") effectively terminating the licensing agreement between Integra and CFO relating to the development of shoulder arthroplasty products.

Assets and liabilities divested consisted of the following as of December 31, 2020 (dollar amounts in thousands):


Prepaid expenses and other current assets	$	713
Right of use asset - operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	$	162,104

Other liabilities	$	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$	11,751

The divestiture did not represent a strategic shift that had a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method of the Extremity Orthopedics business to the Company's Tissue Technologies reporting unit. In connection with the sale, the Company recognized a gain of $41.8 million that is presented in Gain from the sale of business in the consolidated statement of operations for the year ended December 31, 2021. The Company finalized the net working capital to Smith & Nephew as of December 31, 2021.

The Company also entered into a transition services agreement ("TSA") with Smith & Nephew which requires the Company to provide certain services on behalf of Smith & Nephew for the duration of the period subsequent to the sale of the business as defined in the TSA. The Company recognized a payable due to Smith & Nephew of $2.3 million as of December 31, 2022, which is included in the consolidated balance sheet within accrued expenses and other current liabilities. The TSA includes services such as invoicing and cash collections from customers on behalf of Smith & Nephew. As of December 31, 2022, the Company has concluded the majority of the transition services agreement, pending final payment.

ACell, Inc. Acquisition

On January 20, 2021, the Company acquired ACell, Inc. (the "ACell Acquisition") for an acquisition purchase price of $306.9 million plus contingent considerations of up to $100 million, that may be payable upon achieving certain revenue-based performance milestones in 2022, 2023 and 2025. The final working capital adjustments of $1.3 million was finalized and paid as of June 30, 2021. ACell was a privately-held company that offered a portfolio of regenerative products for complex wound management, including developing and commercializing products based on MatriStem Urinary Bladder Matrix, a technology platform derived from porcine urinary bladder extracellular matrix.

Assets Acquired and Liabilities Assumed at Fair Value

The ACell Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination are recognized at their fair values as of the acquisition date.

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


Dollars in thousands	Final Valuation		Weighted Average Life
Current assets:
Cash	$	2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaid expenses and other current assets	1,498
Total current assets	$	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000		13-14 years
Goodwill	94,147
Right of use asset - operating leases	9,259
Deferred tax assets	7,465
Other assets	148
Total assets acquired	$	408,780

Current liabilities:
Accounts payable	$	718
Accrued expenses	5,966
Current portion of lease liability - operating leases	1,673
Total current liabilities	$	8,357
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	61,724
Contingent consideration	23,900
Total liabilities assumed	101,842

Net assets acquired	$	306,938

Intangible Assets

The estimated fair value of the developed technology acquired was determined using the multi-period excess earnings method of the income approach, which estimates value based on the present value of future economic benefits. 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 product including net revenues, cost of sales, R&D costs, selling and marketing costs, 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 8.5% 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 ACell acquisition to the Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

Contingent Consideration

As part of the acquisition, the Company is required to make payments to the former shareholders of ACell up to $100 million based on the achievement of certain revenue-based performance milestones in 2022, 2023, and 2025. Based on revenue performance in 2022, no payment will be made for the first performance milestone. The Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specific milestone. The Company estimated the fair value of the contingent consideration to be $23.9 million at the acquisition date. The Company recorded $3.7 million and $21.8 million in other liabilities as of December 31, 2022 and 2021, respectively, in the consolidated balance sheets of the Company. The change in the fair value of the contingent obligation was primarily as a result of changes in the timing and amount of revenue estimates.

The Company determined the acquisition date fair value of contingent consideration obligations using a Monte Carlo simulation, as well as significant unobservable inputs, reflecting the Company’s assessment of the assumptions market participants would use to value these liabilities. 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 most likely payouts are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligations is 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 considerations may result from changes in discount periods and rates and changes in the timing and amount of revenue estimates.

Deferred Tax Liabilities

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
OPERATING ACTIVITIES:
Net income	$ 180,550	$ 169,075	$ 133,892
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	118,299	119,836	116,031
Non-cash in-process research and development expense	0	0	519
Non-cash impairment charges	0	2,754	0
Deferred income tax (benefit) provision	(4,585)	(2,755)	(64,138)
Share-based compensation	27,725	36,210	19,590
Amortization of debt issuance costs and expenses associated with debt refinancing	6,845	7,030	12,076
Non-cash lease expense	2,816	3,834	2,955
Accretion of bond issuance discount	0	0	15,415
Loss (Gain) on disposal of property and equipment and construction in-progress	(6,813)	2,240	7,855
Gain from the sale of businesses	(644)	(41,798)	0
Change in fair value of contingent consideration and others	(20,304)	(2,162)	951
Changes in assets and liabilities:
Accounts receivable	(33,905)	7,265	52,105
Inventories	(29,124)	5,374	(48,348)
Prepaid expenses and other current assets	8,612	(21,143)	1,632
Other non-current assets	(2,182)	7,875	13,735
Accounts payable, accrued expenses and other current liabilities	17,343	32,874	(57,512)
Contract liabilities	4,274	28	(37)
Other non-current liabilities	(4,438)	(14,110)	(2,889)
Net cash provided by operating activities	264,469	312,427	203,832
INVESTING ACTIVITIES:
Purchases of property and equipment	(42,343)	(48,022)	(38,890)
Proceeds from sale of business	23,960	190,468	0
Acquired in-process research and development and intangibles	(4,742)	(58)	(25,000)
Cash paid for business acquisitions, net of cash acquired	(51,509)	(303,910)	0
Proceeds from sales of property and equipment	11,145	3	3,657
Net proceeds (payments) on swaps designated as net investment hedges	4,909	76	(7,840)
Net cash used in investing activities	(58,580)	(161,443)	(68,073)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	40,750	25,500	171,500
Payments on debt	(148,550)	(125,500)	(441,000)
Purchase of option hedge on convertible notes	0	0	(104,248)
Proceeds from convertible notes issuance	0	0	575,000
Proceeds from sale of stock purchase warrants	0	0	44,563
Payment of debt issuance costs	0	(249)	(24,347)
Purchase of treasury stock	(125,000)	0	(100,000)
Proceeds from exercised stock options	5,465	6,824	5,232
Cash taxes paid in net equity settlement	(24,618)	(4,801)	(5,075)
Net cash (used in) provided by financing activities	(251,953)	(98,226)	121,625
Effect of exchange rate changes on cash and cash equivalents	(10,723)	(9,476)	13,871
Net increase (decrease) in cash and cash equivalents	(56,787)	43,282	271,255
Cash and cash equivalents at beginning of period	513,448	470,166	198,911
Cash and cash equivalents at end of period	$ 456,661	$ 513,448	$ 470,166

COMMITMENTS AND CONTINGENCIES (Tables)

12 Months Ended

Dec. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Schedule of Contingent Consideration

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the years ended December 31, 2022 and 2021 is as follows (in thousands):


Year ended December 31, 2022	Contingent Consideration Liability Related to Acquisition of:
	Arkis (See Note 4)				Location in Financial Statements	Derma Sciences		ACell Inc. (See Note 4)				SIA				Location in Financial Statements
	Short-term		Long-term			Long-term		Short-term		Long-term		Long-term
Balance as of January 1, 2022	$	3,691	$	11,408		$	230	$	—	$	21,800	$	—
Additions	—		—			—				—		57,607
Transfers from long-term to current portion	—		—			—		4,885		(4,885)		—
Change in fair value of contingent consideration liabilities	(846)		(1,358)		Research and development	—		(4,885)		(13,215)		—				Selling, general and administrative
Balance as of December 31, 2022	$	2,845	$	10,050		$	230	$	—	$	3,700	$	57,607	$	—


Year ended December 31, 2021	Contingent Consideration Liability Related to Acquisition of:
	Arkis (See Note 4)				Location in Financial Statements	Derma Sciences		ACell Inc. (See Note 4)		Location in Financial Statements
	Short-term		Long-term			Long-term		Long-term
Balance as of January 1, 2021	$	3,415	$	11,746		$	230	$	—
Additions	—		—			—		23,900
Transfers from long-term to current portion	276		(276)			—		—
Change in fair value of contingent consideration liabilities	—		$	(62)	Research and development	—		(2,100)		Selling, general and administrative
Balance as of December 31, 2021	$	3,691	$	11,408		$	230	$	21,800

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Total revenue, net	$ 1,557,666	$ 1,542,448	$ 1,371,868
Costs and expenses:
Cost of goods sold	587,355	597,808	520,834
Research and development	101,193	93,051	77,381
Selling, general and administrative	616,316	637,445	594,526
Intangible asset amortization	13,882	16,914	27,757
Total costs and expenses	1,318,746	1,345,218	1,220,498
Operating income	238,920	197,230	151,370
Interest income	11,917	6,737	9,297
Interest expense	(49,594)	(50,395)	(71,581)
Gain from sale of businesses	644	41,798	0
Other income, net	12,007	19,307	4,434
Income before income taxes	213,894	214,677	93,520
Provision (benefit) for income taxes	33,344	45,602	(40,372)
Net income	$ 180,550	$ 169,075	$ 133,892
Net income per share
Basic (in dollars per share)	$ 2.18	$ 2.00	$ 1.58
Diluted (in dollars per share)	$ 2.16	$ 1.98	$ 1.57
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	82,997	84,698	84,650
Diluted (in shares)	83,516	85,485	85,228

SEGMENT AND GEOGRAPHIC INFORMATION (Narrative) (Details)	12 Months Ended
	Dec. 31, 2022 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	40,000

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

12 Months Ended

Dec. 31, 2022

Stockholders' Equity Note [Abstract]

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

Changes in accumulated other comprehensive loss by component between December 31, 2022 and 2021 are presented in the table below, net of tax:


Dollars in thousands	Gains and Losses on Derivatives		Defined Benefit Pension Items		Foreign Currency Items		Total
Balance at December 31, 2021	$	(42,981)	$	1,893	$	(4,067)	$	(45,155)
Other comprehensive gain (loss)	80,335		7,429		(17,807)		69,957
Less: Amounts reclassified from accumulated other comprehensive income, net	14,537		—		—		14,537
Net current-period other comprehensive gain (loss)	65,798		7,429		(17,807)		55,420
Balance at December 31, 2022	$	22,817	$	9,322	$	(21,874)	$	10,265

For the year ended December 31, 2022, the Company reclassified a gain of $15.0 million and a loss of $0.4 million from accumulated other comprehensive loss to other income, net and interest income, respectively.

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Inventories, Net) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Finished goods	$ 172,088	$ 162,528
Work in process	70,598	65,323
Raw materials	81,897	89,535
Total inventories, net	$ 324,583	$ 317,386

BUSINESS	12 Months Ended
BUSINESS	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS	BUSINESSIntegra LifeSciences Holdings Corporation (the “Company”) was incorporated in Delaware in 1989. The Company is a worldwide leader in medical technology. The Company was founded with the acquisition of an engineered collagen technology platform used to repair and regenerate tissue. Since then, Integra has developed numerous product lines from this technology for applications ranging from burn and deep tissue wounds to the repair of dura mater in the brain, as well as nerves and tendons. The Company has expanded its base regenerative technology business to include surgical instruments, neurosurgical products and advanced wound care through global acquisitions and product development to meet the evolving needs of its customers and enhance patient care. The Company sells its products directly through various sales forces and through a variety of other distribution channels.

ACQUISITIONS AND DIVESTITURES - Fair Value Acquisition SIA (Details) - USD ($) $ in Thousands	Dec. 06, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Goodwill		$ 1,038,881	$ 1,013,458	$ 932,367
Surgical Innovation Association Inc
Business Acquisition [Line Items]
Cash	$ 4,438
Trade accounts receivable, net	1,551
Inventories, net	2,900
Prepaid expenses and other current assets	1,654
Total current assets	10,543
Intangible assets	75,000
Goodwill	41,854
Total assets acquired	127,397
Accounts payable	2,044
Total current liabilities	2,044
Deferred tax liability	11,799
Contingent consideration	57,607
Total liabilities assumed	71,450
Net assets acquired	$ 55,947
Weighted Average Life	14 years

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2022	Feb. 21, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	000-26224
Entity Registrant Name	INTEGRA LIFESCIENCES HOLDINGS CORP
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0317849
Entity Address, Address Line One	1100 Campus Road
Entity Address, Postal Zip Code	08540
Entity Address, City or Town	Princeton
Entity Address, State or Province	NJ
City Area Code	609
Local Phone Number	275-0500
Title of 12(b) Security	Common Stock, Par Value $.01 Per Share
Trading Symbol	IART
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Shell Company	false
Entity Public Float			$ 3,916.0
Entity Common Stock, Shares Outstanding (in shares)		81,636,066
Documents Incorporated by Reference	Certain portions of the registrant’s definitive proxy statement relating to its scheduled May 12, 2023 Annual Meeting of Stockholders, which will be filed with the Securities and Exchange Commission, are incorporated by reference in Part III of this Annual Report on Form 10-K.
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Central Index Key	0000917520

DEBT (Maximum Total Leverage Ratio Table) (Details) - Senior Credit Facility	Jul. 14, 2020
September 30, 2022 through June 30, 2023
Debt Instrument [Line Items]
Debt Instrument, Covenant, Maximum Leverage Ratio	4,500
September 30, 2023 and the last day of each fiscal quarter thereafter
Debt Instrument [Line Items]
Debt Instrument, Covenant, Maximum Leverage Ratio	4,000.00

SEGMENT AND GEOGRAPHIC INFORMATION (Net Sales and Profit by Reportable Segment) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Net Sales
Total revenues	$ 1,557,666	$ 1,542,448	$ 1,371,868
Segment Profit
Amortization	(13,882)	(16,914)	(27,757)
Operating income	238,920	197,230	151,370
Codman Specialty Surgical
Segment Net Sales
Total revenues	1,019,564	1,025,232	894,831
Tissue Technologies
Segment Net Sales
Total revenues	538,102	517,216	477,037
Operating Segments
Segment Profit
Operating income	651,675	667,670	516,287
Operating Segments \| Codman Specialty Surgical
Segment Profit
Operating income	417,873	439,471	356,657
Operating Segments \| Tissue Technologies
Segment Profit
Operating income	233,802	228,199	159,630
Corporate and other
Segment Profit
Operating income	$ (398,873)	$ (453,526)	$ (337,160)

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

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+ Details

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 456,661	$ 513,448
Trade accounts receivable, net of allowances of $4,304 and $4,735	263,465	231,831
Inventories, net	324,583	317,386
Prepaid expenses and other current assets	116,789	91,051
Total current assets	1,161,498	1,153,716
Property, plant and equipment, net	311,302	311,703
Right of use asset - operating leases	148,284	84,543
Intangible assets, net	1,126,609	1,145,573
Goodwill	1,038,881	1,013,458
Deferred tax assets, net	45,994	56,950
Other assets	57,190	16,440
Total assets	3,889,758	3,782,383
Current Liabilities:
Current portion of borrowings under senior credit facility	38,125	45,000
Current portion of lease liability - operating leases	14,624	14,775
Accounts payable, trade	102,100	61,837
Contract liabilities	7,253	5,295
Accrued compensation	78,771	92,656
Accrued expenses and other current liabilities	80,033	120,458
Total current liabilities	320,906	340,021
Long-term borrowings under senior credit facility	733,149	824,257
Long-term borrowings under securitization facility	104,700	112,500
Long-term convertible securities	567,341	564,426
Lease liability - operating leases	157,420	90,329
Deferred tax liabilities	63,338	45,788
Other liabilities	138,501	120,258
Total liabilities	2,085,355	2,097,579
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; 90,477 and 89,600 issued at December 31, 2022 and 2021, respectively	905	896
Additional paid-in capital	1,276,977	1,264,943
Treasury stock, at cost; 6,823 and 4,899 shares at December 31, 2022 and 2021, respectively	(362,862)	(234,448)
Accumulated other comprehensive income (loss)	10,265	(45,155)
Retained earnings	879,118	698,568
Total stockholders’ equity	1,804,403	1,684,804
Total liabilities and stockholders’ equity	$ 3,889,758	$ 3,782,383

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Adoption of 2020-06 (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Deferred tax liabilities	$ 63,338	$ 45,788
Long-term convertible securities	567,341	564,426
Retained earnings	$ 879,118	$ 698,568
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Deferred tax liabilities			$ (20,600)
Retained earnings			(2,800)
Additional paid-in capital			(63,300)
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Reclassification
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Long-term convertible securities			89,100
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Amortization and Equity Costs Reclassification
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Long-term convertible securities			$ (2,500)

SEGMENT AND GEOGRAPHIC INFORMATION

12 Months Ended

Dec. 31, 2022

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 Instruments business, which sells more than 40,000 instrument patterns and surgical and lighting products to hospitals, surgery centers, dental, podiatry, and veterinary offices.

•The Tissue Technologies segment includes such offerings as skin and wound repair, plastics & surgical reconstruction products, bone grafts, and nerve and tendon repair products.

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

The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions, and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by reportable segment for the years ended December 31, 2022, 2021 and 2020 are as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Segment Net Sales
Codman Specialty Surgical	$	1,019,564	$	1,025,232	$	894,831
Tissue Technologies	538,102		517,216		477,037
Total revenues	$	1,557,666	$	1,542,448	$	1,371,868
Segment Profit
Codman Specialty Surgical	$	417,873	$	439,471	$	356,657
Tissue Technologies	233,802		228,199		159,630
Segment profit	651,675		667,670		516,287
Amortization	(13,882)		(16,914)		(27,757)
Corporate and other	(398,873)		(453,526)		(337,160)
Operating income	$	238,920	$	197,230	$	151,370

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 revenue to geographic areas based on the location of the customer. Total revenue, net and long-lived assets (tangible) by major geographic area are summarized below:


Dollars in thousands	United States(1)		Europe		Asia Pacific		Rest of the World		Consolidated
Total revenue, net:
2022	$	1,126,810	$	170,903	$	176,477	$	83,476	$	1,557,666
2021	1,089,526		191,327		182,034		79,561		1,542,448
2020	971,975		172,689		157,174		70,030		1,371,868
Total long-lived assets:
2022	$	440,223	$	60,857	$	12,975	$	2,721	$	516,776
2021	339,535		55,026		11,289		6,836		412,686

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

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+ Details

DEBT (Narrative) (Details)		3 Months Ended		12 Months Ended
DEBT (Narrative) (Details)	Feb. 04, 2020 USD ($) $ / shares	Sep. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 09, 2020 USD ($)	Feb. 03, 2020 USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility, classified as current				$ 38,125,000	$ 45,000,000
Interest payments, year one				42,700,000
Interest payments, year two				39,100,000
Interest payments, year three				3,600,000
Cost of call transactions				0	0	$ 104,248,000
Proceeds from warrant transactions				0	0	$ 44,563,000
Long-term convertible securities				567,341,000	564,426,000
Securitization facility, outstanding borrowings, maximum limit				150,000,000
Secured long-term debt, securitization program				$ 104,700,000	$ 112,500,000
Security facility, weighted average interest rate				5.00%	1.10%
Level 2
Debt Instrument [Line Items]
Securitization facility, fair value of amount outstanding				$ 104,900,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity								$ 1,300,000,000
Line of credit facility outstanding				$ 0	$ 31,300,000
Weighted average interest rate on debt					1.40%
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity								60,000,000
Swingline Loan
Debt Instrument [Line Items]
Maximum borrowing capacity								60,000,000
Senior Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity								2,200,000,000
Capitalized incremental financing costs								4,600,000
Previously capitalized financing costs, written-off			$ 1,200,000
Incremental financing cost expense		$ 3,300,000
Senior Credit Facility \| Minimum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage				0.15%
Senior Credit Facility \| Maximum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage				0.30%
Senior Credit Facility \| Eurodollar Rate \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option				1.00%
Senior Credit Facility \| Eurodollar Rate \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option				2.25%
Senior Credit Facility \| Overnight Federal Funds Rate
Debt Instrument [Line Items]
Interest rates available to the company at its option				0.50%
Senior Credit Facility \| One-Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available to the company at its option				1.00%
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding				$ 0
Letters of credit outstanding				1,600,000	$ 1,600,000
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity								$ 877,500,000
Line of credit facility outstanding				$ 771,300,000	$ 843,800,000
Weighted average interest rate on debt				5.60%	1.40%
Term loan component of senior credit facility, classified as current				$ 38,100,000	$ 45,000,000
Term Loan Facility \| Secured Debt \| Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				800,800,000
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Capitalized incremental financing costs	$ 13,200,000
Convertible notes, aggregate principal amount	$ 575,000,000
Convertible notes, interest rate	0.50%
Debt proceeds, classified as equity at time of offering	$ 104,500,000
Effective interest rate	4.20%
Initial conversion rate	0.0135739
Initial conversion price (in dollars per share) \| $ / shares	$ 73.67
Maximum selling price of the company's common stock of the conversion price	130.00%
Maximum average conversion value of notes	98.00%
Combination settlement for debt conversion, minimum settled in cash per principal amount							$ 1,000
Redemption price, percentage	100.00%
Warrant strike price (in dollars per share) \| $ / shares	$ 113.34
Long-term convertible securities				575,000,000
Fair value				560,500,000
Cash interest				$ 2,900,000	$ 2,900,000
2025 Notes \| Convertible Debt \| Call Option
Debt Instrument [Line Items]
Cost of call transactions	$ 104,200,000
Proceeds from warrant transactions	$ 44,500,000
Initial strike price (in dollars per share) \| $ / shares	$ 73.67

STOCK-BASED COMPENSATION (Summary of Employee Stock-Based Compensation Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 27,725	$ 36,210	$ 19,591
Total estimated tax benefit related to stock-based compensation expense	10,574	13,804	6,221
Net effect on net income	17,151	22,406	13,370
Cost of goods sold
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	549	470	344
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	1,739	1,644	1,471
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 25,437	$ 34,096	$ 17,776

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Arkis \| Accrued Expenses and Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 3,691	$ 3,415
Additions	0	0
Transfers from long-term to current portion	0	276
Change in fair value of contingent consideration liabilities	846	0
Balance, End of Period	2,845	3,691
Arkis \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	11,408	11,746
Additions	0	0
Transfers from long-term to current portion	0	(276)
Change in fair value of contingent consideration liabilities	1,358	62
Balance, End of Period	10,050	11,408
Derma Sciences \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	230
Additions	0	0
Transfers from long-term to current portion	0	0
Change in fair value of contingent consideration liabilities	0	0
Balance, End of Period	230	230
ACell \| Accrued Expenses and Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Additions
Transfers from long-term to current portion	4,885
Change in fair value of contingent consideration liabilities	4,885
Balance, End of Period	0	0
ACell \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	21,800	0
Additions	0	23,900
Transfers from long-term to current portion	(4,885)	0
Change in fair value of contingent consideration liabilities	13,215	2,100
Balance, End of Period	$ 3,700	$ 21,800

DERIVATIVE INSTRUMENTS (Narrative) (Details) SFr in Thousands, € in Millions				12 Months Ended
	Oct. 03, 2022 USD ($)	May 26, 2022 USD ($)	Sep. 30, 2021 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Sep. 26, 2022 USD ($)	Sep. 26, 2022 CHF (SFr)	May 26, 2022 CHF (SFr)	Oct. 04, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value				$ 104,351,000		$ 68,192,000	$ (96,837,000)
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value				104,351,000		68,192,000
Derivative fair value				76,173,000		16,497,000
Cash Flow Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Notional amount				1,475,000,000		1,775,000,000
Foreign Currency Forward Contract \| Not Designated as Hedging Instrument
Derivative [Line Items]
Notional amount							$ 4,200,000
Currency Swap \| Not Designated as Hedging Instrument
Derivative [Line Items]
Notional amount			$ 6,400,000										$ 7,300,000
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Notional amount														$ 471,600,000	SFr 420,100
Intercompany loan, quarterly payment \| SFr					SFr 5,800
Other comprehensive income (loss), net investment hedge, gain (loss), reclassification, before tax	$ 1,600,000	$ 4,900,000
Gain (loss) recognized in other income				8,400,000		9,100,000
Gain (loss) estimated to be reclassified to earnings during next twelve months				4,500,000
Cross-Currency Interest Rate Swap \| Designated as Hedging Instrument
Derivative [Line Items]
Notional amount		300,000,000								SFr 288,000
Cross-Currency Interest Rate Swap \| Cash Flow Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Notional amount											$ 50,000,000
Gain (loss) recognized in other income				11,100,000		$ 23,800,000
Cross-Currency Interest Rate Swap \| Net Investment Hedging
Derivative [Line Items]
Notional amount			52,000,000									€ 44.9
Gain (loss) recorded in AOCL, change in fair value			$ 100,000
Cross-Currency Interest Rate Swap \| Net Investment Hedging \| Designated as Hedging Instrument
Derivative [Line Items]
Derivative, notional amount, terminated		$ 250,000,000								SFr 222,300
Gain (loss) estimated to be reclassified to earnings during next twelve months				11,700,000
Cross-Currency Interest Rate Swap \| Short
Derivative [Line Items]
Notional amount																$ 300,000,000
Cross-Currency Interest Rate Swap \| Short \| Codman
Derivative [Line Items]
Notional amount				$ 49,100,000					SFr 48,500
Derivative, notional amount, terminated	$ 100,000,000							$ 50,000,000
Cross-Currency Interest Rate Swap \| Long
Derivative [Line Items]
Notional amount \| SFr																	SFr 291,200

INCOME TAXES (Schedule of Uncertain Tax Benefits Reconciliation) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Uncertain Tax Benefits [Roll Forward]
Balance, beginning of year	$ 676	$ 702	$ 676
Gross increases:
Current year tax positions	37	0	0
Prior years' tax positions	0	0	26
Other	0	(26)	0
Balance, end of year	$ 713	$ 676	$ 702

LEASES AND RELATED PARTY LEASES - Narrative (Details)	12 Months Ended
LEASES AND RELATED PARTY LEASES - Narrative (Details)	Dec. 31, 2022 USD ($) renewal_option	Dec. 31, 2021 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewal_option	1
Operating lease expense	$ 22,600,000	$ 20,300,000
Future minimum lease payments, finance leases	0
Affiliated Entity
Operating Leased Assets [Line Items]
Operating lease expense	$ 300,000	$ 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
Affiliated Entity \| Five Year Option Lease From November 1, 2029 Through October 31, 2034
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2029 through October 31, 2034
Affiliated Entity \| Five Year Option Lease From November 1, 2034 Through October 31, 2039
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2034 through October 31, 2039

DERIVATIVE INSTRUMENTS (Fair Value of Derivative Instruments By Balance Sheet Location) (Details) SFr in Thousands, € in Millions	Dec. 31, 2022 USD ($)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Oct. 04, 2021 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-currency swap
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount								$ 471,600,000	SFr 420,100
Cross-currency swap \| Net Investment Hedges
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount						$ 52,000,000	€ 44.9
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 76,173,000			$ 16,497,000
Total derivatives designated as hedges — Liabilities	32,874,000			64,838,000
Designated as Hedging Instrument \| Cash Flow Hedges
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount	1,475,000,000			1,775,000,000
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount	1,500,000,000			1,800,000,000
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	16,682,000			0
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	40,030,000			4,373,000
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	0			18,187,000
Designated as Hedging Instrument \| Interest rate swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	0			30,143,000
Designated as Hedging Instrument \| Cross-currency swap
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount		$ 300,000,000	SFr 288,000
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges
Derivatives, Fair Value [Line Items]
Aggregate Notional Amount					$ 50,000,000
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	4,497,000			4,900,000
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	3,528,000			8,283,000
Designated as Hedging Instrument \| Cross-currency swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	8,738,000			4,859,000
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	11,653,000			5,120,000
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	3,311,000			2,104,000
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	0			0
Designated as Hedging Instrument \| Cross-currency swap \| Net Investment Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 20,608,000			$ 3,366,000

DERIVATIVE INSTRUMENTS (Schedule of Interest Rate Swap Derivatives) (Details) - Cash Flow Hedging - Designated as Hedging Instrument - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Derivative [Line Items]
Notional Amount	$ 1,475,000,000	$ 1,775,000,000
Estimated Fair Value	56,712,000	(43,956,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Notional Amount	$ 0	300,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value	$ 0	(5,268,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 150,000,000	150,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value	$ 5,012,000	(5,520,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional Amount	$ 200,000,000	200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value	$ 8,380,000	(7,421,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.22%
Estimated Fair Value	$ 1,831,000	(5,512,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.199%
Estimated Fair Value	$ 1,905,000	(5,464,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional Amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.209%
Estimated Fair Value	$ 1,970,000	(5,494,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.885%
Estimated Fair Value	$ 4,252,000	(6,886,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.867%
Estimated Fair Value	$ 4,153,000	(6,764,000)
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 15, 2020 Tranche 1
Derivative [Line Items]
Notional Amount	$ 575,000,000	575,000,000
Fixed Interest Rate	1.415%
Estimated Fair Value	$ 23,742,000	3,552,000
1-month USD LIBOR Loan \| Interest Rate Swap Designated December 15, 2020 Tranche 2
Derivative [Line Items]
Notional Amount	$ 125,000,000	125,000,000
Fixed Interest Rate	1.404%
Estimated Fair Value	$ 5,467,000	$ 821,000

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Restructuring Reserve [Roll Forward]
Balance, beginning of the year	$ 10,226	$ 6,372
Payments and other adjustments	(12,267)	(336)
Balance, end of the year	5,107	10,226
Cost of goods sold
Restructuring Reserve [Roll Forward]
Charges:	1,494	3,436
Research and development
Restructuring Reserve [Roll Forward]
Charges:	72	288
Selling, general and administrative
Restructuring Reserve [Roll Forward]
Charges:	$ 5,582	$ 466

INCOME TAXES (Tables)

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

Schedule of Income (Loss) Before Income Taxes

Income before income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
United States operations	$	92,642	$	91,150	$	15,082
Foreign operations	121,252		123,527		78,438
Total	$	213,894	$	214,677	$	93,520

Schedule of Effective Income Tax Rate Reconciliation

A reconciliation of the U.S. Federal statutory rate to the Company’s effective tax rate is as follows:


	Years Ended December 31,
	2022		2021		2020
Federal statutory rate	21.0	%	21.0	%	21.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	0.1	%	1.9	%	1.2	%
Foreign operations	(3.9)	%	(4.0)	%	(7.9)	%
Excess tax benefits from stock compensation	(2.4)	%	(1.2)	%	(1.0)	%
Intercompany profit in inventory	0.3	%	(0.2)	%	1.2	%
Nondeductible facilitative costs	0.2	%	0.3	%	1.1	%
Contingent Consideration	(2.0)	%	(0.2)	%	0.2	%
Research and development credit	(1.4)	%	(1.2)	%	(1.6)	%
Return to provision	(0.5)	%	(0.7)	%	(2.3)	%
Global intangible low-taxed income ("GILTI")	2.8	%	0.7	%	2.5	%
Nondeductible executive compensation	1.8	%	0.9	%	2.4	%
Fair market value step up on intra-entity transfer of intellectual property	—	%	—	%	(63.3)	%
Gain from sale of business - book to tax differences	—	%	3.9	%	2.8	%
Other	(0.4)	%	—	%	0.5	%
Effective tax rate	15.6	%	21.2	%	(43.2)	%

Schedule of Provision for Income Taxes

The provision for income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Current:
Federal	$	24,201	$	31,938	$	6,184
State	3,835		11,377		5,029
Foreign	9,893		5,042		12,553
Total current	$	37,929	$	48,357	$	23,766
Deferred:
Federal	(11,591)		(12,830)		(5,079)
State	(2,316)		(3,688)		(1,760)
Foreign	9,322		13,763		(57,299)
Total deferred	$	(4,585)	$	(2,755)	$	(64,138)
Provision for income taxes	$	33,344	$	45,602	$	(40,372)

Schedule of Deferred Tax Assets and Liabilities

The income tax effects of significant temporary differences that give rise to deferred tax assets and liabilities, shown before jurisdictional netting, are presented below:


	December 31,
Dollars in thousands	2022		2021
Assets:
Doubtful accounts	$	2,261	$	2,029
Inventory related items	31,950		31,841
Tax credits	13,084		13,319
Accrued vacation	2,175		3,042
Accrued bonus	4,944		7,415
Stock compensation	10,175		13,955
Deferred revenue	2,130		1,742
Net operating loss carryforwards	30,707		26,198
Capitalization of research and development expenses	51,542		36,770
Unrealized foreign exchange gain	6,228		12,849
Charitable contributions carryforward	180		206

Leases and Other	39,788		41,371
Total deferred tax assets	195,164		190,737
Less valuation allowance	(9,651)		(9,767)
Deferred tax assets after valuation allowance	$	185,513	$	180,970
Liabilities:
Intangible and fixed assets	(166,891)		(152,150)
Unrealized foreign exchange loss	(12,991)		—
Leases and Other	(22,975)		(17,658)
Total deferred tax liabilities	$	(202,857)	$	(169,808)

Total net deferred tax assets (liabilities)	$	(17,344)	$	11,162

Schedule of Uncertain Tax Benefits Reconciliation

A reconciliation of the beginning and ending amount of uncertain tax benefits is as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
	(In thousands)
Balance, beginning of year	$	676	$	702	$	676
Gross increases:
Current year tax positions	37		—		—
Prior years' tax positions	—		—		26
Other	—		(26)		—
Balance, end of year	$	713	$	676	$	702

Summary of Valuation Allowance

The valuation allowance at December 31, 2022 and 2021 primarily remained unchanged from respective prior periods; decreasing by an immaterial amount in both periods.


	Balance at Beginning of Period	Charged to Costs and Expenses	Other	Deductions	Balance at End of Period
Description
Dollars in thousands
Year ended December 31, 2022
Deferred tax assets valuation allowance	15,258	(515)		(71)	14,672
Year ended December 31, 2021
Deferred tax assets valuation allowance	13,825	1,444	89	(100)	15,258
Year ended December 31, 2020
Deferred tax assets valuation allowance	12,069	1,617	—	139	13,825

DERIVATIVE INSTRUMENTS

12 Months Ended

Dec. 31, 2022

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 the Company's expected LIBOR-indexed floating-rate borrowings.

The Company held the following interest rate swaps as of December 31, 2022 and 2021 (dollar amounts in thousands):


	December 31, 2022		December 31, 2021							December 31, 2022		December 31, 2021
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month USD LIBOR Loan	—		300,000		December 13, 2017	January 1, 2018	December 31, 2022	2.201	%	$	—	$	(5,268)
1-month USD LIBOR Loan	150,000		150,000		December 13, 2017	July 1, 2019	June 30, 2024	2.423	%	5,012		(5,520)
1-month USD LIBOR Loan	200,000		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	8,380		(7,421)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	1,831		(5,512)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	1,905		(5,464)
1-month USD LIBOR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	1,970		(5,494)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	4,252		(6,886)
1-month USD LIBOR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	4,153		(6,764)
1-month USD LIBOR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	23,742		3,552
1-month USD LIBOR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	5,467		821
	$	1,475,000	$	1,775,000						$	56,712	$	(43,956)

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.

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. Those amounts are subsequently reclassified to earnings from AOCI as impacted by the hedged item when the hedged item affects 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, 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 Swiss Francs ("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 an acquisition. On September 26, 2022, the Company amended the CHF-denominated intercompany loan to extend the termination date to September 2023 and as a result, the Company early terminated the cross-currency swap designated as cash flow hedge of an intercompany loan with aggregate notional amount of $50.0 million. Simultaneously, the Company entered into a cross-currency swap agreement to convert a notional amount of CHF 48.5 million equivalent to $49.1 million of this

amended intercompany loan into U.S. dollars. The loss recorded by the Company upon the settlement of the swap was not material for the period. As of December 31, 2022, $49.1 million of the $300.0 million notional amount remain outstanding.

On December 21, 2020, the Company entered into cross-currency swap agreements to convert a notional amount of $471.6 million equivalent to 420.1 million of a CHF-denominated intercompany loan into U.S. dollars. The CHF-denominated intercompany loan was the result of an intra-entity transfer of certain intellectual property rights to a subsidiary in Switzerland completed during the fourth quarter of 2020. The intercompany loan requires quarterly payments of CHF 5.8 million plus accrued interest. As a result, the aggregate notional amount of the related cross-currency swaps will decrease by a corresponding amount.

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 December 31, 2022 and 2021 (dollar amounts in thousands):


					December 31, 2022	December 31, 2021	December 31, 2022		December 31, 2021
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)










Pay CHF	October 2, 2017	October 2, 2022	1.95%	CHF	—	145,598	—		(8,283)
Receive U.S.$			4.52%	$	—	150,000

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	374,137	397,137	(4,241)		41
Receive U.S.$			3.98%	$	420,001	445,821

Pay CHF	September 28, 2022	September 29, 2023	1.95%	CHF	48,532	—	(3,528)		—
Receive U.S.$			5.32%	$	49,142	—

Total							$	(7,769)	$	(8,242)

On October 3rd, 2022, in accordance with the termination date, the Company settled cross-currency swaps designated as cash flow hedges of an intercompany loan with aggregate notional amounts of $100 million. Based on the closing exchange rates, the gain upon settlement of these swaps was approximately $1.6 million which was offset by the loss on the settlement of the intercompany loan.

On October 4, 2021 in accordance with the termination date, the Company settled a cross-currency swap designated as a cash flow hedge of an intercompany loan with an aggregate notional amount of $50.0 million. The gain recorded by the Company upon the settlement of the swap was not material for the period.

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.

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 ,December 16, 2020 and May 26, 2022, 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 December 31, 2022 and 2021 (dollar amounts in thousands):


					December 31, 2022	December 31, 2021	December 31, 2022		December 31, 2021
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)


Pay EUR	October 3, 2018	September 30, 2023	—%	EUR	51,760	51,760	4,713		2,503
Receive U.S.$			2.57%	$	60,000	60,000

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	4,307		2,147
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	December 16, 2020	December 16, 2027	—%	CHF	—	222,300	—		(792)
Receive USD			1.10%	$	—	250,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	288,210	—	(14,663)		—
Receive U.S.$			1.94%	$	300,000	—

Total							$	(5,643)	$	3,858

On May 26, 2022, the Company early settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $250 million equivalent to 222.3 million CHF. The original settlement date was December 16, 2027. As a result of the settlement, the Company recorded a gain of $4.9 million in AOCI. On May 26, 2022, the Company entered into cross-currency swap agreements designated as net investment hedge to replace these swaps with a notional amount of $300 million equivalent to 288 million CHF.

On September 30, 2021, in accordance with the termination date, the Company settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $52 million equivalent to 44.9 million Euros. As a result of the settlement, the Company recorded a gain of $0.1 million in AOCI.

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.

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 term of the derivative instruments. The fair values of the interest rate swaps and cross-currency swaps were developed using a market approach based on publicly available market yield curves and the terms of the swap. The Company performs ongoing assessments of counterparty credit risk.

Effects of Derivative Instruments on Financial Position and Results of Operations

The following table summarizes the fair value for derivatives designated as hedging instruments in the consolidated balance sheets as of December 31, 2022 and 2021:


	Fair Value as of December 31,
Dollars in thousands	2022		2021
Location on Balance Sheet (1):
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Cross-currency swap	4,497		4,900
Interest rate swap(2)	16,682		—
Net Investment Hedges
Cross-currency swap	11,653		5,120
Other assets
Cash Flow Hedges
Interest rate swap(2)	40,030		4,373
Net Investment Hedges
Cross-currency swap	3,311		2,104
Total derivatives designated as hedges — Assets	$	76,173	$	16,497

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap(2)	$	—	$	18,187
Cross-currency swap	3,528		8,283
Net Investment Hedges
Cross-currency swap	—		—
Other liabilities
Cash Flow Hedges
Interest rate swap(2)	—		30,143
Cross-currency swap	8,738		4,859
Net Investment Hedges
Cross-currency swap	20,608		3,366
Total derivatives designated as hedges — Liabilities	32,874		64,838

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

(2)At December 31, 2022 and 2021, the total notional amounts related to the Company’s interest rate swaps were $1.5 billion and $1.8 billion respectively.


Dollars in thousands	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 Year		Location in Statements of Operations
Year Ended December 31, 2022
Cash Flow Hedges
Interest rate swap	$	(43,956)	$	93,308	$	(7,360)	$	56,712	Interest expense
Cross-currency swap	(9,688)		8,847		19,430		(20,271)		Other income, net
Net Investment Hedges
Cross-currency swap	(2,321)		2,196		6,789		(6,914)		Interest income
	$	(55,965)	$	104,351	$	18,859	$	29,527
Year Ended December 31, 2021
Cash Flow Hedges
Interest rate swap	$	(93,769)	$	27,402	$	(22,411)	$	(43,956)	Interest expense
Cross-currency swap	(1,073)		24,275		32,890		(9,688)		Other income, net
Net Investment Hedges
Cross-currency swap	(12,291)		16,515		6,545		(2,321)		Interest income
	$	(107,133)	$	68,192	$	17,024	$	(55,965)

For the years ended December 31, 2022 and 2021, the Company recorded a gain of $11.1 million and gain of $23.8 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation of the cross-currency swaps, designated as cash flow hedges, to offset the gains or losses recognized on the intercompany loans.

For the years ended December 31, 2022 and 2021, the Company recorded gains of $8.4 million and $9.1 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps designated as cash flow hedges.

The estimated gain that is expected to be reclassified to other income, net from AOCI as of December 31, 2022, for the cross-currency swaps designated as cash flow hedges within the next twelve months is $4.5 million. As of December 31, 2022, 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.

The estimated gain that is expected to be reclassified to interest income from AOCI as of December 31, 2022 for the cross-currency swaps designated as net investment hedges, within the next twelve months is $11.7 million.

Derivative Instruments not designated hedges:

During the fourth quarter of 2020, the Company entered into foreign currency forward contracts, with a notional amount of $4.2 million, to mitigate the foreign exchange risk related to certain intercompany loans denominated in Canadian Dollar ("CAD"). These contracts were settled in third quarter of 2022.

During the second quarter of 2021, the Company entered into a foreign currency swap, with a notional amount of $7.3 million, to mitigate the risk from fluctuations in foreign currency exchange rates associated with an intercompany loan denominated in JPY. In a foreign currency swap transaction, the Company agrees with another party to exchange, at specified intervals, the difference between one currency and another currency at a fixed exchange rate, generally set at inception, calculated by reference to an agreed upon notional amount. The notional amount of each currency is exchanged at the inception and termination of the currency swap by each party. The Company subsequently paid down a portion of this swap, bringing the notional amount down to $6.4 million.

The following table summarizes the gains (losses) of derivative instruments not designated as hedges on the condensed consolidated statements of income, which was included in other income:


Dollars in thousands	December 31,
	2022		2021
Foreign currency forward contracts	$	—	$	(174)
Foreign currency swaps	1,258		629
Total	$	1,258	$	455

DERIVATIVE INSTRUMENTS (Schedule of Net Investment Hedges Derivatives) (Details) € in Thousands, SFr in Thousands	Dec. 31, 2022 USD ($)	Dec. 31, 2022 CHF (SFr)	Dec. 31, 2022 EUR (€)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Dec. 31, 2021 CHF (SFr)	Dec. 31, 2021 EUR (€)	Sep. 30, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount											$ 471,600,000	SFr 420,100
Cross-Currency Interest Rate Swap \| Long
Derivative [Line Items]
Aggregate Notional Amount \| SFr														SFr 291,200
Cross-Currency Interest Rate Swap \| Short
Derivative [Line Items]
Aggregate Notional Amount													$ 300,000,000
Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount				$ 300,000,000	SFr 288,000
Net Investment Hedging \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount									$ 52,000,000	€ 44,900
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 4,713,000					$ 2,503,000
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 51,760					€ 51,760
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Interest Rate	2.57%	2.57%	2.57%
Aggregate Notional Amount	$ 60,000,000					60,000,000
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 4,307,000					2,147,000
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| €			€ 38,820					€ 38,820
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Interest Rate	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000,000					45,000,000
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 0					(792,000)
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Three \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr		SFr 0					SFr 222,300
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Interest Rate	1.10%	1.10%	1.10%
Aggregate Notional Amount	$ 0					250,000,000
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ (14,663,000)					0
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Four \| Long
Derivative [Line Items]
Fixed Interest Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount \| SFr		SFr 288,210					SFr 0
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Interest Rate	1.94%	1.94%	1.94%
Aggregate Notional Amount	$ 300,000,000					0
Net Investment Hedging \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ (5,643,000)					$ 3,858,000

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 17,442	$ 15,077
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 72,169	$ 12,610

Label	Element	Value
Accounting Standards Update [Extensible Enumeration]	us-gaap_AccountingStandardsUpdateExtensibleList	Accounting Standards Update 2016-13 [Member]

- Definition

Indicates amendment to accounting standards.

+ References

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+ Details

AACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Line Items]
Other income, net	$ 12,007	$ 19,307	$ 4,434
Interest income	(11,917)	$ (6,737)	$ (9,297)
Gains and Losses on Derivatives \| Reclassification out of Accumulated Other Comprehensive Income
Accumulated Other Comprehensive Income (Loss) [Line Items]
Other income, net	15,000
Interest income	$ (400)

STOCK-BASED COMPENSATION (Summary of Weighted-Average Assumptions) (Details) - $ / shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-Based Payment Arrangement [Abstract]
Dividend yield	0.00%	0.00%	0.00%
Expected volatility	30.00%	29.00%	27.00%
Risk free interest rate	2.01%	1.30%	0.89%
Expected life of option from grant date	7 years	7 years	7 years
Weighted average grant date fair value of options granted (in dollars per share)	$ 23.15	$ 22.59	$ 13.03

INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Income Tax [Line Items]
Effective tax rate		15.60%	21.20%	(43.20%)
Effective income tax reconciliation, tax benefit, excess stock-based compensation deductions		$ 5,100
Effective Income Tax rate reconciliation, prior year income taxes, amount		2,400
Excess tax benefits from stock compensation			$ 3,100
Income tax benefit, transfer intra-entity intellectual property, amount				$ 59,200
Effective worldwide tax rate				20.20%
Effective income tax rate reconciliation, foreign income tax rate differential, increase (decrease), amount		$ 400	$ 63,600
Effective foreign income tax rate		15.90%	15.20%	(57.10%)
Deferred tax asset, increase		$ 20,200
Unrecognized tax benefits that would impact effective tax rate		700
Increase in unrecognized tax benefits is reasonably possible		300
Penalties and interest expense		0	$ 0	$ 0
Penalties and interest accrued	$ 0	0	0	$ 0
Extremity Orthopedics
Income Tax [Line Items]
Tax expense related to sale of business			$ 8,500
Foreign Tax Authority
Income Tax [Line Items]
Operating loss carryforwards		75,500
Operating loss carryforwards, not subject to expiration		16,400
Operating loss carryforwards, subject to expiration		59,100
Foreign Tax Authority \| Switzerland
Income Tax [Line Items]
Deferred income tax benefit, transfer intra-entity intellectual property, amount	$ 59,200
Federal
Income Tax [Line Items]
Operating loss carryforwards		79,500
Operating loss carryforwards, not subject to expiration		18,600
State and Local Jurisdiction
Income Tax [Line Items]
Operating loss carryforwards		$ 37,900

DEBT (Tables)

12 Months Ended

Dec. 31, 2022

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios

The Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) is the following:


Fiscal Quarter						Maximum Consolidated Total Leverage Ratio


September 30, 2022 through June 30, 2023						4.50 to 1.00
September 30, 2023 and the last day of each fiscal quarter thereafter						4.00 to 1.00

Schedule of Contractual Repayments of Debt

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


Year-ended December 31, 2022	Principal Repayment
Dollars in thousands
2023	$	38,125
2024	$	67,500
2025	$	669,375
	$	775,000

- Definition

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

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+ Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Narrative) (Details)	1 Months Ended	12 Months Ended
	May 31, 2019	Dec. 31, 2022 USD ($) Segment reporting_unit Customer	Dec. 31, 2021 USD ($) Customer	Dec. 31, 2020 USD ($) Customer	Feb. 04, 2020 USD ($)
Summary Of Significant Accounting Policies [Line Items]
Provision (recoveries) for doubtful accounts		$ (200,000)	$ 1,100,000	$ (3,600,000)
Inventory, capitalized expenses		0	0
Depreciation expense		40,100,000	39,400,000	42,100,000
Interest expense capitalized into property, plant, and equipment		$ 1,400,000	1,200,000
Number of reportable segments \| Segment		2
Number of reporting units \| reporting_unit		3
Contributions to Integra Foundation		$ 0.0	1,200,000	800,000
Foreign currency transaction gain (loss)		(3,300,000)	100,000	(1,600,000)
Restructuring costs		$ 5,107,000	10,226,000	6,372,000
Defer payment and taxation, base salary, percentage (up to)	75.00%	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%	100.00%
Interest paid		$ 42,200,000	43,200,000	47,300,000
Interest paid, capitalized into construction in progress		1,400,000	1,200,000	2,300,000
Income taxes paid		35,900,000	49,500,000	29,800,000
Property and equipment purchases included in liabilities		10,500,000	4,700,000	1,600,000
Closure of Facility
Summary Of Significant Accounting Policies [Line Items]
Restructuring costs		2,000,000	10,200,000
Reorganization Projects
Summary Of Significant Accounting Policies [Line Items]
Restructuring costs		$ 3,100,000
2025 Notes
Summary Of Significant Accounting Policies [Line Items]
Convertible debt					$ 575,000,000
Convertible Debt \| 2025 Notes
Summary Of Significant Accounting Policies [Line Items]
Debt, interest rate					0.50%
Rebound
Summary Of Significant Accounting Policies [Line Items]
Asset Acquisition, Development Milestone Payment To Be Paid			$ 5,000,000	$ 20,000,000
Sales Revenue, Net \| Customer Concentration Risk
Summary Of Significant Accounting Policies [Line Items]
Concentration risk, threshold percentage		10.00%	10.00%	10.00%
Concentration risk, number of customers over benchmark \| Customer		0	0	0
Minimum
Summary Of Significant Accounting Policies [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance		1 month
Maximum
Summary Of Significant Accounting Policies [Line Items]
Manufacturing period for products shipped with no alternative use and right of payment for performance		3 months

ACQUISITIONS AND DIVESTITURES - Assets and Liabilities Divested (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - Extremity Orthopedics $ in Thousands	Dec. 31, 2020 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Prepaid expenses and other current assets	$ 713
Right of use asset-operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	162,104
Other liabilities	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$ 11,751

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Treasury Stock	Additional Paid-In Capital	Additional Paid-In Capital Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment
Balance, Beginning of Period (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	$ 1,416,736	$ (200)	$ 887	$ (119,943)	$ 1,213,620		$ (76,402)	$ 398,574	$ (200)
Balance, Beginning of Period, Treasury Stock (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	133,892							133,892
Other comprehensive loss, net of tax	2,343						2,343
Issuance of common stock through employee stock purchase plan (in shares)			13,000
Issuance of common stock through employee stock purchase plan	694				694
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)			503,000	11,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	(538)		$ 2	$ 526	(1,066)
Share-based compensation	19,401		$ 4		19,397
Share repurchase and equity component of the convertible note issuance, net	42,539				42,539
Accelerated shares repurchased (in shares)				(2,060,000)
Accelerated shares repurchased	(100,000)			$ (115,724)	15,724
Balance, End of Period (in shares) at Dec. 31, 2020			89,251,000
Balance, End of Period at Dec. 31, 2020	$ 1,514,867	$ (66,047)	$ 893	$ (235,141)	1,290,908	$ (63,274)	(74,059)	532,266	$ (2,773)
Balance, End of Period, Treasury Stock (in shares) at Dec. 31, 2020				(4,914,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	Accounting Standard Update 2020-06 [Member]
Net income	$ 169,075							169,075
Other comprehensive loss, net of tax	28,904						28,904
Issuance of common stock through employee stock purchase plan (in shares)			18,000
Issuance of common stock through employee stock purchase plan	1,127				1,127
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)			331,000	15,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	895		$ 1	$ 693	201
Share-based compensation	35,983		$ 2		35,981
Balance, End of Period (in shares) at Dec. 31, 2021			89,600,000
Balance, End of Period at Dec. 31, 2021	$ 1,684,804		$ 896	$ (234,448)	1,264,943		(45,155)	698,568
Balance, End of Period, Treasury Stock (in shares) at Dec. 31, 2021	(4,899,000)			(4,899,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 180,550							180,550
Other comprehensive loss, net of tax	55,420						55,420
Issuance of common stock through employee stock purchase plan (in shares)			17,000
Issuance of common stock through employee stock purchase plan	1,078				1,078
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)			859,000	14,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes	(20,229)		$ 7	$ 738	(20,974)
Share-based compensation	27,780		$ 2		27,778
Accelerated shares repurchased (in shares)				(1,938,000)
Accelerated shares repurchased	(125,000)			$ (129,152)	4,152
Balance, End of Period (in shares) at Dec. 31, 2022			90,476,000
Balance, End of Period at Dec. 31, 2022	$ 1,804,403		$ 905	$ (362,862)	$ 1,276,977		$ 10,265	$ 879,118
Balance, End of Period, Treasury Stock (in shares) at Dec. 31, 2022	(6,823,000)			(6,823,000)

INCOME TAXES (Schedule of Deferred Tax Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Assets:
Doubtful accounts	$ 2,261	$ 2,029
Inventory related items	31,950	31,841
Tax credits	13,084	13,319
Accrued vacation	2,175	3,042
Accrued bonus	4,944	7,415
Stock compensation	10,175	13,955
Deferred revenue	2,130	1,742
Net operating loss carryforwards	30,707	26,198
Capitalization of research and development expenses	51,542	36,770
Unrealized foreign exchange gain	6,228	12,849
Charitable contributions carryforward	180	206
Leases and Other	39,788	41,371
Total deferred tax assets	195,164	190,737
Less valuation allowance	(9,651)	(9,767)
Deferred tax assets after valuation allowance	185,513	180,970
Liabilities:
Intangible and fixed assets	(166,891)	(152,150)
Unrealized foreign exchange loss	(12,991)	0
Leases and Other	(22,975)	(17,658)
Total deferred tax liabilities	(202,857)	(169,808)
Total net deferred tax assets (liabilities)	$ 17,344
Total net deferred tax assets (liabilities)		$ 11,162

COMMITMENTS AND CONTINGENCIES (Fair Value Contingent Consideration) (Details) - Contingent Consideration Liability - Level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Arkis \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 11,408	$ 11,746
Transfers from long-term to current portion	0	(276)
Change in fair value of contingent consideration liabilities	(1,358)	(62)
Balance, End of Period	10,050	11,408
Additions	0	0
Arkis \| Accrued Expenses and Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	3,691	3,415
Transfers from long-term to current portion	0	276
Change in fair value of contingent consideration liabilities	(846)	0
Balance, End of Period	2,845	3,691
Additions	0	0
Derma Sciences \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	230
Transfers from long-term to current portion	0	0
Change in fair value of contingent consideration liabilities	0	0
Balance, End of Period	230	230
Additions	0	0
ACell \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	21,800	0
Transfers from long-term to current portion	(4,885)	0
Change in fair value of contingent consideration liabilities	(13,215)	(2,100)
Balance, End of Period	3,700	21,800
Additions	0	23,900
ACell \| Accrued Expenses and Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Transfers from long-term to current portion	4,885
Change in fair value of contingent consideration liabilities	(4,885)
Balance, End of Period	0	0
Additions
Surgical Innovation Association Inc \| Other Noncurrent Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Transfers from long-term to current portion	0
Change in fair value of contingent consideration liabilities	0
Balance, End of Period	57,607	$ 0
Additions	$ 57,607

STOCK-BASED COMPENSATION (Narrative) (Details) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	May 31, 2017	May 31, 2010	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for purchase (in shares)			3,100,000
Dividend yield			0.00%	0.00%	0.00%
Share-based compensation expense recognized			$ 27,725	$ 36,210	$ 19,591
Intrinsic value, options exercised			4,000	11,100	8,700
Cash received from option exercises and employee stock purchase plan			5,500	6,800	5,200
Tax benefit realized from stock options exercised			600	2,200	1,700
Capitalized share-based compensation cost			$ 600	$ 500	$ 400
2003 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)			14,700,000
Increase in authorized shares (in shares)	1,700,000	3,500,000
2000 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)			4,000,000
2001 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)			4,000,000
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)			3,000,000
Shares available for purchase (in shares)			2,000,000
Shares issued (in shares)			20,780	16,948	18,284
ESPP proceeds received			$ 1,100	$ 1,100	$ 1,100
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			4 years
Share-based compensation expense recognized			$ 3,500	5,000	3,200
Total unrecognized compensation costs related to unvested awards			$ 3,500
Weighted-average period for cost recognition, in years			2 years
Employee Stock Option \| Director
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			1 year
Employee Stock Option \| Employee
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			8 years
Employee Stock Option \| Directors and Certain Executive Officers \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			6 years
Employee Stock Option \| Directors and Certain Executive Officers \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period, in years			10 years
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			3 years
Restricted Stock, Performance Stock and Contract Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense recognized			$ 24,300	31,200	16,400
Total unrecognized compensation costs related to unvested awards			$ 29,700
Weighted-average period for cost recognition, in years			2 years
Fair value of shares vested			$ 65,000	$ 15,700	$ 17,300
Requisite service periods of performance stock, restricted stock and contract stock awards, in years			3 years
Performance Shares Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vested or expected to vest at end of year (in shares)			129,399

SEGMENT AND GEOGRAPHIC INFORMATION (Total Revenue by Major Geographic Area) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Segment Reporting Information [Line Items]
Total revenue, net	$ 1,557,666	$ 1,542,448	$ 1,371,868
Total long-lived assets	516,776	412,686
United States (Includes long-lived assets in Puerto Rico)
Segment Reporting Information [Line Items]
Total revenue, net	1,126,810	1,089,526	971,975
Total long-lived assets	440,223	339,535
Europe
Segment Reporting Information [Line Items]
Total revenue, net	170,903	191,327	172,689
Total long-lived assets	60,857	55,026
Asia Pacific
Segment Reporting Information [Line Items]
Total revenue, net	176,477	182,034	157,174
Total long-lived assets	12,975	11,289
Rest of the World
Segment Reporting Information [Line Items]
Total revenue, net	83,476	79,561	$ 70,030
Total long-lived assets	$ 2,721	$ 6,836

- Definition

+ References

+ Details

ACQUISITIONS AND DIVESTITURES (Tables)

12 Months Ended

Dec. 31, 2022

Business Combination and Asset Acquisition [Abstract]

Schedule of Major Classes of Assets and Liabilities Held For Sale

Assets and liabilities divested consisted of the following as of December 31, 2020 (dollar amounts in thousands):


Prepaid expenses and other current assets	$	713
Right of use asset - operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	$	162,104

Other liabilities	$	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$	11,751

Schedule of Assets Acquired and Liabilities Assumed

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


Dollars in thousands	Valuation as of December 6, 2022		Weighted Average Life
Current assets:
Cash	$	4,438
Trade accounts receivable, net	1,551
Inventories, net	2,900
Prepaid expenses and other current assets	1,654
Total current assets	$	10,543
Intangible assets	75,000		14 years
Goodwill	41,854
Total assets acquired	$	127,397

Current liabilities:
Accounts payable and accrued expenses	$	2,044
Total current liabilities	$	2,044
Deferred Tax Liability	11,799
Contingent consideration	57,607
Total liabilities assumed	71,450

Net assets acquired	$	55,947

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


Dollars in thousands	Final Valuation		Weighted Average Life
Current assets:
Cash	$	2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaid expenses and other current assets	1,498
Total current assets	$	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000		13-14 years
Goodwill	94,147
Right of use asset - operating leases	9,259
Deferred tax assets	7,465
Other assets	148
Total assets acquired	$	408,780

Current liabilities:
Accounts payable	$	718
Accrued expenses	5,966
Current portion of lease liability - operating leases	1,673
Total current liabilities	$	8,357
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	61,724
Contingent consideration	23,900
Total liabilities assumed	101,842

Net assets acquired	$	306,938

- Definition

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

+ References

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+ Details

RETIREMENT BENEFIT PLANS (Scheduled of Funded Status) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Reconciliation Of Funded Status
Fair value of plan assets	$ 38,053	$ 39,914	$ 37,825
Benefit obligations	50,364	65,184	$ 72,869
Unfunded benefit obligations	$ 12,311	$ 25,270

- Definition

Amount of asset segregated and restricted to provide benefit under defined benefit plan. Asset includes, but is not limited to, stock, bond, other investment, earning from investment, and contribution by employer and employee.

+ References + Details

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Revenues Disaggregated by Major Source) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Total revenue	$ 1,557,666	$ 1,542,448	$ 1,371,868
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total revenue	1,019,564	1,025,232	894,831
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total revenue	794,017	802,959	716,339
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total revenue	225,547	222,273	178,492
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total revenue	538,102	517,216	477,037
Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total revenue	406,689	392,463	293,038
Tissue Technologies \| Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total revenue	0	0	78,316
Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total revenue	$ 131,413	$ 124,753	$ 105,683

- Definition

+ References

+ Details

STOCK-BASED COMPENSATION (Tables)

12 Months Ended

Dec. 31, 2022

Share-Based Payment Arrangement [Abstract]

Summary Of Employee Stock-Based Compensation Expense

Stock-based compensation expense - all related to employees and members of the Board of Directors - recognized under the authoritative guidance was as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Cost of goods sold	549		470		344
Research and development	1,739		1,644		1,471
Selling, general and administrative	$	25,437	$	34,096	$	17,776
Total stock-based compensation expense	27,725		36,210		19,591
Total estimated tax benefit related to stock-based compensation expense	10,574		13,804		6,221
Net effect on net income	$	17,151	$	22,406	$	13,370

Summary Of Weighted-Average Assumptions

The following weighted-average assumptions were used in the calculation of fair value:


	Years Ended December 31,
	2022	2021	2020
Dividend yield	0%	0%	0%
Expected volatility	30%	29%	27%
Risk free interest rate	2.01%	1.30%	0.89%
Expected life of option from grant date	7 years	7 years	7 years
Weighted average grant date fair value of options granted	$23.15	$22.59	$13.03

Summary Of Stock Option Activity

The following table summarizes the Company’s stock option activity.


	Shares	Weighted Average Exercise Price		Weighted Average Contractual Term in Years	Aggregate Intrinsic Value
Stock Options	(In thousands)				(In thousands)
Outstanding at January 1, 2022	1,225	$	45.11	4.30	$26,970
Granted	146	65.11		—	—
Exercised	(155)	28.32		—	—
Forfeited or Expired	(14)	50.68		—	—
Outstanding at December 31, 2022	1,202	$	49.63	4.14	$	10,772
Exercisable at December 31, 2022	871	$	45.82	3.30	$	9,635

Summary Of Restricted Stock, Performance Stock, and Contract Stock Activity

The following table summarizes the Company’s awards of restricted stock, performance stock and contract stock for the year ended December 31, 2022.


	Restricted Stock Awards			Performance Stock and Contract Stock Awards
	Shares	Weighted Average Grant Date Fair Value Per Share		Shares	Weighted Average Grant Date Fair Value Per Share
	(In thousands)			(In thousands)
Unvested, January 1, 2022	422	$	58.78	442	60.62
Granted	334	62.88		245	62.89
Adjustments for performance achievement related to award target	—	—		(18)	60.76
Cancellations	(34)	62.29		(10)	59.88
Released	(239)	58.27		(252)	59.38
Unvested, December 31, 2022	483	$	61.63	407	62.88

GOODWILL AND OTHER INTANGIBLE ASSETS (Components of Company's Identifiable Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,697,532	$ 1,646,892
Accumulated Amortization	(570,923)	(501,319)
Net	1,126,609	1,145,573
Codman trade name
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	166,693	167,758
Net	$ 166,693	$ 167,758
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	18 years	18 years
Cost	$ 1,204,325	$ 1,132,954
Accumulated Amortization	(370,968)	(307,013)
Net	$ 833,357	$ 825,941
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 193,081	$ 211,344
Accumulated Amortization	(144,040)	(142,755)
Net	$ 49,041	$ 68,589
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 97,265	$ 98,367
Accumulated Amortization	(34,674)	(31,468)
Net	$ 62,591	$ 66,899
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	30 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(17,170)	(16,192)
Net	$ 13,041	$ 14,019
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	11 years	11 years
Cost	$ 5,957	$ 6,258
Accumulated Amortization	(4,071)	(3,891)
Net	$ 1,886	$ 2,367

LEASES AND RELATED PARTY LEASES

12 Months Ended

Dec. 31, 2022

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 December 31, 2022. 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 year ended December 31, 2022 and 2021, was $22.6 million and $20.3 million, respectively, which includes $0.3 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases at December 31, 2022 were as follows:


	December 31, 2022			December 31, 2021
	(In thousands, except lease term and discount rate)

ROU assets	$	148,284		$	84,543

Current lease liabilities	14,624			14,775
Non-current lease liabilities	157,420			90,329
Total lease liabilities	$	172,044		$	105,104

Weighted average remaining lease term (in years):

Leased facilities	16.9 years			10.4 years
Leased vehicles	2.0 years			2.1 years

Weighted average discount rate:
Leased facilities	5.4		%	5.1		%
Leased vehicles	2.7		%	2.6		%

Supplemental cash flow information related to leases was as follows:


	December 31, 2022		December 31, 2021
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	17,442	$	15,077

ROU assets obtained in exchange for lease liabilities:
Operating leases	72,169		12,610

Future minimum lease payments under operating leases at December 31, 2022 were as follows:


	Related Parties		Third Parties		Total
	(In thousands)
2023	296		20,024		20,320
2024	296		20,869		21,165
2025	296		19,198		19,494
2026	296		16,830		17,126
2027	296		15,886		16,182
Thereafter	542		164,622		165,164
Total minimum lease payments	$	2,022	$	257,429	$	259,451
Less: Imputed interest					$	87,407
Total lease liabilities					172,044
Less: Current lease liabilities					14,624
Long-term lease liabilities					157,420

There were no future minimum lease payments under finance leases at December 31, 2022.

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 stockholders 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, 2029 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, 2029 through October 31, 2034 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2034 through October 31, 2039 at the fair market rental rate of the premises.

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2022
Audit Information [Abstract]
Auditor Name	PricewaterhouseCoopers LLP
Auditor Location	Florham Park, New Jersey
Auditor Firm ID	238000

GOODWILL AND OTHER INTANGIBLE ASSETS (Narrative) (Details) $ in Millions	12 Months Ended
	Dec. 31, 2022 USD ($) reporting_unit	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Goodwill [Line Items]
Number of reporting units \| reporting_unit	3
Amortization expense	$ 78.3	$ 83.3	$ 74.5
Expected annual amortization expense, 2023	82.3
Expected annual amortization expense, 2024	81.7
Expected annual amortization expense, 2025	81.7
Expected annual amortization expense, 2026	81.5
Expected annual amortization expense, 2027	79.6
Expected annual amortization expense, thereafter	551.6
Amortization of product technology	$ 64.4	$ 66.5	$ 46.7

RETIREMENT BENEFIT PLANS (Schedule of Net Periodic Benefit Costs) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Service cost	$ 2,419	$ 2,741
Interest cost	194	100
Expected return on plan assets	(1,381)	(893)
Amortization of prior service cost (credit)	(326)	(281)
Recognized actuarial losses	9	186
Settlements	0	51
Net period benefit cost	$ 915	$ 1,904
Defined Benefit Plan, Net Periodic Benefit Cost (Credit) Excluding Service Cost, Statement of Income or Comprehensive Income Not Disclosed Flag	Net periodic benefit costs
DefinedBenefitPlanNetPeriodicBenefitCostCreditAmortizationOfPriorServiceCostCreditStatementOfIncomeOrComprehensiveIncomeExtensibleListNotDisclosedFlag	Net periodic benefit costs
DefinedBenefitPlanNetPeriodicBenefitCostCreditExpectedReturnLossStatementOfIncomeOrComprehensiveIncomeExtensibleListNotDisclosedFlag	Net periodic benefit costs
DefinedBenefitPlanNetPeriodicBenefitCostCreditInterestCostStatementOfIncomeOrComprehensiveIncomeExtensibleListNotDisclosedFlag	Net periodic benefit costs
DefinedBenefitPlanNetPeriodicBenefitCostCreditSettlementGainLossStatementOfIncomeOrComprehensiveIncomeExtensibleListNotDisclosedFlag	Net periodic benefit costs

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

12 Months Ended

Dec. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill in 2022 and 2021 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at January 1, 2021	$	671,975	$	260,392	$	932,367
ACell Acquisition	—		94,147		94,147
Foreign currency translation	(8,547)		(4,509)		(13,056)
Balance at December 31, 2021	$	663,428	$	350,030	$	1,013,458
Sale of non-core traditional wound care business	—		(5,019)		(5,019)
SIA Acquisition	—		41,855		41,855
Foreign currency translation	(7,209)		(4,204)		(11,413)
Balance at December 31, 2022	$	656,219	$	382,662	$	1,038,881

Schedule of Components of Indefinite-Lived Intangible Assets

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


	December 31, 2022
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,204,325	$	(370,968)	$	833,357
Customer relationships	12 years	193,081		(144,040)		49,041
Trademarks/brand names	28 years	97,265		(34,674)		62,591
Codman trade name	Indefinite	166,693		—		166,693
Supplier relationships	30 years	30,211		(17,170)		13,041
All other	11 years	5,957		(4,071)		1,886
		$	1,697,532	$	(570,923)	$	1,126,609


	December 31, 2021
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,132,954	$	(307,013)	$	825,941
Customer relationships	12 years	211,344		(142,755)		68,589
Trademarks/brand names	28 years	98,367		(31,468)		66,899
Codman trade name	Indefinite	167,758		—		167,758
Supplier relationships	30 years	30,211		(16,192)		14,019
All other	11 years	6,258		(3,891)		2,367
		$	1,646,892	$	(501,319)	$	1,145,573

Schedule of Components of Finite-Lived Intangible Assets

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


	December 31, 2022
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,204,325	$	(370,968)	$	833,357
Customer relationships	12 years	193,081		(144,040)		49,041
Trademarks/brand names	28 years	97,265		(34,674)		62,591
Codman trade name	Indefinite	166,693		—		166,693
Supplier relationships	30 years	30,211		(17,170)		13,041
All other	11 years	5,957		(4,071)		1,886
		$	1,697,532	$	(570,923)	$	1,126,609


	December 31, 2021
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,132,954	$	(307,013)	$	825,941
Customer relationships	12 years	211,344		(142,755)		68,589
Trademarks/brand names	28 years	98,367		(31,468)		66,899
Codman trade name	Indefinite	167,758		—		167,758
Supplier relationships	30 years	30,211		(16,192)		14,019
All other	11 years	6,258		(3,891)		2,367
		$	1,646,892	$	(501,319)	$	1,145,573

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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+ Details

DERIVATIVE INSTRUMENTS (Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations) (Details) - USD ($) $ in Thousands		12 Months Ended
	Sep. 30, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		$ 1,684,804	$ 1,514,867	$ 1,416,736
Amount of Gain (Loss) Recognized in AOCI		104,351	68,192	(96,837)
Balance, End of Period		1,804,403	1,684,804	1,514,867
Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(45,155)	(74,059)	(76,402)
Balance, End of Period		10,265	(45,155)	(74,059)
Cross-currency swap \| Net Investment Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	$ 100
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI		104,351	68,192
Amount of Gain (Loss) Reclassified from AOCI into Earnings		18,859	17,024
Designated as Hedging Instrument \| Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(55,965)	(107,133)
Balance, End of Period		29,527	(55,965)	(107,133)
Designated as Hedging Instrument \| Interest rate swap \| Interest expense \| Cash Flow Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(43,956)	(93,769)
Amount of Gain (Loss) Recognized in AOCI		93,308	27,402
Amount of Gain (Loss) Reclassified from AOCI into Earnings		(7,360)	(22,411)
Balance, End of Period		56,712	(43,956)	(93,769)
Designated as Hedging Instrument \| Cross-currency swap \| Other income, net \| Cash Flow Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(9,688)	(1,073)
Amount of Gain (Loss) Recognized in AOCI		8,847	24,275
Amount of Gain (Loss) Reclassified from AOCI into Earnings		19,430	32,890
Balance, End of Period		(20,271)	(9,688)	(1,073)
Designated as Hedging Instrument \| Cross-currency swap \| Interest income \| Net Investment Hedges
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(2,321)	(12,291)
Amount of Gain (Loss) Recognized in AOCI		2,196	16,515
Amount of Gain (Loss) Reclassified from AOCI into Earnings		6,789	6,545
Balance, End of Period		$ (6,914)	$ (2,321)	$ (12,291)

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Changes in Contract Assets and Liabilities) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 11,412
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(11,412)
Contract asset, net of transferred to trade receivables on contracts during the period	10,122
Contract asset, End of Period	10,122
Contract Liability
Contract liability, Beginning of Period	11,946
Recognition of revenue included in beginning of year contract liability	(5,349)
Contract liability, net of revenue recognized on contracts during the period	9,596
Foreign currency translation	(66)
Contract liability, End of Period	$ 16,127

INCOME TAXES

12 Months Ended

Dec. 31, 2022

Income Tax Disclosure [Abstract]

INCOME TAXES

Income before income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
United States operations	$	92,642	$	91,150	$	15,082
Foreign operations	121,252		123,527		78,438
Total	$	213,894	$	214,677	$	93,520

A reconciliation of the U.S. Federal statutory rate to the Company’s effective tax rate is as follows:


	Years Ended December 31,
	2022		2021		2020
Federal statutory rate	21.0	%	21.0	%	21.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	0.1	%	1.9	%	1.2	%
Foreign operations	(3.9)	%	(4.0)	%	(7.9)	%
Excess tax benefits from stock compensation	(2.4)	%	(1.2)	%	(1.0)	%
Intercompany profit in inventory	0.3	%	(0.2)	%	1.2	%
Nondeductible facilitative costs	0.2	%	0.3	%	1.1	%
Contingent Consideration	(2.0)	%	(0.2)	%	0.2	%
Research and development credit	(1.4)	%	(1.2)	%	(1.6)	%
Return to provision	(0.5)	%	(0.7)	%	(2.3)	%
Global intangible low-taxed income ("GILTI")	2.8	%	0.7	%	2.5	%
Nondeductible executive compensation	1.8	%	0.9	%	2.4	%
Fair market value step up on intra-entity transfer of intellectual property	—	%	—	%	(63.3)	%
Gain from sale of business - book to tax differences	—	%	3.9	%	2.8	%
Other	(0.4)	%	—	%	0.5	%
Effective tax rate	15.6	%	21.2	%	(43.2)	%

Our effective tax rate was 15.6% and 21.2% of income before income taxes for the years ended December 31, 2022 and December 31, 2021, respectively. In 2022, the Company’s lower effective tax rate was driven by a $5.1 million income tax benefit related to stock compensation and a $2.4 million income tax benefit related to the filing of amended federal and state returns for prior years. In 2021, the Company's higher effective tax rate was driven in part by an $8.5 million income tax expense for nondeductible goodwill related to the sale of the Extremity Orthopedics business, offset by a $3.1 million income tax benefit related to excess tax benefits from stock compensation. In 2020, the Company’s lower worldwide effective tax rate was primarily driven by an $59.2 million income tax benefit on an intra-entity transfer of certain intellectual property, substantially completed during the fourth quarter in 2020. Excluding this transaction, the effective worldwide tax rate for 2020 was 20.2%.

In December 2020, the Company completed an intra-entity transfer of certain intellectual property rights to one of its subsidiaries in Switzerland. While the transfer did not result in a taxable gain, the Company’s Swiss subsidiary received a step-up in tax basis based on the fair value of the transferred intellectual property rights. The Company determined the fair value using a discounted cash flow model based on expectations of revenue growth rates, royalty rates, discount rates, and useful lives of the intellectual property. The Company recorded a $59.2 million deferred tax benefit in Switzerland related to the amortizable tax basis in the transferred intellectual property.

During 2022, the Company’s foreign operations generated a $0.4 million increase in income tax expense when compared to the same period in 2021, because of geographic and business mix of taxable earnings and losses, among other factors. The 2022 foreign effective tax rate is 15.9%, compared to 15.2% in 2021. The Company’s foreign tax rate is primarily based upon statutory rates.

During 2021, the Company’s foreign operations generated a $63.6 million increase in income tax expense when compared to the same period in 2020, because of the intra-entity transfer of certain intellectual property in 2020, geographic and business mix of taxable earnings and losses, among other factors. The 2021 foreign effective tax rate is 15.2%, compared to (57.1)% in 2020. The Company’s foreign tax rate is primarily based upon statutory rates and is also impacted by the intra-entity transfer of certain intellectual property as described above for 2020.

Changes to income tax laws and regulations, in any of the tax jurisdictions in which the Company operates, could impact the effective tax rate. Various governments, both U.S. and non-U.S., are increasingly focused on tax reform and revenue-raising legislation. On August 16, 2022, the Inflation Reduction Act of 2022 (the “Act”) was signed into law, the company does not expect the law to have a material impact on the company’s effective tax rate. Further, legislation in foreign jurisdictions may be enacted, in response to the base erosion and profit-sharing (BEPS) project begun by the Organization for Economic Cooperation and Development (OECD). The OECD recently finalized major reform of the international tax system with respect to implementing a global minimum tax rate. Such changes in U.S. and Non-U.S. jurisdictions could have an adverse effect on the Company’s effective tax rate.

The provision for income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
Current:
Federal	$	24,201	$	31,938	$	6,184
State	3,835		11,377		5,029
Foreign	9,893		5,042		12,553
Total current	$	37,929	$	48,357	$	23,766
Deferred:
Federal	(11,591)		(12,830)		(5,079)
State	(2,316)		(3,688)		(1,760)
Foreign	9,322		13,763		(57,299)
Total deferred	$	(4,585)	$	(2,755)	$	(64,138)
Provision for income taxes	$	33,344	$	45,602	$	(40,372)

The income tax effects of significant temporary differences that give rise to deferred tax assets and liabilities, shown before jurisdictional netting, are presented below:


	December 31,
Dollars in thousands	2022		2021
Assets:
Doubtful accounts	$	2,261	$	2,029
Inventory related items	31,950		31,841
Tax credits	13,084		13,319
Accrued vacation	2,175		3,042
Accrued bonus	4,944		7,415
Stock compensation	10,175		13,955
Deferred revenue	2,130		1,742
Net operating loss carryforwards	30,707		26,198
Capitalization of research and development expenses	51,542		36,770
Unrealized foreign exchange gain	6,228		12,849
Charitable contributions carryforward	180		206

Leases and Other	39,788		41,371
Total deferred tax assets	195,164		190,737
Less valuation allowance	(9,651)		(9,767)
Deferred tax assets after valuation allowance	$	185,513	$	180,970
Liabilities:
Intangible and fixed assets	(166,891)		(152,150)
Unrealized foreign exchange loss	(12,991)		—
Leases and Other	(22,975)		(17,658)
Total deferred tax liabilities	$	(202,857)	$	(169,808)

Total net deferred tax assets (liabilities)	$	(17,344)	$	11,162

The 2017 U.S. Tax Cuts and Jobs Act contained a provision which requires, for tax purposes, the capitalization and amortization of research and development expenses; effective for years beginning after December 31, 2021. The Company’s deferred tax assets increased by $20.2 million within the table above, related to the 2017 Tax Act.

At December 31, 2022, the Company had net operating loss carryforwards of $79.5 million for federal income tax purposes, $75.5 million for foreign income tax purposes and $37.9 million for state income tax purposes to offset future taxable income. The majority of the federal net operating loss carryforwards expire through 2037, while $18.6 million have an indefinite carry forward period. For foreign net operating loss carryforwards, $59.1 million will expire through 2028, while the remaining $16.4 million have an indefinite carry forward period. The state net operating loss carryforwards expire through 2036.

The valuation allowance relates to deferred tax assets for certain items that will be deductible for income tax purposes under very limited circumstances and for which the Company believes it will not satisfy the more likely than not threshold for realization of the associated tax benefit. In the event that the Company determines that it would be able to realize more or less than the recorded amount of net deferred tax assets, an adjustment to the deferred tax asset valuation allowance would be recorded in the period such a determination is made.

The valuation allowance at December 31, 2022 and 2021 primarily remained unchanged from respective prior periods; decreasing by an immaterial amount in both periods.


	Balance at Beginning of Period	Charged to Costs and Expenses	Other	Deductions	Balance at End of Period
Description
Dollars in thousands
Year ended December 31, 2022
Deferred tax assets valuation allowance	15,258	(515)		(71)	14,672
Year ended December 31, 2021
Deferred tax assets valuation allowance	13,825	1,444	89	(100)	15,258
Year ended December 31, 2020
Deferred tax assets valuation allowance	12,069	1,617	—	139	13,825

As of December 31, 2022, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed to be indefinitely reinvested unless there is a manner under which to remit the earnings with no material tax cost. Material taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. The Company will repatriate foreign earnings when there is no need for reinvestment overseas and no material tax cost to bring the earnings back to the United States. Reinvestment considerations would include future acquisitions, transactions, and capital expenditure plans.

A reconciliation of the beginning and ending amount of uncertain tax benefits is as follows:


	Years Ended December 31,
Dollars in thousands	2022		2021		2020
	(In thousands)
Balance, beginning of year	$	676	$	702	$	676
Gross increases:
Current year tax positions	37		—		—
Prior years' tax positions	—		—		26
Other	—		(26)		—
Balance, end of year	$	713	$	676	$	702

Approximately $0.7 million of the balance at December 31, 2022 relates to uncertain tax positions that, if recognized, would affect the annual effective tax rate. The Company has $0.3 million of uncertain tax positions at December 31, 2022 related to tax positions for which it is reasonably possible that the amounts could be reduced during the twelve months following December 31, 2022.

The Company recognizes interest and penalties relating to uncertain tax positions in income tax expense. The Company recognized a minimal benefit for the years ended December 31, 2022, 2021 and 2020. The Company had minimal interest and penalties accrued for the years ended December 31, 2022 and 2021 and 2020.

The Company files Federal income tax returns, as well as multiple state, local and foreign jurisdiction tax returns. The Company is no longer subject to examinations of its U.S. consolidated Federal income tax returns by the IRS through fiscal year 2015. Additionally, the Company is no longer subject to examinations by the IRS for fiscal year 2017. All significant state and local matters have been concluded through fiscal year 2014. All significant foreign matters have been settled through fiscal 2015.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 2
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=6424122&loc=d3e41874-109331

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Property, Plant and Equipment Balances and Corresponding Lives) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total	$ 641,031	$ 626,577
Less: Accumulated depreciation	(329,729)	(314,874)
Property, plant and equipment, net	311,302	311,703
Land
Property, Plant and Equipment [Line Items]
Total	966	1,512
Buildings and building improvements
Property, Plant and Equipment [Line Items]
Total	$ 14,710	19,032
Buildings and building improvements \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	5 years
Buildings and building improvements \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	40 years
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total	$ 164,292	155,495
Leasehold improvements \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	1 year
Leasehold improvements \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	20 years
Machinery and production equipment
Property, Plant and Equipment [Line Items]
Total	$ 181,780	183,270
Machinery and production equipment \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	3 years
Machinery and production equipment \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	20 years
Demonstration equipment
Property, Plant and Equipment [Line Items]
Total	$ 3,792	2,791
Demonstration equipment \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	4 years
Demonstration equipment \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	5 years
Information systems and hardware
Property, Plant and Equipment [Line Items]
Total	$ 151,330	148,706
Information systems and hardware \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	1 year
Information systems and hardware \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	7 years
Furniture, fixtures, and office equipment
Property, Plant and Equipment [Line Items]
Total	$ 20,286	20,921
Furniture, fixtures, and office equipment \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	1 year
Furniture, fixtures, and office equipment \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	15 years
Construction-in-progress
Property, Plant and Equipment [Line Items]
Total	$ 103,875	$ 94,850

RETIREMENT BENEFIT PLANS (Schedule of Expected Benefit Payments and Minimum Contribution on Unfunded Plans) (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Retirement Benefits [Abstract]
2023	$ 2,211
2024	2,045
2025	2,050
2026	1,929
2027	1,868
Next five years	$ 11,068

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

12 Months Ended

Dec. 31, 2022

Revenue from Contract with Customer [Abstract]

Schedule of Changes in Contract Assets and Contract Liabilities

The following table summarized the changes in the contract asset and liability balances for the year ended December 31, 2022:


Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2022	$	11,412
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(11,412)
Contract asset, net of transferred to trade receivables on contracts during the period	10,122
Contract asset, December 31, 2022	$	10,122

Contract Liability
Contract liability, January 1, 2022	$	11,946
Recognition of revenue included in beginning of year contract liability	(5,349)
Contract liability, net of revenue recognized on contracts during the period	9,596
Foreign currency translation	(66)
Contract liability, December 31, 2022	$	16,127

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for years-ended December 31, 2022, 2021 and 2020 (dollar amounts in thousands):


	Year Ended December 31, 2022		Year Ended December 31, 2021		Year Ended December 31, 2020
Neurosurgery	$	794,017	$	802,959	$	716,339
Instruments	225,547		222,273		178,492
Total Codman Specialty Surgical	1,019,564		1,025,232		894,831

Wound Reconstruction and Care(2)(3)	406,689		392,463		293,038
Extremity Orthopedics(1)	—		—		78,316
Private Label	131,413		124,753		105,683
Total Tissue Technologies	538,102		517,216		477,037
Total revenue	$	1,557,666	$	1,542,448	$	1,371,868

(1) On January 4, 2021, the Company completed its sale of its Extremity Orthopedics business. See Note 4, Acquisitions and Divestitures, for details

(2) See Note 4. Acquisitions and Divestitures, for details around the ACell acquisition.

(3) On August 31, 2022, the Company completed the sale of its non-core traditional wound care ("TWC") business. See Note 4, Acquisitions and Divestitures

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Statement of Comprehensive Income [Abstract]
Net income	$ 180,550	$ 169,075	$ 133,892
Other comprehensive (loss) income, before tax:
Change in foreign currency translation adjustments	(17,807)	(17,362)	53,363
Unrealized gain (loss) on derivatives
Unrealized derivative gain (loss) arising during period	104,351	68,192	(96,837)
Less: Reclassification adjustments for gain (loss) included in net income	18,859	17,024	(24,442)
Unrealized gain (loss) on derivatives	85,492	51,168	(72,395)
Defined benefit pension plan - net gain (loss) arising during period	7,429	6,998	4,604
Total other comprehensive gain (loss), before tax	75,114	40,804	(14,428)
Income tax (expense) benefit related to items in other comprehensive gain (loss)	(19,694)	(11,900)	16,771
Total other comprehensive gain (loss), net of tax	55,420	28,904	2,343
Comprehensive income, net of tax	$ 235,970	$ 197,979	$ 136,235

GOODWILL AND OTHER INTANGIBLE ASSETS (Schedule of Changes in Carrying Amount of Goodwill) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Beginning of period	$ 1,013,458	$ 932,367
Sale of non-core traditional wound care business	(5,019)
Foreign currency translation	(11,413)	(13,056)
End of period	1,038,881	1,013,458
ACell, Inc.
Goodwill [Roll Forward]
Goodwill acquisition		94,147
Surgical Innovation Association Inc
Goodwill [Roll Forward]
Goodwill acquisition	41,855
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of period	663,428	671,975
Sale of non-core traditional wound care business	0
Foreign currency translation	(7,209)	(8,547)
End of period	656,219	663,428
Codman Specialty Surgical \| ACell, Inc.
Goodwill [Roll Forward]
Goodwill acquisition		0
Codman Specialty Surgical \| Surgical Innovation Association Inc
Goodwill [Roll Forward]
Goodwill acquisition	0
Tissue Technologies
Goodwill [Roll Forward]
Beginning of period	350,030	260,392
Sale of non-core traditional wound care business	(5,019)
Foreign currency translation	(4,204)	(4,509)
End of period	382,662	350,030
Tissue Technologies \| ACell, Inc.
Goodwill [Roll Forward]
Goodwill acquisition		$ 94,147
Tissue Technologies \| Surgical Innovation Association Inc
Goodwill [Roll Forward]
Goodwill acquisition	$ 41,855

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

ACQUISITIONS AND DIVESTITURES - Business Acquisition, Narrative (Details) - Surgical Innovation Association Inc $ in Thousands	Dec. 06, 2022 USD ($) contingentLiability
Business Acquisition [Line Items]
Payments to acquire business	$ 51,500
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	$ 90,000
Discount rate	18.00%
Business Acquisition, number of payments \| contingentLiability	2
Revenue Based Performance Milestones
Business Acquisition [Line Items]
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	$ 50,000
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	32,600
FDA Approval Of Premarket Approval
Business Acquisition [Line Items]
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	40,000
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)	$ 25,000

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Roll forward of Valuation for Doubtful Accounts (Details) - SEC Schedule, 12-09, Allowance, Credit Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
SEC Schedule, 12-09, Valuation and Qualifying Accounts Disclosure [Line Items]
Balance at Beginning of Period	$ 4,735	$ 6,439	$ 4,303
Charged to Costs and Expenses	238	(1,059)	3,635
Other	0	341	0
Deductions	(669)	986	(1,499)
Balance at End of Period	$ 4,304	$ 4,735	$ 6,439

ACQUISITIONS AND DIVESTITURES - Divestitures, Narrative (Details) - USD ($)				12 Months Ended
	Aug. 31, 2022	Jan. 20, 2021	Jan. 04, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Jun. 30, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of business				$ 23,960,000	$ 190,468,000	$ 0
Gain from sale of businesses				644,000	41,798,000	$ 0
ACell, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payments to acquire business		$ 306,900,000
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)		$ 100,000,000
Working capital adjustment							$ 1,300,000
Discount rate		8.50%
Contingent consideration		$ 23,900,000
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)				3,700,000	21,800,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Traditional Wound Care
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of business, disposition price	$ 28,800,000
Proceeds from sale of business	27,800,000
Sale of business, contingent consideration	$ 1,000,000
Period for revenue based performance milestone	2 years
Cash divested from deconsolidation	$ 3,500,000
Gain from sale of businesses				600,000
Discontinued operation, continuing involvement, prepaid asset	$ 11,100,000
Inventory purchase, prepaid expenses and other current assets				8,300,000
Disposal group, payable recognized				2,700,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Extremity Orthopedics
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of business, disposition price			$ 240,000,000
Gain from sale of businesses					$ 41,800,000
Transitional supply agreement, payable				$ 2,300,000
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Extremity Orthopedics \| Consortium of Focused Orthopedists, LLC
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of extremity orthopedics business, payment for terminating license agreement			$ 41,500,000