0000917520-25-000017 | 10-K | XBRL Viewer | Integra Lifesciences Holdings Corp

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DERIVATIVE INSTRUMENTS (Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	$ 1,587,884	$ 1,804,403	$ 1,684,804
Amount of Gain (Loss) Recognized in AOCI	62,638	(22,071)	104,351
Balance, end of period	1,545,280	1,587,884	1,804,403
Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(15,106)	10,265	(45,155)
Balance, end of period	(27,571)	(15,106)	10,265
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	87,127	(52,809)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	64,003	(5,577)
Designated as Hedging Instrument \| Accumulated Other Comprehensive Income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(17,705)	29,527
Balance, end of period	5,419	(17,705)	29,527
Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	43,556	56,712
Amount of Gain (Loss) Recognized in AOCI	22,692	4,899
Amount of Gain (Loss) Reclassified from AOCI into Earnings	17,454	18,055
Balance, end of period	48,794	43,556	56,712
Cross-Currency Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(15,763)	(20,271)
Amount of Gain (Loss) Recognized in AOCI	41,013	(27,406)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	36,871	(31,914)
Balance, end of period	(11,621)	(15,763)	(20,271)
Cross-Currency Interest Rate Swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	(45,498)	(6,914)
Amount of Gain (Loss) Recognized in AOCI	24,489	(30,738)
Amount of Gain (Loss) Reclassified from AOCI into Earnings	10,121	7,846
Balance, end of period	(31,130)	(45,498)	(6,914)
Forward Currency Forward Contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCI	(400)	400
Forward Currency Forward Contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Cost of goods sold
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, beginning of period	0	0
Amount of Gain (Loss) Recognized in AOCI	(1,067)	436
Amount of Gain (Loss) Reclassified from AOCI into Earnings	(443)	436
Balance, end of period	$ (624)	$ 0	$ 0

FAIR VALUE MEASUREMENTS (Tables)

12 Months Ended

Dec. 31, 2024

Fair Value Disclosures [Abstract]

Schedule of Fair Value Measurements, Recurring and Nonrecurring

Assets and liabilities measured and recorded at fair value on a recurring basis as of December 31, 2024, 2023, and 2022 consisted of the following:


		Years Ended
Dollars in thousands	Fair Value Measurement	2024		2023		2022
Assets:
Cash and cash equivalents	Level 1	$	246,375	$	276,402	$	456,661
Short-term investments	Level 1	27,192		32,694		—
Interest rate swaps	Level 2	48,795		43,556		56,712
Pension plan assets	Level 2	51,818		45,724		38,053
Foreign currency forward contracts (not designated as hedges)	Level 2	1,700		1,200		1,100
Total Assets:		$	375,880	$	399,576	$	552,526

Liabilities:
Cross currency rate swaps	Level 2	$	4,367	$	40,672	$	7,769
Net investment hedges	Level 2	31,113		49,609		5,643
Foreign currency forward contracts	Level 2	914		—		—
Contingent consideration	Level 3	69,657		87,312		74,432
Pension project benefit obligation	Level 2	67,262		65,101		50,364
Total Liabilities:		$	173,313	$	242,694	$	138,208

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, 2024 and 2023 is as follows (in thousands):


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates, Inc.			Location in Financial Statements
Balance as of January 1, 2024	$	15,755		$	2,557	$	300		$	68,700
Payments	—			—		—			(12,400)
Change in fair value of contingent consideration liabilities	(2,787)		Research and development	129		(297)			(2,300)			Selling, general and administrative
Balance as of December 31, 2024	$	12,968		$	2,686	$	3		$	54,000

Short-Term	$	8,560		$	—	$	—		$	17,900		Accrued expenses and other current liabilities
Long-Term	4,408			2,686		3			36,100			Other liabilities
Total	$	12,968		$	2,686	$	3		$	54,000


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell Inc.		Surgical Innovations Associates, Inc.		Location in Financial Statements
Balance as of January 1, 2023	$	12,895		$	230	$	3,700	$	57,607
Additions	—			—		—		—
Change in fair value of contingent consideration liabilities	2,860		Research and development	2,327		(3,400)		11,093		Selling, general and administrative
Balance as of December 31, 2023	$	15,755		$	2,557	$	300	$	68,700

Short-Term	$	7,778		$	—	$	—	$	13,400	Accrued expenses and other current liabilities
Long-Term	7,977			2,557		300		55,300		Other liabilities
Total	$	15,755		$	2,557	$	300	$	68,700

A rollforward of the fair value of the contingent consideration liabilities, as determined by Level 3 unobservable inputs, during the years ended December 31, 2024, December 31, 2023, and December 31, 2022 were as follows:


	Years Ended
Dollars in thousands	2024		2023		2022
Balance at beginning of period	$	87,312	$	74,432	$	37,129
Change in fair value	(5,255)		12,880		37,303
Payments	(12,400)		—		—
Balance at end of period	$	69,657	$	87,312	$	74,432

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)

12 Months Ended

Dec. 31, 2024

Segment Reporting [Abstract]

Schedule of Segment Reporting Information

The table below presents information about reported segments for the years ended December 31, 2024, 2023, and 2022 are as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2024 Total revenue, net	$	1,143,636	$	466,891	$	—	$	1,610,527

Cost of goods sold	384,422		162,535		181,509		728,466
Research and development	30,770		18,140		66,467		115,377
Selling, general and administrative	224,370		147,047		345,566		716,983
Intangible asset amortization	—		—		21,290		21,290
2024 Total cost and expenses	639,562		327,722		614,832		1,582,116

2024 Operating income (loss)	$	504,074	$	139,169	$	(614,832)	28,411
Interest income							20,040
Interest expense							(70,632)
Other income, net							3,944
(Loss) before income taxes							$	(18,237)

	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2023 Total revenue, net	$	1,058,993	$	482,580	$	—	$	1,541,573

Cost of goods sold	364,144		164,966		127,728		656,838
Research and development	29,984		24,202		50,006		104,192
Selling, general and administrative	214,335		159,364		282,942		656,641
Intangible asset amortization	—		—		12,376		12,376
2023 Total cost and expenses	608,463		348,532		473,052		1,430,047

2023 Operating income (loss)	$	450,530	$	134,048	$	(473,052)	111,526
Interest income							17,202
Interest expense							(51,377)
Other income, net							3,718
Income before income taxes							$	81,069

	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2022 Total revenue, net	$	1,019,564	$	538,102	$	—	$	1,557,666

Cost of goods sold	345,742		120,937		120,676		587,355
Research and development	35,902		28,936		36,355		101,193
Selling, general and administrative	220,047		154,427		241,842		616,316
Intangible asset amortization	—		—		13,882		13,882
2022 Total cost and expenses	601,691		304,300		412,755		1,318,746

2022 Operating income (loss)	$	417,873	$	233,802	$	(412,755)	238,920
Interest income							11,917
Interest expense							(49,594)
Gain on sale of business							644
Other income, net							12,007
Income before income taxes							$	213,894

Schedule of Geographic Revenue, by Area

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


Dollars in thousands	United States		Europe		Asia Pacific		Rest of the World		Consolidated
Total revenue, net:
2024	$	1,192,675	$	158,496	$	176,614	$	82,742	$	1,610,527
2023	1,100,730		165,221		193,096		82,526		1,541,573
2022	1,126,810		170,903		176,477		83,476		1,557,666
Total long-lived assets:
2024	534,336		52,385		28,264		1,295		616,280
2023	481,508		51,730		19,842		1,497		554,577
2022	440,223		60,857		12,975		2,721		516,776

ACQUISITIONS AND DIVESTITURES

12 Months Ended

Dec. 31, 2024

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

ACQUISITIONS AND DIVESTITURES

Durepair® Acquisition

On October 2, 2024, the Company completed the acquisition of the product rights for the Durepair® Regeneration Matrix (“Durepair”), a non-synthetic dura substitute for repair of the dura mater during neurosurgical procedures, from Medtronic plc for total cash consideration of $45.0 million. The Company made a cash payment of $10.0 million upon the closing of the acquisition and will make additional cash payments of $15.0 million upon the first anniversary of the acquisition and $20.0 million upon the second anniversary of the acquisition. The additional cash payments to be paid in October 2025 and October 2026 were included at their present values in accrued expenses and other current liabilities and other liabilities, respectively, as of December 31, 2024.

The acquisition of the product rights for Durepair, which consist of certain patents and trademarks, regulatory approvals, and other records, has been accounted for as an asset acquisition in accordance with ASC 805 as the acquisition does not include an assembled workforce and substantially all of the fair value of the assets acquired is concentrated in a single identifiable intangible asset.

Acclarent, Inc. Acquisition

On April 1, 2024, the Company completed the acquisition of all of the outstanding capital stock of Acclarent, Inc. (“Acclarent”), a developer and marketer of medical devices used in ENT procedures, from Ethicon, Inc., a subsidiary of Johnson & Johnson, for approximately $282.0 million in cash, subject to customary adjustments set forth in the purchase agreement related to working capital balances transferred to the Company. In September 2024, the Company finalized the working capital adjustment in the amount of $4.2 million, which resulted in a reduction to goodwill. This adjustment has been settled during the three months ending December 31, 2024. During the quarter ended December 31, 2024, the Company also recognized a measurement period adjustment to recognize deferred tax liabilities of $1.1 million with a corresponding increase to goodwill as a result of a change to the estimated deferred tax rate applied and the book-to-tax difference associated with fixed assets acquired.

The addition of Acclarent’s ENT product portfolio, including sinus balloon dilation, eustachian tube balloon dilation, and surgical navigation systems technologies, and dedicated salesforce will enhance the Company’s position in the ENT specialty device market.

Acclarent’s results of operations have been reported in the Company’s Codman Specialty Surgical reportable segment from the date of acquisition. The Company recorded revenue from Acclarent of approximately $95.0 million, in the consolidated statements of operations and comprehensive income for the year ended December 31, 2024. The net income or loss attributable to this acquisition cannot be identified on a stand-alone basis because it is in the process of being integrated into the Company’s operations.

Assets Acquired and Liabilities Assumed at Fair Value

The Acclarent acquisition has been accounted for using the acquisition method of accounting in accordance with ASC 805. 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 fair values of the assets acquired and liabilities assumed at the acquisition date:


Dollars in thousands	Estimated Fair Value		Estimated Useful Life
Current assets:
Cash	$	—
Trade accounts receivable, net of allowances of $3,885	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	$	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	989
Intangible assets, net
Completed technology	202,000		12 years
Trademarks/brand names	3,000		5 years
All other	17,000		4 years
Goodwill	62,482
Deferred tax assets	6,895
Total assets acquired	$	344,841

Current liabilities:
Accounts payable, trade	$	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	$	11,653
Lease liability - operating leases	624
Deferred tax liabilities	54,753
Total liabilities assumed	$	67,030

Net assets acquired	$	277,811

The carrying value of trade accounts receivable, prepaid expenses, other current assets, accounts payable, contract liabilities, accrued compensation, accrued expenses and other current liabilities, as well as certain other current and non-current assets and liabilities, generally represented the fair value at the date of acquisition.

Intangible Assets

The estimated fair value of the intangible assets 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 attributable to the intangible assets. The significant assumptions used in developing the valuation included the estimated annual net cash flows including application of revenue growth rates, cost of sales, the discount rate that appropriately reflects the risk inherent in each future cash flow stream, obsolescence rate, and an assessment of the asset’s life cycle, as well as other factors. The assumptions used in the financial forecasts were based on historical data, supplemented by current and anticipated growth rates, management plans, and market-comparable information. Fair value determinations require considerable judgment and are sensitive to changes in underlying assumptions and factors. The intangible assets acquired have a weighted average useful life of 11 years.

The Company used a discount rate of 12.2% 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

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 has been allocated to the Codman Specialty Surgical segment, as shown in Note 7. Goodwill and Other Intangibles. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes.

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.

Pro Forma Results (unaudited)

The Company’s unaudited pro forma revenues for the years ended December 31, 2024 and 2023, giving effect as if Acclarent had been acquired as of January 1, 2023, were $1,638.1 million and $1,658.0 million, respectively. The calculation of unaudited pro forma net income for the years ended December 31, 2024 and 2023 is not practicable because of complexities associated with its hypothetical calculation due to the allocation of certain costs to Acclarent from Johnson & Johnson. The unaudited pro forma revenue is presented for illustrative purposes only and does not indicate the actual financial results of the Company if the acquisition of Acclarent in the current year had been completed on January 1, 2023, nor is it indicative of the results of operations in future periods.

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 (the “SIA Acquisition”) plus contingent consideration of up to $90.0 million. In addition to the purchase price, the acquisition includes two separate contingent consideration 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 United States Food and Drug Administration (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 are reported within Integra’s Tissue Technologies segment.

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	Final Valuation		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, net	75,000		14 years
Goodwill	41,380
Total assets acquired	$	126,923

Current liabilities:
Accounts payable and accrued expenses	$	2,044
Total current liabilities	$	2,044
Deferred tax liabilities	11,325
Contingent consideration	57,607
Total liabilities assumed	70,976

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 18.0% 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 using the fair value hierarchy described 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 shareholders of SIA up to $90.0 million, dependent upon (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). In the second quarter of 2024, the Company paid out $12.4 million related to the 2023 performance year. 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 for the revenue-based milestone. The Company used probabilities of achieving the conditions to calculate the fair value of the contingent consideration for the PMA approval milestone. See Note 15. Commitments and Contingencies to the Notes to Consolidated Financial Statements for further details.

Deferred Tax Liabilities

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, which are pending finalization between the parties.

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.

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Statement [Abstract]
Total revenue, net	$ 1,610,527	$ 1,541,573	$ 1,557,666
Costs and expenses:
Cost of goods sold	728,466	656,838	587,355
Research and development	115,377	104,192	101,193
Selling, general and administrative	716,983	656,641	616,316
Intangible asset amortization	21,290	12,376	13,882
Total costs and expenses	1,582,116	1,430,047	1,318,746
Operating income	28,411	111,526	238,920
Interest income	20,040	17,202	11,917
Interest expense	(70,632)	(51,377)	(49,594)
Gain from sale of businesses	0	0	644
Other income, net	3,944	3,718	12,007
(Loss) income before income taxes	(18,237)	81,069	213,894
(Benefit) Provision for income taxes	(11,293)	13,328	33,344
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Net (loss) income per share
Basic (in dollars per share)	$ (0.09)	$ 0.85	$ 2.18
Diluted (in dollars per share)	$ (0.09)	$ 0.84	$ 2.16
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	77,010	80,089	82,997
Diluted (in shares)	77,010	80,337	83,516

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
OPERATING ACTIVITIES:
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	140,893	123,512	118,299
Non-cash impairment charges	12,209	0	0
Deferred income tax benefit	(20,731)	(11,885)	(4,585)
Share-based compensation	24,377	20,143	27,725
Amortization of debt issuance costs and expenses associated with debt refinancing	5,593	6,164	6,845
Non-cash lease expense	835	2,189	2,816
Lease incentive	8,452	0	0
Loss (Gain) on disposal of property and equipment and construction in-progress	1,496	777	(6,813)
Gain from the sale of businesses	0	0	(644)
Change in fair value of contingent consideration and others	(5,791)	12,888	(20,304)
Changes in assets and liabilities:
Accounts receivable	7,398	4,593	(33,905)
Inventories	(28,149)	(59,773)	(29,124)
Prepaid expenses and other current assets	(8,187)	2,652	8,612
Other non-current assets	(2,842)	(8,535)	(2,182)
Accounts payable, accrued expenses and other current liabilities	(2,674)	(20,229)	17,343
Contract liabilities	3,540	128	4,274
Other non-current liabilities	(93)	(410)	(4,438)
Net cash provided by operating activities	129,382	139,955	264,469
INVESTING ACTIVITIES:
Purchases of property and equipment	(104,418)	(66,865)	(42,343)
Purchases of intangible assets	(9,953)	0	0
Proceeds from sale of business	0	0	23,960
Acquired in-process research and development and intangibles	0	0	(4,742)
Purchases of short term investments	(48,997)	(32,694)	0
Cash paid for business acquisitions, net of cash acquired	(277,811)	0	(51,509)
Proceeds from sales of property and equipment	0	0	11,145
Proceeds from maturities of short-term investments	54,500	0	0
Net proceeds on swaps designated as net investment hedges	(4,129)	5,381	4,909
Net cash used in investing activities	(390,808)	(94,178)	(58,580)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness	486,500	165,100	40,750
Payments on debt	(187,131)	(110,600)	(148,550)
Payment of debt issuance costs	0	(7,879)	0
Purchase of treasury stock	(52,471)	(275,000)	(125,000)
Payments for contingent considerations	(11,923)	0	0
Proceeds from exercised stock options	6,398	4,317	5,465
Cash taxes paid in net equity settlement	(3,510)	(5,863)	(24,618)
Net cash provided by (used in) financing activities	237,863	(229,925)	(251,953)
Effect of exchange rate changes on cash and cash equivalents	(6,464)	3,889	(10,723)
Net decrease in cash and cash equivalents	(30,027)	(180,259)	(56,787)
Cash and cash equivalents at beginning of period	276,402	456,661	513,448
Cash and cash equivalents at end of period	$ 246,375	$ 276,402	$ 456,661

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)

12 Months Ended

Dec. 31, 2024

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; accounting for business combinations; valuation of goodwill and intangible assets including estimated projected cash flows, discount rates, and estimated useful lives used to value and test goodwill and intangible assets for impairment; income taxes and valuation allowances recorded against deferred tax assets; valuation of stock-based compensation; valuation of derivative instruments; valuation of contingent liabilities; and fair value of debt instruments. 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.

Short Term Investments

SHORT-TERM INVESTMENTS

The Company had short-term investments, which primarily consisted of time deposits with original maturities between three months and one year. The short-term investments, which are valued based on Level 1 measurements in the fair value hierarchy, totaled approximately $27.2 million at December 31, 2024 compared to $32.7 million at December 31, 2023. Interest and dividends are recorded in income when earned.

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.

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.

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	2024		2023
Finished goods	$	223,729	$	196,402
Work in process	79,423		74,035
Raw materials	125,938		119,171
Total inventories, net	$	429,090	$	389,608

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 FASB Topic 350-40, Intangibles - Goodwill and Other - Internal-Use Software (“ASC 350-40”).

Capitalized Interest

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.

Acquisitions

ACQUISITIONS

The Company accounts for the acquisition of a business in accordance with FASB Topic 805, Business Combinations (“ASC 805”). Amounts paid to acquire a business are allocated to the assets acquired and liabilities assumed based on their respective estimated fair values as of the date of acquisition in accordance with the fair value hierarchy described in FASB Topic 820, Fair Value Measurement (“ASC 820”). 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. Results of operations of acquired companies are included in the Company’s results of operations as of the respective acquisition dates.

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. 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 estimated annual net cash flows including application of forecasted revenue growth rates, cost of sales, the discount rate that appropriately reflects the risk inherent in each future cash flow stream, the obsolescence curve, and an assessment of the asset’s life cycle, as well as other factors such as the consideration of legal, technical, regulatory, economic, and competitive risks. The fair value assigned to acquired 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.

In-process research and development (“IPR&D”) acquired in connection with the acquisition of a business in accordance with ASC 805 is initially recognized at fair value and 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, research and development costs, selling and marketing costs, general and administrative 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.

Research and 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 project is subsequently abandoned, the indefinite-lived intangible asset is charged to expense.

Due to the uncertainty associated with research and development projects, there are risks that actual results will differ materially from the original cash flow projections or that the research and development project will not 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 recognized 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. In accordance with FASB Topic 350, Intangibles - Goodwill and Other (“ASC 350”), goodwill is not subject to amortization but is tested for impairment at the reporting unit level annually in the third quarter. Additionally, the Company may perform interim tests of goodwill for impairment if an event occurs or circumstances change that could potentially reduce the fair value of a reporting unit below its carrying amount. The carrying value of each reporting unit is determined by assigning the assets and liabilities, including the existing goodwill and intangible assets, to those reporting units. 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. Developed technologies and other definite-lived intangible assets are amortized over their estimated useful lives either using the straight-line method or, if reliably determinable, based on the pattern of which the economic benefit of the asset is expected to be utilized. The Company capitalizes costs incurred to renew or extend the term of recognized intangible assets, if applicable, and amortizes those costs over their expected useful lives.

In accordance with ASC 350, the Company tests its indefinite-lived intangible assets for impairment annually in the third quarter. 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 indefinite-lived intangible assets 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. The quantitative test uses an income approach to determine the fair value of the indefinite-lived intangible asset. The income approach utilizes the estimated discounted cash flows for the indefinite-lived intangible asset. Estimates and assumptions used in the income approach to calculate projected future discounted cash flows included revenue growth rates, cost of sales, terminal growth rate, and a discount rate for each indefinite-lived intangible asset. Discount rates are determined using a weighted average cost of capital 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. The assumptions used are inherently subject to uncertainty and slight changes in these assumptions could have a significant impact on the concluded value. The estimates and assumptions applied represent a Level 3 measurement in the fair value hierarchy described in ASC 820. Level 3 inputs are supported by limited or no market activity and reflect the Company’s assumptions in measuring fair value.

Developed technologies and other definite-lived intangible assets are amortized over their estimated useful lives either using the straight-line method or, if reliably determinable, based on the pattern of which the economic benefit of the asset is expected to be utilized. Definite-lived intangible assets tested periodically for impairment in accordance with FASB Topic 360, Property, Plant and Equipment (“ASC 360”) when events or changes in circumstances indicate that an asset’s carrying value may not be recoverable. The evaluation for recoverability involves comparing the carrying amount of the definite-lived intangible asset to the Company’s expectations of the future undiscounted cash flows derived from the definite-lived intangible asset. In the event the carrying value of the definite-lived intangible asset exceeds the undiscounted future cash flows expected to be derived from the definite-lived intangible asset over its remaining estimated useful life, the definite-lived intangible asset is considered not recoverable and the definite-lived intangible asset is tested for impairment. 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.

Refer to Note 7. Goodwill and Other Intangibles for more information.

Long-Lived Assets

LONG-LIVED ASSETS

Long-lived assets held and used by the Company, including property, plant and equipment, intangible assets, and lease right-of-use assets 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 their fair values as either assets or liabilities on the balance sheet. The Company determines the fair value of its derivative instruments using the fair value hierarchy described in ASC 820, 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

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, including potential repayment of the 2025 Notes, 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.

Refer to Note 12. Income Taxes for more information.

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 in accordance with FASB Topic 606, Revenue from Contracts with Customers (“ASC 606”).

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.

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.

Refer to Note 3. Revenue from Contracts with Customers for more information.

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 Estimates

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 Assets and Liabilities

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 a contract liability.

Shipping and Handling Fees

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

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, but has a history of providing benefits for employees in the case of involuntary termination. In situations outside the U.S., there are minimum statutory termination benefits requirements by country that 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 situations where the Company pays out termination benefits in excess of statutory minimum amounts based on management’s discretion, the Company records these termination costs once communication is made to the affected employees.

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 tax deficiencies from stock-based compensation are included in the provision for income taxes in the consolidated statement of operations.

Retirement Benefit Plans

RETIREMENT BENEFIT PLANS

Defined Benefit Pension Plans

The Company maintains defined benefit pension plans that cover certain employees in France, Japan, Germany, India, 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.

Refer to Note 10. Retirement Benefit Plans for more information.

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 March 2020, the Financial Accounting Standards Board (“FASB”) issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting, and, in January 2021, subsequently amended the initial guidance in 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. In December 2022, the FASB issued ASU 2022-06, Reference Rate Reform (Topic 848): Deferral of the Sunset Date of Topic 848, which delayed the effective date from December 31, 2022 to December 31, 2024. 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 the Secured Overnight Financing Rate (“SOFR”) as a more robust reference rate alternative to LIBOR. On March 24, 2023, the Company entered into the seventh amendment and restatement (the “March 2023 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. In connection with the March 2023 Amendment, the Company replaced all LIBOR-based contracts with SOFR, which is calculated based on overnight transactions under repurchase agreements backed by Treasury securities. In addition, on April 17, 2023 the Company entered into an amendment (the “April 2023 Amendment”) of the Securitization Facility (as defined below) and amended the interest rate from LIBOR to a SOFR-indexed rate. (See Note 5. Debt). In March 2023, the Company entered into a basis swap where the Company receives Term SOFR and pays daily compounded SOFR to convert the portfolio of swaps from daily compounded SOFR to term SOFR. The Company has elected to adopt the optional expedient under Topic 848, which will allow the interest rate swap hedging relationship to continue, without de-designation, due to the change in the indexed rate from LIBOR to SOFR. The adoption of this guidance did not have a material impact on the consolidated financial statements.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”) which enhances the transparency of income tax disclosures by expanding annual disclosure requirements related to the rate reconciliation and income taxes paid. The amendments are effective for fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company does not plan to early adopt and is currently evaluating ASU 2023-09 to determine its impact on the Company’s future disclosures.

In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”), which updates reportable segment disclosure requirements primarily through enhanced disclosures about significant segment expenses. The amendments are effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments should be applied retrospectively to all prior periods presented in the financial statements. The Company adopted ASU 2023-07 as of December 31, 2024 on a retrospective basis to all prior periods presented. The adoption did not have a material impact on the Company’s consolidated financial statements.

In November 2024, the FASB issued ASU 2024-03, Income Statement - Reporting Comprehensive Income - Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses, which requires additional disclosure of the nature of expenses included in the income statement. The standard requires disclosures about specific types of expenses included in the expense captions presented in the income statement. This ASU is effective for fiscal years beginning after December 15, 2026, and interim periods beginning after December 15, 2027, with early adoption permitted. The requirements should be applied on a prospective basis while retrospective application is permitted. We are currently evaluating the impact that the adoption of this guidance will have on our disclosures.

Shipping and Handling Fees and Contract Assets and Liabilities

REVENUE RECOGNITION

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

Refer to Note 3. Revenue from Contracts with Customers for more information.

Performance Obligations

Significant Estimates

Contract Assets and Liabilities

Shipping and Handling Fees

Product Warranties

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

Taxes Collected from Customers

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

STOCK-BASED COMPENSATION (Summary of Employee Stock-Based Compensation Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 24,377	$ 20,142	$ 27,725
Total estimated tax benefit related to stock-based compensation expense	4,677	5,223	10,574
Net effect on net income	19,700	14,919	17,151
Cost of goods sold
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	649	588	549
Research and development
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	2,697	2,071	1,739
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total stock-based compensation expense	$ 21,031	$ 17,483	$ 25,437

LEASES AND RELATED PARTY LEASES

12 Months Ended

Dec. 31, 2024

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 material finance leases as of December 31, 2024. 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 Right of Use (“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, 2024 and 2023, was $24.3 million and $24.0 million, respectively, which includes $0.3 million, in related party operating lease expense.

Supplemental balance sheet information related to operating leases at December 31, 2024 were as follows:


	December 31, 2024			December 31, 2023
	(In thousands, except lease term and discount rate)

ROU assets	$	144,042		$	156,184

Current lease liabilities	14,540			15,284
Non-current lease liabilities	166,930			166,849
Total lease liabilities	$	181,470		$	182,133

Weighted average remaining lease term (in years):

Leased facilities	16.1 years			16.3 years
Leased vehicles	2.3 years			1.9 years

Weighted average discount rate:
Leased facilities	5.4		%	5.9		%
Leased vehicles	2.8		%	2.7		%

Supplemental cash flow information related to leases was as follows:


	December 31, 2024		December 31, 2023
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	24,122	$	20,655

ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$	3,565	$	9,843

Future minimum lease payments under operating leases at December 31, 2024 were as follows:


	Related Parties		Third Parties		Total
	(In thousands)
2025	$	296	$	23,050	$	23,346
2026	296		19,841		20,137
2027	296		19,405		19,701
2028	296		17,649		17,945
2029	246		17,480		17,726
Thereafter	—		169,433		169,433
Total minimum lease payments	$	1,430	$	266,858	$	268,288
Less: Imputed interest					86,818
Total lease liabilities					181,470
Less: Current lease liabilities					14,540
Long-term lease liabilities					$	166,930

There were no material future minimum lease payments under finance leases at December 31, 2024.

Related Party Leases

The Company leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a principal stockholder of the Company. The term of the current lease agreement is through October 31, 2029 at an annual rate of approximately $0.3 million. 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.

Lease Impairment Charge

The Company approved a plan to transition the commercial distribution of PriMatrix® and SurgiMend® from the Boston facility to the Company’s manufacturing facility in Braintree, Massachusetts and permanently cease use of the Boston facility. As a result, in the second quarter of 2024, the Company recorded a $4.6 million impairment charge in the Tissue Technologies reportable segment, as the carrying amounts of the operating lease right-of-use asset and fixed assets related to the Boston facility exceeded their fair values based on the Company’s estimates of future discounted cash flows through the end of the lease term and the end of their remaining useful lives, respectively. The $4.6 million impairment charge was comprised of a $1.7 million impairment of an operating lease right-of-use asset and a $2.9 million write-off of fixed assets, which was recorded as a component of cost of goods sold in the consolidated statements of operations.

ACQUISITIONS AND DIVESTITURES - Narrative (Details) $ in Thousands							1 Months Ended	3 Months Ended		12 Months Ended
	Oct. 02, 2026 USD ($)	Oct. 02, 2025 USD ($)	Oct. 02, 2024 USD ($)	Apr. 01, 2024 USD ($)	Dec. 06, 2022 USD ($) payment	Aug. 31, 2022 USD ($)	Sep. 30, 2024 USD ($)	Dec. 31, 2024 USD ($)	Jun. 30, 2024 USD ($)	Dec. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Business Acquisition [Line Items]
Business combination, recognize deferred tax liabilities								$ 1,100
Payment for contingent consideration										$ 11,923	$ 0	$ 0
Proceeds from sale of business										0	0	23,960
Gain from sale of businesses										0	0	644
Disposal Group, Disposed of by Sale, Not Discontinued Operations \| Traditional Wound Care
Business Acquisition [Line Items]
Sale of business, disposition price						$ 28,800
Proceeds from sale of business						27,800
Sale of business, contingent consideration						$ 1,000
Period for revenue based performance milestone						2 years
Cash divested from deconsolidation						$ 3,500
Gain from sale of businesses												$ 600
Acclarent, Inc.
Business Acquisition [Line Items]
Purchase price of business acquisition				$ 282,000
Final working capital adjustment							$ 4,200
Revenue of acquiree since acquisition date										$ 95,000
Estimated Useful Life										11 years
Discount rate				12.20%
Surgical Innovations Associates, Inc.
Business Acquisition [Line Items]
Estimated Useful Life					14 years
Discount rate					18.00%
Payments to acquire business					$ 51,500
Business acquisition, number of payments \| payment					2
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)					$ 90,000
Surgical Innovations Associates, Inc. \| 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
Payment for contingent consideration									$ 12,400
Surgical Innovations Associates, Inc. \| 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
Acclarent
Business Acquisition [Line Items]
Pro forma revenue										$ 1,638,100	$ 1,658,000
Durepair Regeneration Matrix
Business Acquisition [Line Items]
Upfront payment			$ 45,000
Payments for asset acquisitions			$ 10,000
Durepair Regeneration Matrix \| Forecast
Business Acquisition [Line Items]
Payments for asset acquisitions	$ 20,000	$ 15,000

INCOME TAXES (Schedule of Uncertain Tax Benefits Reconciliation) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Reconciliation of Uncertain Tax Benefits [Roll Forward]
Balance, beginning of year	$ 812	$ 713	$ 676
Gross increases:
Current year tax positions	0	0	37
Prior years' tax positions	35	372	0
Lapse of statute	(21)	(273)	0
Balance, end of year	$ 826	$ 812	$ 713

LEASES AND RELATED PARTY LEASES - Narrative (Details)	3 Months Ended	12 Months Ended
LEASES AND RELATED PARTY LEASES - Narrative (Details)	Jun. 30, 2024 USD ($)	Dec. 31, 2024 USD ($) renewalOption	Dec. 31, 2023 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) \| renewalOption		1
Operating lease expense		$ 24,300,000	$ 24,000,000.0
Future minimum lease payments, finance leases		$ 0
Asset impairment charges	$ 4,600,000
Operating lease, impairment loss	1,700,000
Impairment, long-lived asset, held-for-use	$ 2,900,000
Impairment, Long-Lived Asset, Held-for-Use, Statement of Income or Comprehensive Income [Extensible Enumeration]		Cost of goods sold
Related Party
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
Related Party \| Five Year Option Lease From November 1, 2029 Through October 31, 2034
Operating Leased Assets [Line Items]
Period for extended lease		November 1, 2029 through October 31, 2034
Related Party \| 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
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

Insider Trading Policies and Procedures	12 Months Ended
Insider Trading Policies and Procedures	Dec. 31, 2024
Insider Trading Policies and Procedures [Line Items]
Insider Trading Policies and Procedures Adopted	true

RETIREMENT BENEFIT PLANS (Schedule of Assumptions Used Periodic Benefit Cost and Actuarial Present Value) (Details)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Retirement Benefits [Abstract]
Discount rate	1.14%	1.51%
Expected return on plan assets	3.65%	3.67%
Rate of compensation increase	2.12%	2.00%
Interest crediting rate for cash balance plans	1.00%	1.00%

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Schedule of Changes in Accumulated Other Comprehensive Income (Loss) by Component) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	$ 1,587,884	$ 1,804,403	$ 1,684,804
Other comprehensive gain (loss)	41,036
Less: Amounts reclassified from accumulated other comprehensive income, net	53,501
Total other comprehensive gain (loss), net of tax	(12,465)	(25,371)	55,420
Balance, end of period	1,545,280	1,587,884	1,804,403
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	(15,106)	10,265	(45,155)
Total other comprehensive gain (loss), net of tax	(12,465)	(25,371)	55,420
Balance, end of period	(27,571)	(15,106)	$ 10,265
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	21,489
Other comprehensive gain (loss)	50,119
Less: Amounts reclassified from accumulated other comprehensive income, net	44,996
Total other comprehensive gain (loss), net of tax	5,123
Balance, end of period	26,612	21,489
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	2,712
Other comprehensive gain (loss)	2,040
Less: Amounts reclassified from accumulated other comprehensive income, net	724
Total other comprehensive gain (loss), net of tax	1,316
Balance, end of period	4,028	2,712
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, beginning of period	(39,307)
Other comprehensive gain (loss)	(11,123)
Less: Amounts reclassified from accumulated other comprehensive income, net	7,781
Total other comprehensive gain (loss), net of tax	(18,904)
Balance, end of period	$ (58,211)	$ (39,307)

- Definition

Amount of equity (deficit) attributable to parent. Excludes temporary equity and equity attributable to noncontrolling interest.

+ References

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Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 5: http://www.xbrl.org/2003/role/exampleRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 210
-Name Accounting Standards Codification
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 946
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-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-09(4)(b))
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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-Name Accounting Standards Codification
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-Paragraph 3
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Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(g)(1)(ii))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 323
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481687/323-10-50-3

Reference 13: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 825
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 28
-Subparagraph (f)
-Publisher FASB
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Reference 14: http://fasb.org/us-gaap/role/ref/legacyRef
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-Publisher FASB
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+ Details

STOCK-BASED COMPENSATION (Summary of Weighted-Average Assumptions) (Details) - $ / shares	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Dividend yield	0.00%	0.00%	0.00%
Expected volatility	33.00%	30.00%	30.00%
Risk free interest rate	4.09%	3.86%	2.01%
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)	$ 15.68	$ 21.58	$ 23.15

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Narrative) (Details)	12 Months Ended
	Dec. 31, 2024 USD ($) Segment reporting_unit customer	Dec. 31, 2023 USD ($) customer	Dec. 31, 2022 USD ($) customer
Summary Of Significant Accounting Policies [Line Items]
Short-term investments	$ 27,192,000	$ 32,694,000
Provision (recoveries) for doubtful accounts	3,400,000	3,000,000	$ 200,000
Inventory, capitalized expenses	0	0
Depreciation expense	42,400,000	40,900,000	40,100,000
Interest expense capitalized into property, plant, and equipment	$ 4,500,000
Number of reportable segments \| Segment	2
Number of reporting units \| reporting_unit	3
Contributions to integra foundation	$ 300,000	0	0
Foreign currency transaction gain (loss)	$ (2,300,000)	(4,400,000)	3,300,000
Defer payment and taxation, base salary, percentage (up to)	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%
Interest paid	$ 64,400,000	44,300,000	42,200,000
Interest paid, capitalized into construction in progress	4,500,000	2,400,000	1,400,000
Income taxes paid	22,700,000	23,600,000	35,900,000
Property and equipment purchases included in liabilities	12,300,000	$ 10,000,000.0	$ 10,500,000
Definite-lived intangible assets acquired, amount included in liabilities	$ 32,700,000
Sales Revenue, Net \| Customer Concentration Risk
Summary Of Significant Accounting Policies [Line Items]
Concentration risk, number of customers over benchmark \| customer	0	0	0
Concentration risk, threshold percentage	10.00%	10.00%	10.00%
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

GOODWILL AND OTHER INTANGIBLE ASSETS (Narrative) (Details)	3 Months Ended		12 Months Ended
	Sep. 30, 2024	Mar. 31, 2024	Dec. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Goodwill [Line Items]
Non-cash impairment charges			$ 12,209,000	$ 0	$ 0
Intangible assets, net			1,207,588,000	1,067,833,000
Amortization			105,200,000	82,800,000	78,300,000
Expected annual amortization expense, 2025			106,000,000.0
Expected annual amortization expense, 2026			105,800,000
Expected annual amortization expense, 2027			104,900,000
Expected annual amortization expense, 2028			101,300,000
Expected annual amortization expense, 2029			96,000,000.0
Expected annual amortization expense, thereafter			528,200,000
Amortization of product technology			84,000,000.0	$ 70,400,000	$ 64,400,000
Customer Relationships
Goodwill [Line Items]
Non-cash impairment charges			7,100,000
Completed technology \| Completed Technology, SurgiMend
Goodwill [Line Items]
Intangible assets, net			32,800,000
Completed technology \| Completed Technology, PriMatrix
Goodwill [Line Items]
Intangible assets, net			24,400,000
Trade name
Goodwill [Line Items]
Impairment of indefinite-lived intangible assets			0
Tissue Technologies
Goodwill [Line Items]
Percentage of fair value in excess of carrying amount	21.20%	19.90%
Goodwill, impairment loss			0
Reporting unit, fair value increase (decrease), percent	(0.045)
Neurosurgery
Goodwill [Line Items]
Percentage of fair value in excess of carrying amount	11.70%
Goodwill, impairment loss			$ 0
Reporting unit, fair value increase (decrease), percent	(0.038)
Instruments
Goodwill [Line Items]
Percentage of fair value in excess of carrying amount			22.10%
Goodwill, impairment loss			$ 0
Reporting unit, fair value increase (decrease), percent	(0.035)
Measurement Input, Long-Term Revenue Growth Rate \| Valuation Technique, Discounted Cash Flow
Goodwill [Line Items]
Reporting unit, measurement input increase (decrease)	(0.50)
Measurement Input, Long-Term Revenue Growth Rate \| Valuation Technique, Discounted Cash Flow \| Tissue Technologies
Goodwill [Line Items]
Measurement input	0.025	0.020
Measurement Input, Long-Term Revenue Growth Rate \| Valuation Technique, Discounted Cash Flow \| Neurosurgery
Goodwill [Line Items]
Measurement input	0.025
Measurement Input, Long-Term Revenue Growth Rate \| Valuation Technique, Discounted Cash Flow \| Instruments
Goodwill [Line Items]
Measurement input	0.025
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow
Goodwill [Line Items]
Reporting unit, measurement input increase (decrease)	50
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow \| Trade name
Goodwill [Line Items]
Indefinite-lived intangible assets, measurement input			0.130
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow \| Tissue Technologies
Goodwill [Line Items]
Measurement input	0.125	0.145
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow \| Neurosurgery
Goodwill [Line Items]
Measurement input	0.120
Measurement Input, Discount Rate \| Valuation Technique, Discounted Cash Flow \| Instruments
Goodwill [Line Items]
Measurement input	0.115

DEBT (Schedule of Carrying Values and Estimated Fair Values of Debt Instruments) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Carrying Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	$ 1,808,569	$ 1,509,200
Debt issuance costs	(5,476)	(9,651)
Total debt	1,803,093	1,499,549
Estimated Fair Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	1,772,712	1,460,059
Total debt	1,772,712	1,460,059
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Total debt	555,600
2025 Notes \| Level 1 \| Carrying Value \| Convertible Debt
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	575,000	575,000
2025 Notes \| Level 1 \| Estimated Fair Value \| Convertible Debt
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	555,594	541,219
Securitization \| Level 2 \| Carrying Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	108,100	89,200
Securitization \| Level 2 \| Estimated Fair Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	105,831	87,069
term loan \| Term Loan Facility \| Level 2 \| Carrying Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	760,469	775,000
term loan \| Term Loan Facility \| Level 2 \| Estimated Fair Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	751,143	762,869
Revolving component
Debt Instrument [Line Items]
Debt issuance costs	(7,600)
Revolving component \| Senior Credit Facility \| Level 2 \| Carrying Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	365,000	70,000
Revolving component \| Senior Credit Facility \| Level 2 \| Estimated Fair Value
Debt Instrument [Line Items]
Debt instrument, gross, fair value disclosure	$ 360,144	$ 68,902

FAIR VALUE MEASUREMENTS - Schedule Assets and Liabilities on a Recurring Basis (Details) - Fair Value, Recurring - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Assets:
Total assets	$ 375,880	$ 399,576	$ 552,526
Liabilities:
Total liabilities	173,313	242,694	138,208
Level 1
Assets:
Cash and cash equivalents	246,375	276,402	456,661
Short-term investments	27,192	32,694	0
Level 2
Assets:
Pension plan assets	51,818	45,724	38,053
Liabilities:
Pension project benefit obligation	67,262	65,101	50,364
Level 2 \| Interest Rate Swap
Assets:
Derivative assets	48,795	43,556	56,712
Level 2 \| Forward Currency Forward Contracts
Assets:
Derivative assets	1,700	1,200	1,100
Liabilities:
Derivative liabilities	914	0	0
Level 2 \| Cross-Currency Interest Rate Swap \| Cash Flow Hedges
Liabilities:
Derivative liabilities	4,367	40,672	7,769
Level 2 \| Cross-Currency Interest Rate Swap \| Net Investment Hedges
Liabilities:
Derivative liabilities	31,113
Level 2 \| Net Investment Hedge \| Net Investment Hedges
Liabilities:
Derivative liabilities		49,609	5,643
Level 3
Liabilities:
Contingent consideration	$ 69,657	$ 87,312	$ 74,432

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Changes in Contract Assets and Liabilities) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)
Contract asset, net of transferred to trade receivables on contracts during the period	6,146
Contract asset, End of Period	6,146
Contract Liability
Contract liability, Beginning of Period	16,252
Recognition of revenue included in beginning of year contract liability	(10,307)
Contract liability, acquired with Acclarent	3,984
Contract liability, net of revenue recognized on contracts during the period	9,874
Foreign currency translation	(134)
Contract liability, End of Period	$ 19,669

DEBT (Maximum Total Leverage Ratio Table) (Details) - Senior Credit Facility	Mar. 24, 2023
March 31, 2023 through September 30, 2024
Debt Instrument [Line Items]
Debt instrument, covenant, maximum leverage ratio	4.50
December 31, 2024 through September 30, 2025
Debt Instrument [Line Items]
Debt instrument, covenant, maximum leverage ratio	5.00
December 31, 2025 through June 30, 2026
Debt Instrument [Line Items]
Debt instrument, covenant, maximum leverage ratio	4.25
September 30, 2026 and the last day of each fiscal quarter thereafter
Debt Instrument [Line Items]
Debt instrument, covenant, maximum leverage ratio	4.00

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/exampleRef
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Reference 6: http://www.xbrl.org/2003/role/exampleRef
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Reference 7: http://www.xbrl.org/2003/role/exampleRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Paragraph 1B
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Reference 15: http://www.xbrl.org/2003/role/disclosureRef
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 27: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

12 Months Ended

Dec. 31, 2024

Accounting Policies [Abstract]

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

BASIS OF PRESENTATION

PRINCIPLES OF CONSOLIDATION

USE OF ESTIMATES

CASH AND CASH EQUIVALENTS

SHORT-TERM INVESTMENTS

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, were charges of $3.4 million for the year ended December 31, 2024, $3.0 million for the year ended December 31, 2023, and $0.2 million for the year ended December 31, 2022.

The below table shows the roll forward of the allowance for doubtful accounts for the years ended December 31, 2024, 2023, and 2022:


	Balance at Beginning of Period		Charged to Costs and Expenses	Acquisition	Deductions	Balance at End of Period
Dollars in thousands
Year Ended:
December 31, 2024	$	4,879	3,416	2,162	(3,540)	$	6,917
December 31, 2023	$	4,304	2,963	—	(2,388)	$	4,879
December 31, 2022	$	4,735	238	—	(669)	$	4,304

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	2024		2023
Finished goods	$	223,729	$	196,402
Work in process	79,423		74,035
Raw materials	125,938		119,171
Total inventories, net	$	429,090	$	389,608

PROPERTY, PLANT AND EQUIPMENT

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


	December 31,
Dollars in thousands	2024		2023		Useful Lives
Land	$	952	$	978
Buildings and building improvements	19,748		14,859		5-40 years
Leasehold improvements	179,904		171,062		1-20 years
Machinery and equipment	214,786		202,023		3-20 years

Information systems and hardware	171,739		160,899		1-7 years
Furniture, fixtures, and office equipment	18,887		20,549		1-15 years
Construction-in-progress	196,630		137,276
Total	802,646		707,646
Less: Accumulated depreciation	(396,923)		(367,447)
Property, plant and equipment, net	$	405,723	$	340,199

Depreciation expense associated with property, plant and equipment was $42.4 million, $40.9 million, and $40.1 million for the years ended December 31, 2024, 2023, and 2022, respectively.

CAPITALIZED INTEREST

ACQUISITIONS

Refer to Note 4. Acquisitions and Divestitures for more information.

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.

Refer to Note 7. Goodwill and Other Intangibles for more information.

LONG-LIVED ASSETS

INTEGRA FOUNDATION

DERIVATIVES

Refer to Note 6. Derivative Instruments for more information.

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 $2.3 million, net losses of $4.4 million, and net gains of $3.3 million are reported in other income, net in the statements of operations, for the year ended December 31, 2024, 2023, and 2022, respectively.

INCOME TAXES

Refer to Note 12. Income Taxes for more information.

REVENUE RECOGNITION

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

Refer to Note 3. Revenue from Contracts with Customers for more information.

RESEARCH AND DEVELOPMENT

EMPLOYEE TERMINATION BENEFITS

The Company incurred employee termination costs on restructuring activities in the consolidated statement of operations for the years ended December 31, 2024 and 2023. The following table summarizes the restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the years ended December 31, 2024 and 2023.


	Years Ended December 31,
(Dollars in thousands)	2024		2023
Balance, beginning of the year	$	2,113	$	5,107
Charges:
Cost of Goods Sold	377		—
Research and development	602		—
Selling, general and administrative	3,968		1,048
Payments and other adjustments	(1,909)		(4,042)
Balance, end of the year	$	5,151	$	2,113

STOCK-BASED COMPENSATION

Refer to Note 9. Stock Based Compensation for more information.

RETIREMENT BENEFIT PLANS

Defined Benefit Pension Plans

Deferred Compensation Plan

Refer to Note 10. Retirement Benefit Plans for more information.

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, 2024, 2023, and 2022 .

RECENT ACCOUNTING PRONOUNCEMENTS

SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION

Cash paid for interest during the years ended December 31, 2024, 2023, and 2022 was $64.4 million (net of $4.5 million that was capitalized into construction in progress), $44.3 million (net of $2.4 million that was capitalized into construction in progress), and $42.2 million (net of $1.4 million that was capitalized into construction in progress), respectively.

Cash paid for income taxes, net of refunds, for the years ended December 31, 2024, 2023, and 2022 were $22.7 million, $23.6 million, and $35.9 million, respectively.

NON-CASH INVESTING AND FINANCING ACTIVITIES

Property and equipment purchases included in liabilities at December 31, 2024, 2023, and 2022 were $12.3 million, $10.0 million, and $10.5 million, respectively.

Definite-lived intangible asset purchases included in liabilities at December 31, 2024 were $32.7 million.

DERIVATIVE INSTRUMENTS (Schedule of Derivative Instruments) (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Derivative [Line Items]
Notional Amount	$ 1,125,000	$ 1,475,000
Estimated Fair Value	48,795	43,556
Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional Amount	$ 0	150,000
Fixed Interest Rate	2.423%
Estimated Fair Value	$ 0	2,105
Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional Amount	$ 0	200,000
Fixed Interest Rate	2.313%
Estimated Fair Value	$ 0	4,978
Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.22%
Estimated Fair Value	$ 421	1,349
Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.199%
Estimated Fair Value	$ 502	1,312
Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional Amount	$ 75,000	75,000
Fixed Interest Rate	3.209%
Estimated Fair Value	$ 403	1,346
Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional Amount	$ 100,000	100,000
Fixed Interest Rate	2.885%
Estimated Fair Value	$ 3,406	3,015
Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional Amount	$ 100,000	100,000
Fixed Interest Rate	2.867%
Estimated Fair Value	$ 3,507	3,052
Interest Rate Swap Designated December 15, 2020 Tranche 1
Derivative [Line Items]
Notional Amount	$ 575,000	575,000
Fixed Interest Rate	1.415%
Estimated Fair Value	$ 34,537	22,965
Interest Rate Swap Designated December 15, 2020 Tranche 2
Derivative [Line Items]
Notional Amount	$ 125,000	125,000
Fixed Interest Rate	1.404%
Estimated Fair Value	$ 7,848	5,263
Interest Rate Swap Designated March 31, 2023
Derivative [Line Items]
Notional Amount	0	0
Estimated Fair Value	$ (1,829)	$ (1,829)

INCOME TAXES

12 Months Ended

Dec. 31, 2024

Income Tax Disclosure [Abstract]

INCOME TAXES

Income before income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2024		2023		2022
United States operations	$	(172,273)	$	(31,649)	$	92,642
Foreign operations	154,036		112,718		121,252
Total	$	(18,237)	$	81,069	$	213,894

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


	Years Ended December 31,
	2024		2023		2022
Federal statutory rate	21.0	%	21.0	%	21.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	15.3	%	2.9	%	0.1	%
Benefit derived from foreign operations	22.4	%	(17.2)	%	(1.6)	%
Nondeductible meals and entertainment	(5.0)	%	1.1	%	0.1	%

Intercompany profit in inventory	4.2	%	3.3	%	0.3	%


Research and development credit	24.1	%	(5.7)	%	(1.4)	%


Nondeductible executive compensation & stock compensation shortfall	(19.7)	%	2.3	%	(0.6)	%
Transaction and deal related costs	(4.1)	%	3.3	%	(1.8)	%

Changes in valuation allowances	(6.0)	%	4.9	%	—	%
Return to provision	10.1	%	(0.8)	%	(0.5)	%
Other	(0.4)	%	1.3	%	—	%
Effective tax rate	61.9	%	16.4	%	15.6	%

Our effective tax rate was 61.9% and 16.4% of income before income taxes for the years ended December 31, 2024 and December 31, 2023, respectively.

In 2024, the Company’s effective tax rate was driven by federal, state, and international tax benefits generated from operating losses in certain jurisdictions, including a $4.4 million benefit from federal and state research tax credits, offset by the inclusion of Global Intangible Low-Taxed Income (“GILTI”). In 2023, the Company’s effective tax rate was primarily driven by the inclusion of GILTI, offset by a $5.8 million income tax benefit related to a four-year tax credit received by a Swiss subsidiary. The Company received an extension of the 2018 Swiss tax grant for three years, until the 2027 tax year. The net benefit of the tax credit, recorded as of December 31, 2023, was based on projections of use of the incremental tax grant. The Company’s Swiss subsidiary may offset the tax credit against cantonal and communal income and capital taxes during tax years 2024 through 2027. Any unused balance at the end of the 2027 tax period will be forfeited.

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.

During 2024, the Company’s foreign operations generated a $0.4 million increase in income tax expense when compared to the same period in 2023, because of geographic and business mix of taxable earnings and losses, among other factors. The 2024 foreign effective tax rate is 12.3% compared to 16.4% in 2023.

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 Act was signed into law, for which the Company did not experience a material impact on the Company’s effective tax rate. Further, legislation in foreign jurisdictions may be enacted, in continued response to the base erosion and profit-sharing (“BEPS”) project begun by the Organization for Economic Cooperation and Development (“OECD”).

The OECD released model rules related to a new 15% global minimum tax regime (“Pillar 2”). A number of the jurisdictions that the Company operates in have adopted some form of the model rules, which became effective beginning in 2024. The Pillar 2 rules are complex and provide for delays for implementing the tax during the early transition years, if certain conditions are met. The Company calculated an immaterial amount related to Pillar 2 tax liability for the year ending December 31, 2024, aided by certain transition safe-harbor results in Switzerland. Related 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	2024		2023		2022
Current:
Federal	$	(257)	$	10,973	$	24,201
State	1,330		2,851		3,835
Foreign	8,365		11,389		9,893
Total current	$	9,438	$	25,213	$	37,929
Deferred:
Federal	(27,148)		(19,060)		(11,591)
State	(4,093)		93		(2,316)
Foreign	10,510		7,082		9,322
Total deferred	$	(20,731)	$	(11,885)	$	(4,585)
Provision for income taxes	$	(11,293)	$	13,328	$	33,344

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	2024		2023
Assets:
Doubtful accounts	$	3,370	$	2,581
Inventory related items	34,731		41,466
Tax credits	17,922		18,859
Accrued vacation	2,447		2,184
Accrued bonus	5,279		4,259
Stock compensation	8,343		9,117
Deferred revenue	4,206		1,849
Net operating loss carryforwards	27,370		28,799
Capitalization of research and development expenses	68,311		61,138
Unrealized foreign exchange gain	8,655		13,907
Charitable contributions carryforward	212		206

Leases and Other	59,339		55,271
Total deferred tax assets	240,185		239,636
Less valuation allowance	(15,504)		(12,486)
Deferred tax assets after valuation allowance	$	224,681	$	227,150
Liabilities:
Intangible and fixed assets	(218,125)		(168,229)
Unrealized foreign exchange loss	(11,280)		(10,024)
Leases and Other	(21,186)		(38,134)
Total deferred tax liabilities	$	(250,591)	$	(216,387)

Total net deferred tax (liabilities) assets	$	(25,910)	$	10,763

The 2017 U.S. Tax Cuts and Jobs Act (the “2017 Tax 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 $10.4 million and $14.4 million at December 31, 2024 and December 31, 2023 respectively within the table above, related to the 2017 Tax Act.

At December 31, 2024, the Company had net operating loss carryforwards of $51.2 million for federal income tax purposes, $106.7 million for foreign income tax purposes and $46.5 million for state income tax purposes to offset future taxable income. For the federal net operating loss carryforwards, $51.2 million will expire through 2037. For foreign net operating loss carryforwards, $87.5 million will expire through 2028, while the remaining $19.1 million have an indefinite carry forward period. The state net operating loss carryforwards expire through 2042.

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, 2024 increased by $3.0 million, as compared to 2023, primarily driven by a $1.1 million increase related to the expiring Swiss federal tax credit. The valuation allowance for 2023 had increased by $2.8 million, as compared to 2022, primarily driven by the newly recognized Swiss tax credit.


	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, 2024
Deferred tax assets valuation allowance	17,823	5,330	(429)	(367)	22,357
Year ended December 31, 2023
Deferred tax assets valuation allowance	14,672	3,069	26	56	17,823
Year ended December 31, 2022
Deferred tax assets valuation allowance	15,258	(515)	—	(71)	14,672

As of December 31, 2024, 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. 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	2024		2023		2022
	(In thousands)
Balance, beginning of year	$	812	$	713	$	676
Gross increases:
Current year tax positions	—		—		37
Prior years' tax positions	35		372		—
Lapse of statute	(21)		(273)		—

Balance, end of year	$	826	$	812	$	713

Approximately $0.8 million of the balance at December 31, 2024 relates to uncertain tax positions that, if recognized, would affect the annual effective tax rate. The Company has no uncertain tax positions at December 31, 2024 related to tax positions for which it is reasonably possible that the amounts could be reduced during the twelve months following December 31, 2024.

The Company recognizes interest and penalties relating to uncertain tax positions in income tax expense. The Company recognized a minimal expense for the years ended December 31, 2024, 2023, and 2022. The Company had minimal interest and penalties accrued for the years ended December 31, 2024, 2023, and 2022.

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 Internal Revenue Service (“IRS”) through fiscal year 2018. All significant state and local matters have been concluded through fiscal year 2018. All significant foreign matters have been settled through fiscal 2017.

- Definition

The entire disclosure for income tax.

+ References

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+ Details

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Trade accounts receivable, allowances	$ 6,917	$ 4,879
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)	91,610,000	90,920,000
Treasury stock outstanding (in shares)	14,445,000	12,751,000

RETIREMENT BENEFIT PLANS (Schedule of Change in Benefit Obligations and Plan Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$ 65,101	$ 50,364
Interest cost	866	1,157
Service cost	3,113	2,226
Actuarial loss	4,219	8,229
Plan amendments	0	(1,772)
Plan settlements	(870)	(25)
Employee contribution	1,265	1,182
Premiums paid	(456)	(406)
Benefit payment	(1,607)	(812)
Net transfer in/(out)	584	0
Effect of foreign currency exchange rates	(4,953)	4,958
Projected benefit obligations, end of year	67,262	65,101
Change In Plan Assets
Plan assets at fair value, beginning of year	45,724	38,053
Actual return on plan assets	8,200	1,350
Employer contributions	2,874	2,700
Employee contributions	1,265	1,182
Plan settlements	(870)	0
Benefits paid	(1,581)	(812)
Premiums paid	(456)	(406)
Net transfer in/(out)	322	0
Effect of foreign currency exchange rates	(3,660)	3,657
Plan assets at fair value, end of year	$ 51,818	$ 45,724

SEGMENT AND GEOGRAPHIC INFORMATION

12 Months Ended

Dec. 31, 2024

Segment Reporting [Abstract]

SEGMENT AND GEOGRAPHIC INFORMATION

The Company is organized primarily on the basis of products and operates two global reportable segments. Resources are allocated and performance is assessed by the Company’s President and Chief Executive Officer, which the Company has determined to be the Chief Operating Decision Maker (“CODM”).

The two reportable segments and their activities are described below.

•The Codman Specialty Surgical segment operations consist of (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; and (iii) the ENT business, which includes instrumentation, balloon technologies for sinus dilation and eustachian tube dilation, as well as surgical navigation systems.

•The Tissue Technologies segment operations consist of such offerings as skin and wound repair, plastics and surgical reconstruction products, bone grafts, and nerve and tendon repair products. The Tissue Technologies segment includes the Company’s private label business.

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, which are not allocated to the reportable segments.

The accounting policies of both segments are the same as those described in Note 2. Summary of Significant Accounting Policies.

For both segments, the CODM uses segment revenue and segment operating income to assess the performance for each segment and in the annual budgeting and forecasting process. The CODM considers budget-to-actual variances on a quarterly basis for segment revenue and segment operating income when making decisions about allocating capital and personnel to the segments.

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 segments.

The table below presents information about reported segments for the years ended December 31, 2024, 2023, and 2022 are as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2024 Total revenue, net	$	1,143,636	$	466,891	$	—	$	1,610,527

Cost of goods sold	384,422		162,535		181,509		728,466
Research and development	30,770		18,140		66,467		115,377
Selling, general and administrative	224,370		147,047		345,566		716,983
Intangible asset amortization	—		—		21,290		21,290
2024 Total cost and expenses	639,562		327,722		614,832		1,582,116

2024 Operating income (loss)	$	504,074	$	139,169	$	(614,832)	28,411
Interest income							20,040
Interest expense							(70,632)
Other income, net							3,944
(Loss) before income taxes							$	(18,237)

	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2023 Total revenue, net	$	1,058,993	$	482,580	$	—	$	1,541,573

Cost of goods sold	364,144		164,966		127,728		656,838
Research and development	29,984		24,202		50,006		104,192
Selling, general and administrative	214,335		159,364		282,942		656,641
Intangible asset amortization	—		—		12,376		12,376
2023 Total cost and expenses	608,463		348,532		473,052		1,430,047

2023 Operating income (loss)	$	450,530	$	134,048	$	(473,052)	111,526
Interest income							17,202
Interest expense							(51,377)
Other income, net							3,718
Income before income taxes							$	81,069

	Codman Specialty Surgical		Tissue Technologies		Corporate and Other		Total
2022 Total revenue, net	$	1,019,564	$	538,102	$	—	$	1,557,666

Cost of goods sold	345,742		120,937		120,676		587,355
Research and development	35,902		28,936		36,355		101,193
Selling, general and administrative	220,047		154,427		241,842		616,316
Intangible asset amortization	—		—		13,882		13,882
2022 Total cost and expenses	601,691		304,300		412,755		1,318,746

2022 Operating income (loss)	$	417,873	$	233,802	$	(412,755)	238,920
Interest income							11,917
Interest expense							(49,594)
Gain on sale of business							644
Other income, net							12,007
Income before income taxes							$	213,894

The Company does not allocate any long-lived assets to the reportable segments. Asset information by segment is not reported internally or otherwise regularly reviewed by the Chief Operating Decision Maker.

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


Dollars in thousands	United States		Europe		Asia Pacific		Rest of the World		Consolidated
Total revenue, net:
2024	$	1,192,675	$	158,496	$	176,614	$	82,742	$	1,610,527
2023	1,100,730		165,221		193,096		82,526		1,541,573
2022	1,126,810		170,903		176,477		83,476		1,557,666
Total long-lived assets:
2024	534,336		52,385		28,264		1,295		616,280
2023	481,508		51,730		19,842		1,497		554,577
2022	440,223		60,857		12,975		2,721		516,776

- 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

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Current Assets:
Cash and cash equivalents	$ 246,375	$ 276,402
Short-term investments	27,192	32,694
Trade accounts receivable, net of allowances of $6,917 and $4,879	272,370	259,327
Inventories, net	429,090	389,608
Prepaid Expenses	77,001	67,362
Other Current Assets	29,653	32,643
Total current assets	1,081,681	1,058,036
Property, plant and equipment, net	405,723	340,199
Right of use asset - operating leases	144,042	156,184
Intangible assets, net	1,207,588	1,067,833
Goodwill	1,096,952	1,055,462
Deferred tax assets, net	34,923	46,080
Other assets	66,515	58,194
Total assets	4,037,424	3,781,988
Current Liabilities:
Current portion of borrowings under senior credit facility	33,906	14,531
Current portion of lease liability - operating leases	14,540	15,284
Convertible securities	573,170	0
Accounts payable, trade	82,502	92,326
Contract liabilities	10,483	8,540
Accrued compensation	85,617	75,455
Accrued expenses and other current liabilities	121,908	100,844
Total current liabilities	922,126	306,980
Long-term borrowings under senior credit facility	1,087,917	825,563
Long-term borrowings under securitization facility	108,100	89,200
Long-term convertible securities	0	570,255
Lease liability - operating leases	166,930	166,849
Deferred tax liabilities	60,833	35,317
Other liabilities	146,238	199,940
Total liabilities	2,492,144	2,194,104
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; 91,610 and 90,920 issued at December 31, 2024 and 2023, respectively	916	909
Additional paid-in capital	1,323,431	1,302,484
Treasury stock, at cost; 14,445 and 12,751 shares at December 31, 2024 and 2023, respectively	(691,411)	(647,262)
Accumulated other comprehensive (loss)	(27,571)	(15,106)
Retained earnings	939,915	946,859
Total stockholders’ equity	1,545,280	1,587,884
Total liabilities and stockholders’ equity	$ 4,037,424	$ 3,781,988

TREASURY STOCK	12 Months Ended
TREASURY STOCK	Dec. 31, 2024
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of December 31, 2024 and 2023, there were 14.4 million and 12.8 million shares of treasury stock outstanding with a cost of $691.4 million and $647.3 million, respectively, at a weighted average cost per share of $47.86 and $50.76, respectively. On May 16, 2024, the Company entered into a $50.0 million accelerated share repurchase (“May 2024 ASR”) and received 1.3 million shares of common stock at inception of the May 2024 ASR, which represented approximately 70% of the expected total shares under the May 2024 ASR. On July 31, 2024, the early exercise provision was exercised by the May 2024 ASR counterparty. The Company received an additional 0.4 million shares determined using the volume-weighted average price of the Company’s common stock during the term of the May 2024 ASR. On August 15, 2023, the Company entered into a $125.0 million accelerated share repurchase (“August 2023 ASR”) and received 2.3 million shares of the common stock at inception of the August 2023 ASR, which represented approximately 80% of the expected total shares under the August 2023 ASR. On October 18, 2023 the early exercise provision was exercised by the August 2023 ASR counterparty. The Company received an additional 0.9 million shares determined using the volume-weighted average price of the Company’s common stock during the term of the August 2023 ASR. On January 26, 2023, the Company entered into a $150.0 million accelerated share repurchase (“January 2023 ASR”) and received 2.1 million shares of common stock at inception of the January 2023 ASR, which represented approximately 80% of the expected total shares under the January 2023 ASR. The settlement of the January 2023 ASR agreement was completed in the second quarter of 2023, where the Company received 0.6 million shares, determined using the volume-weighted average price of the Company’s common stock during the term of the January 2023 ASR. On August 16, 2022, the Inflation Reduction Act of 2022 (the “Inflation Act”) was signed into law. The Inflation Act implements a new excise tax of 1.0% on the net share repurchases made by the Company effective for share repurchases performed January 1, 2023, or after. In the fourth quarter of 2024, the Company made an excise tax payment of $2.5 million related to the January 2023 ASR and the August 2023 ASR. On July 18, 2023, the Board of Directors authorized a new $225.0 million share repurchase program, replacing the existing $225.0 million program authorized in April 2022. As of December 31, 2024, $50.0 million remained authorized. The program authorized in July 2023, and which expires on December 31, 2025, allows the Company to repurchase its shares opportunistically from time to time. The Company may utilize various methods to effect any repurchases, including open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, including accelerated share repurchases, or a combination of the foregoing, some of which may be effected through Rule 10b5-1 plans. The price and timing of any future purchases under the share repurchase program will depend on factors such as levels of cash generation from operations, the volume of stock option exercises by employees, cash requirements for acquisitions, dividends, economic and market conditions and stock price, and such repurchases may be discontinued at any time.

ACQUISITIONS AND DIVESTITURES - Schedule of Fair Values of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands			12 Months Ended
	Apr. 01, 2024	Dec. 06, 2022	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Trade accounts receivable, allowances			$ 6,917	$ 4,879
Goodwill			1,096,952	$ 1,055,462	$ 1,038,881
Acclarent, Inc.
Current assets:
Cash	$ 0
Trade accounts receivable, allowances			$ 3,885
Trade accounts receivable, net of allowances of $3,885	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	989
Estimated Useful Life			11 years
Goodwill	62,482
Deferred tax assets	6,895
Total assets acquired	344,841
Current liabilities:
Accounts payable, trade	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	11,653
Lease liability - operating leases	624
Deferred tax liabilities	54,753
Total liabilities assumed	67,030
Net assets acquired	277,811
Acclarent, Inc. \| Completed technology
Current assets:
Intangible assets, net	$ 202,000
Estimated Useful Life	12 years
Acclarent, Inc. \| Trademarks and Trade Names
Current assets:
Intangible assets, net	$ 3,000
Estimated Useful Life	5 years
Acclarent, Inc. \| Other Intangible Assets
Current assets:
Intangible assets, net	$ 17,000
Estimated Useful Life	4 years
Surgical Innovations Associates, Inc.
Current assets:
Cash		$ 4,438
Trade accounts receivable, net of allowances of $3,885		1,551
Inventories, net		2,900
Prepaid expenses		1,654
Total current assets		10,543
Intangible assets, net		$ 75,000
Estimated Useful Life		14 years
Goodwill		$ 41,380
Total assets acquired		126,923
Current liabilities:
Accounts payable, trade		2,044
Total current liabilities		2,044
Lease liability - operating leases		11,325
Contingent consideration		57,607
Total liabilities assumed		70,976
Net assets acquired		$ 55,947

DERIVATIVE INSTRUMENTS (Narrative) (Details) $ in Thousands, ¥ in Millions, SFr in Millions	12 Months Ended
	Dec. 31, 2024 USD ($)	Dec. 31, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Feb. 21, 2025 USD ($)	Feb. 21, 2025 CHF (SFr)	Feb. 19, 2025 USD ($)	Feb. 19, 2025 CHF (SFr)	Dec. 31, 2024 CHF (SFr)	Dec. 31, 2024 CNY (¥)	Sep. 30, 2024 USD ($)	Sep. 30, 2024 CHF (SFr)	May 31, 2024 USD ($)	May 31, 2024 CHF (SFr)	Sep. 22, 2023 CHF (SFr)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Derivative [Line Items]
Gain (loss) estimated to be reclassified to earnings during next twelve months	$ 9,400
Unrealized derivative gain (loss) arising during period	62,638		$ (22,071)	$ 104,351
Designated as Hedging Instrument
Derivative [Line Items]
Unrealized derivative gain (loss) arising during period	87,127		(52,809)
Not Designated as Hedging Instrument
Derivative [Line Items]
Derivative assets (liabilities), at fair value, net	1,700		1,200
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	1,125,000		1,475,000
Fair Value Asset (Liability)	48,795		43,556
Interest Rate Swap
Derivative [Line Items]
Gain (loss) estimated to be reclassified to earnings during next twelve months	11,600
Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recognized in accumulated other comprehensive income	22,700		4,900
Gain (loss) recognized in other income	17,500		18,100
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Gain (loss) recognized in other income	4,700		5,500
Gain (loss) estimated to be reclassified to earnings during next twelve months	(4,400)
Aggregate Notional Amount																	$ 471,600	SFr 420.1
Intercompany loan, quarterly payment \| SFr		SFr 5.8
Cross-Currency Interest Rate Swap \| Subsequent Event
Derivative [Line Items]
Aggregate Notional Amount							$ 368,400	SFr 328.1
Cross-Currency Interest Rate Swap \| Codman
Derivative [Line Items]
Derivative, notional amount settled \| SFr															SFr 20.0
Gain (loss) on settlement of derivative											$ 2,300
Cross-Currency Interest Rate Swap \| Codman \| Short
Derivative [Line Items]
Derivative, notional amount, terminated											48,500
Aggregate Notional Amount											$ 31,500	SFr 28.5
Cross-Currency Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recognized in other income	32,200		(37,400)
Fair Value Asset (Liability)	(4,367)		(40,672)
Cross-Currency Interest Rate Swap \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other income, net
Derivative [Line Items]
Unrealized derivative gain (loss) arising during period	41,013		(27,406)
Cross-Currency Interest Rate Swap \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recognized in other income	10,100		7,800
Fair Value Asset (Liability)	(31,113)		(49,609)
Cross-Currency Interest Rate Swap \| Net Investment Hedges \| Designated as Hedging Instrument \| Interest income
Derivative [Line Items]
Unrealized derivative gain (loss) arising during period	24,489		(30,738)
Foreign currency swaps \| Not Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	4,600															$ 7,300
Foreign currency swaps \| Net Investment Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount													$ 75,000	SFr 68.5
Foreign currency swaps \| Net Investment Hedges \| Designated as Hedging Instrument \| Subsequent Event
Derivative [Line Items]
Aggregate Notional Amount					$ 75,000	SFr 67.8
Forward Currency Forward Contracts \| Not Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount \| ¥										¥ 140.0
Forward Currency Forward Contracts \| Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount \| SFr									SFr 16.9
Forward Currency Forward Contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Other income, net
Derivative [Line Items]
Unrealized derivative gain (loss) arising during period	(400)		400
Forward Currency Forward Contracts \| Cash Flow Hedges \| Designated as Hedging Instrument \| Cost of goods sold
Derivative [Line Items]
Unrealized derivative gain (loss) arising during period	$ (1,067)		$ 436

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Tables)

12 Months Ended

Dec. 31, 2024

Equity [Abstract]

Schedule of Comprehensive Income (Loss)

Comprehensive income for the years ended December 31, 2024 and 2023:


Dollars in thousands	2024		2023		2022
Net (loss) income	$	(6,944)	$	67,741	$	180,550
Foreign currency translation adjustment, net of tax	(18,904)		(12,103)		(17,807)
Change in unrealized loss/(gain) on derivatives, net of tax	5,123		(6,658)		65,798
Pension liability adjustment, net of tax	1,316		(6,610)		7,429
Comprehensive income, net	$	(19,409)	$	42,370	$	235,970

Schedule of Changes in Accumulated Other Comprehensive Loss by Component

Changes in accumulated other comprehensive loss by component between December 31, 2024 and 2023 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, 2023	$	21,489	$	2,712	$	(39,307)	$	(15,106)
Other comprehensive gain (loss)	50,119		2,040		(11,123)		41,036
Less: Amounts reclassified from accumulated other comprehensive income, net	44,996		724		7,781		53,501
Net current-period other comprehensive gain (loss)	5,123		1,316		(18,904)		(12,465)
Balance at December 31, 2024	$	26,612	$	4,028	$	(58,211)	$	(27,571)

NET INCOME PER SHARE (Narrative) (Details) - shares shares in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Earnings Per Share [Abstract]
Shares excluded from computation as their effect would be antidilutive (in shares)	1.3	0.6

INCOME TAXES (Tax Valuation Allowance) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Valuation Allowance [Line Items]
Valuation allowance, period increase (decrease)	$ 3,000	$ 2,800
SEC Schedule, 12-09, Valuation Allowance, Deferred Tax Asset
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	17,823	14,672	$ 15,258
Charged to Costs and Expenses	5,330	3,069	(515)
Other	(429)	26	0
Deductions	(367)	56	(71)
Balance at End of Period	22,357	$ 17,823	$ 14,672
Swiss Tax Credit
Valuation Allowance [Line Items]
Valuation allowance, period increase (decrease)	$ 1,100

DERIVATIVE INSTRUMENTS (Schedule of Net Investment Hedges Derivatives) (Details) € in Thousands, SFr in Thousands, $ in Thousands	Dec. 31, 2024 USD ($)	Dec. 31, 2024 CHF (SFr)	Dec. 31, 2024 EUR (€)	Dec. 31, 2023 USD ($)	Dec. 31, 2023 CHF (SFr)	Dec. 31, 2023 EUR (€)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount							$ 471,600	SFr 420,100
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 4,827			$ 2,475
Net Investment Hedges \| 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 \| €			€ 38,820			€ 38,820
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Interest Rate	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000			45,000
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ (27,951)			(48,047)
Net Investment Hedges \| 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 \| SFr		SFr 240,175			SFr 288,210
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Interest Rate	1.94%	1.94%	1.94%
Aggregate Notional Amount	$ 250,000			300,000
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ (3,248)			(4,037)
Net Investment Hedges \| 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 66,525			66,525
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Three \| Short
Derivative [Line Items]
Fixed Interest Rate	2.54%	2.54%	2.54%
Aggregate Notional Amount	$ 75,000			75,000
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ (4,741)			0
Net Investment Hedges \| 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 68,483			SFr 0
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Four \| Short
Derivative [Line Items]
Fixed Interest Rate	2.74%	2.74%	2.74%
Aggregate Notional Amount	$ 75,000			0
Net Investment Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ (31,113)			$ (49,609)

COMMITMENTS AND CONTINGENCIES (Tables)

12 Months Ended

Dec. 31, 2024

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, 2024 and 2023 is as follows (in thousands):


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates, Inc.			Location in Financial Statements
Balance as of January 1, 2024	$	15,755		$	2,557	$	300		$	68,700
Payments	—			—		—			(12,400)
Change in fair value of contingent consideration liabilities	(2,787)		Research and development	129		(297)			(2,300)			Selling, general and administrative
Balance as of December 31, 2024	$	12,968		$	2,686	$	3		$	54,000

Short-Term	$	8,560		$	—	$	—		$	17,900		Accrued expenses and other current liabilities
Long-Term	4,408			2,686		3			36,100			Other liabilities
Total	$	12,968		$	2,686	$	3		$	54,000


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell Inc.		Surgical Innovations Associates, Inc.		Location in Financial Statements
Balance as of January 1, 2023	$	12,895		$	230	$	3,700	$	57,607
Additions	—			—		—		—
Change in fair value of contingent consideration liabilities	2,860		Research and development	2,327		(3,400)		11,093		Selling, general and administrative
Balance as of December 31, 2023	$	15,755		$	2,557	$	300	$	68,700

Short-Term	$	7,778		$	—	$	—	$	13,400	Accrued expenses and other current liabilities
Long-Term	7,977			2,557		300		55,300		Other liabilities
Total	$	15,755		$	2,557	$	300	$	68,700


	Years Ended
Dollars in thousands	2024		2023		2022
Balance at beginning of period	$	87,312	$	74,432	$	37,129
Change in fair value	(5,255)		12,880		37,303
Payments	(12,400)		—		—
Balance at end of period	$	69,657	$	87,312	$	74,432

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2024	Feb. 24, 2025	Jun. 28, 2024
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2024
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
Document Financial Statement Error Correction	false
Shell Company	false
Entity Public Float			$ 2,189.1
Entity Common Stock, Shares Outstanding (in shares)		77,218,920
Documents Incorporated by Reference	Certain portions of the registrant’s definitive proxy statement relating to its scheduled May 9, 2025 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	2024
Document Fiscal Period Focus	FY
Entity Central Index Key	0000917520

COMMITMENTS AND CONTINGENCIES

12 Months Ended

Dec. 31, 2024

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.

In the ordinary course of its business, the Company is involved in, from time to time, various legal actions, including any matters described below, involving product liability, employment, intellectual property and commercial disputes, shareholder related matters, environmental proceedings, tax disputes, and governmental proceedings and investigations, some of which have been settled by the Company. In the opinion of management, such matters 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. If the reasonable estimate of a probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is recorded. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded and actual results may differ from these estimates. 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.

On December 21, 2023, Fortis Advisors, LLC (representative of the security holders of ACell, Inc. (“ACell”)) filed for arbitration against Integra Life Sciences claiming breach of contract related to the earnout consideration from the 2021 acquisition of ACell. Refer to the contingent consideration section of this footnote for additional information on the ACell contingent considerations. The Company believes that it has strong defenses to the allegations in the arbitration and intends to defend the matter vigorously.

On September 12, 2023, a securities class action complaint, captioned Pembroke Pines Firefighters & Police Officers Pension Fund v. Integra LifeSciences Holdings Corporation, No. 23-cv-20321 (D.N.J.), was filed by a purported stockholder of the Company in the United States District Court for the District of New Jersey (the “Pembroke Litigation”) against the Company and certain of the Company’s current and former executive officers. The Pembroke Litigation, filed on behalf of a putative class of stockholders who purchased or acquired the Company’s common stock between March 11, 2019 and May 22, 2023, inclusive, alleges violations of Sections 10(b) and 20(a) of the Securities Exchange Act of 1934, as amended, and Rule 10b-5 promulgated thereunder, on the basis of purportedly materially false and misleading statements and omissions relating to certain quality systems issues identified by the FDA at the Company’s Boston, Massachusetts manufacturing facility, the Company’s efforts to remediate those issues, and the Company’s forecasts for certain products in its Tissue Technologies segment. The complaint seeks, among other things, compensatory damages, attorneys’ fees, expert fees, and other costs. The Company believes that it has strong defenses to the allegations in the Pembroke Litigation, and intends to defend the matter vigorously.

On February 21, 2025, a derivative lawsuit captioned Grabowsky v. Integra LifeSciences Holding Corp. et al, No. 3:25-cv-01399 (D.N.J.) was filed in the United States District Court for the District of New Jersey. The action purports to assert derivative claims on behalf of the Company against its current Board of Directors and certain of its current or former officers and directors. The action asserts claims that the individual defendants breached their fiduciary duties and harmed the Company by making false and misleading statements and omissions relating to certain quality systems issues identified by the FDA at the Company’s Boston, Massachusetts manufacturing facility, the Company’s efforts to remediate those issues, and the Company’s forecasts for certain products in its Tissue Technologies segment.

On March 17, 2021, a complaint was filed against the Company in the Court of Common Pleas of Philadelphia County in Pennsylvania asserting product liability claims relating to a surgical procedure in which the Company’s CUSA® Clarity allegedly was used. The plaintiff seeks damages against the Company based upon plaintiff’s claim that the CUSA® Clarity did not function as intended. The plaintiff also asserts separate claims against the surgeon and the hospital. In the second half of 2024, a settlement was reached, which has since been paid by the Company’s insurance carriers.

Contingent Consideration

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 that are classified within Level 3 of the fair value hierarchy because they are measured at fair value using significant unobservable inputs, including management’s forecast of future revenues for the acquired businesses as well as management’s estimates of the likelihood of achieving the other specified criteria. 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 determined the fair value of contingent consideration during the twelve-month period ended December 31, 2024 and 2023 to reflect the change in fair value during the period.

A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the years ended December 31, 2024 and 2023 is as follows (in thousands):


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell		Surgical Innovations Associates, Inc.			Location in Financial Statements
Balance as of January 1, 2024	$	15,755		$	2,557	$	300		$	68,700
Payments	—			—		—			(12,400)
Change in fair value of contingent consideration liabilities	(2,787)		Research and development	129		(297)			(2,300)			Selling, general and administrative
Balance as of December 31, 2024	$	12,968		$	2,686	$	3		$	54,000

Short-Term	$	8,560		$	—	$	—		$	17,900		Accrued expenses and other current liabilities
Long-Term	4,408			2,686		3			36,100			Other liabilities
Total	$	12,968		$	2,686	$	3		$	54,000


	Contingent Consideration Liability Related to Acquisition of:
	Arkis		Location in Financial Statements	Derma Sciences		ACell Inc.		Surgical Innovations Associates, Inc.		Location in Financial Statements
Balance as of January 1, 2023	$	12,895		$	230	$	3,700	$	57,607
Additions	—			—		—		—
Change in fair value of contingent consideration liabilities	2,860		Research and development	2,327		(3,400)		11,093		Selling, general and administrative
Balance as of December 31, 2023	$	15,755		$	2,557	$	300	$	68,700

Short-Term	$	7,778		$	—	$	—	$	13,400	Accrued expenses and other current liabilities
Long-Term	7,977			2,557		300		55,300		Other liabilities
Total	$	15,755		$	2,557	$	300	$	68,700

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 $10.0 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.

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.

ACell, Inc.

As part of the acquisition of ACell, the Company is required to make payments to the former shareholders of ACell up to $100 million in total for years 2022, 2023, and 2025 based on the achievement by the Company of certain revenue-based performance milestones. The 2022 and 2023 milestones were not achieved, leaving only one contingent milestone remaining. 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.

Surgical Innovations Associates, Inc.

As part of the acquisition of SIA, the Company is required to pay to the former shareholders 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 application for DuraSorb for certain uses by certain timing targets (up to $40.0 million in additional payments). In the second quarter of 2024, the Company paid out $12.4 million related to the 2023 performance year. 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 at the acquisition date.

Other Commitments

In October 2024, the Company entered into a definitive agreement to acquire its manufacturing facility located in Plainsboro, New Jersey currently leased by the Company for $10.4 million in cash at closing. The transaction closed in the first quarter of 2025. See Note 18. Subsequent Events.

RETIREMENT BENEFIT PLANS (Tables)

12 Months Ended

Dec. 31, 2024

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, 2024 and 2023 included the following (amounts in thousands):


	Year ended December 31,
	2024		2023
Service cost	$	3,113	$	2,226
Interest cost	866		1,157
Expected return on plan assets	(1,639)		(1,450)
Amortization of prior service cost (credit)	(585)		(389)
Settlements	(144)		—
Actuarial losses	6		(391)
Net periodic benefit cost	$	1,617	$	1,153

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, 2024 and 2023, respectively:


	As of December 31,
	2024		2023
Discount rate	1.14	%	1.51	%
Expected return on plan assets	3.65	%	3.67	%
Rate of compensation increase	2.12	%	2.00	%
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, 2024 and 2023 and a reconciliation of the funded status at December 31, 2024 and 2023, respectively (amounts in thousands):


	Year Ended December 31,
	2024		2023
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	65,101	$	50,364
Interest cost	866		1,157
Service cost	3,113		2,226
Actuarial loss	4,219		8,229
Plan amendments	—		(1,772)
Plan settlements	(870)		(25)
Employee contribution	1,265		1,182
Premiums paid	(456)		(406)
Benefit payment	(1,607)		(812)
Net transfer in/(out)	584		—
Effect of foreign currency exchange rates	(4,953)		4,958
Projected benefit obligations, end of year	$	67,262	$	65,101

	Year Ended December 31,
	2024		2023
Change In Plan Assets
Plan assets at fair value, beginning of year	$	45,724	$	38,053
Actual return on plan assets	8,200		1,350
Employer contributions	2,874		2,700
Employee contributions	1,265		1,182
Plan settlements	(870)		—
Benefits paid	(1,581)		(812)
Premiums paid	(456)		(406)
Net transfer in/(out)	322		—
Effect of foreign currency exchange rates	(3,660)		3,657
Plan assets at fair value, end of year	$	51,818	$	45,724

Schedule of Funded Status


	Year Ended December 31,
	2024		2023
Reconciliation Of Funded Status
Fair value of plan assets	$	51,818	$	45,724
Benefit obligations	67,262		65,101
Unfunded benefit obligations	$	15,444	$	19,377

Schedule of Expected Benefit Payments

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




2025	$	2,514
2026	$	2,230
2027	$	2,149
2028	$	2,332
2029	$	2,348
Next five years	$	12,278

DEBT (Narrative) (Details)			3 Months Ended	12 Months Ended
DEBT (Narrative) (Details)	Feb. 07, 2020 USD ($) $ / shares	Feb. 04, 2020 USD ($) $ / shares	Mar. 31, 2023 USD ($)	Dec. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Dec. 15, 2023 USD ($)	Mar. 24, 2023 USD ($)	Dec. 09, 2020 USD ($)
Debt Instrument [Line Items]
Current portion of borrowings under senior credit facility				$ 33,906,000	$ 14,531,000
Interest payments, year one				44,700,000
Interest payments, year two				42,400,000
Interest payments, year three				39,900,000
Interest Payments, Year Four				8,700,000
Securitization facility, outstanding borrowings, maximum limit				150,000,000.0
Issuance costs associated with amendment						$ 300,000
Securitization facility, agreement term (in years)						3 years
Remaining unamortized issuance costs						$ 100,000
Secured long-term debt, securitization program				$ 108,100,000	$ 89,200,000
Security facility, weighted average interest rate				5.40%	6.40%
Level 2
Debt Instrument [Line Items]
Securitization facility, fair value of amount outstanding				$ 105,800,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 1,300,000,000
Debt issuance costs, net				7,600,000
Previously capitalized financing costs, written-off			$ 200,000
Line of credit facility outstanding				$ 365,000,000.0	$ 70,000,000.0
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000.0
Swingline Loan
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000.0
Senior Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 2,100,000,000
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 \| Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Debt instrument, basis spread adjustment on variable rate				0.10%
Interest rates available to the company at its option				1.00%
Senior Credit Facility \| Secured Overnight Financing Rate (SOFR) \| Minimum
Debt Instrument [Line Items]
Interest rates available to the company at its option				1.00%
Senior Credit Facility \| Secured Overnight Financing Rate (SOFR) \| Maximum
Debt Instrument [Line Items]
Interest rates available to the company at its option				1.75%
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 \| December 31, 2024 through September 30, 2025
Debt Instrument [Line Items]
Debt instrument, covenant, maximum leverage ratio							5.00
Senior Credit Facility \| Revolving Credit Facility \| Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				$ 360,100,000
Senior Credit Facility \| Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding				0
Letters of credit outstanding				1,700,000	1,700,000
Term Loan Facility \| Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 775,000,000.0
Line of credit facility outstanding				$ 760,500,000	$ 775,000,000.0
Weighted average interest rate on debt				6.00%	6.80%
Current portion of borrowings under senior credit facility				$ 33,900,000	$ 14,500,000
Term Loan Facility \| Secured Debt \| Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				751,100,000
2025 Notes \| Convertible Debt
Debt Instrument [Line Items]
Convertible notes, aggregate principal amount	$ 575,000,000.0			575,000,000.0
Debt, interest rate	0.50%
Debt issuance costs, gross	$ 13,200,000
Debt, initial conversion rate		0.0135739
Debt instrument, convertible, conversion price \| $ / 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%
Class of warrant or right, exercise price of warrants or rights \| $ / shares		$ 113.34
Debt instrument, fair value				$ 555,600,000
2025 Notes \| Convertible Debt \| Call Option
Debt Instrument [Line Items]
Payments for option index to issuers equity		$ 104,200,000
Proceeds from sale of stock purchase warrants		$ 44,500,000

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Inventories, Net) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Accounting Policies [Abstract]
Finished goods	$ 223,729	$ 196,402
Work in process	79,423	74,035
Raw materials	125,938	119,171
Total inventories, net	$ 429,090	$ 389,608

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Dec. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

COMMITMENTS AND CONTINGENCIES (Fair Value Contingent Consideration) (Details) - Contingent Consideration Liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	$ 87,312	$ 74,432	$ 37,129
Payments	(12,400)	0	0
Change in fair value of contingent consideration liabilities	(5,255)	12,880	37,303
Balance, end of period	69,657	87,312	74,432
Level 3 \| Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	15,755	12,895
Payments	0
Additions		0
Change in fair value of contingent consideration liabilities	(2,787)	2,860
Balance, end of period	12,968	15,755	12,895
Level 3 \| Arkis \| Accrued expenses and other current liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	7,778
Balance, end of period	8,560	7,778
Level 3 \| Arkis \| Other liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	7,977
Balance, end of period	4,408	7,977
Level 3 \| Derma Sciences
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	2,557	230
Payments	0
Additions		0
Change in fair value of contingent consideration liabilities	129	2,327
Balance, end of period	2,686	2,557	230
Level 3 \| Derma Sciences \| Accrued expenses and other current liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	0
Balance, end of period	0	0
Level 3 \| Derma Sciences \| Other liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	2,557
Balance, end of period	2,686	2,557
Level 3 \| ACell
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	300	3,700
Payments	0
Additions		0
Change in fair value of contingent consideration liabilities	(297)	(3,400)
Balance, end of period	3	300	3,700
Level 3 \| 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
Balance, end of period	0	0
Level 3 \| ACell \| Other liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	300
Balance, end of period	3	300
Level 3 \| Surgical Innovations Associates, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	68,700	57,607
Payments	(12,400)
Additions		0
Change in fair value of contingent consideration liabilities	(2,300)	11,093
Balance, end of period	54,000	68,700	$ 57,607
Level 3 \| Surgical Innovations Associates, Inc. \| Accrued expenses and other current liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	13,400
Balance, end of period	17,900	13,400
Level 3 \| Surgical Innovations Associates, Inc. \| Other liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	55,300
Balance, end of period	$ 36,100	$ 55,300

INCOME TAXES (Schedule of Deferred Tax Assets and Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Assets:
Doubtful accounts	$ 3,370	$ 2,581
Inventory related items	34,731	41,466
Tax credits	17,922	18,859
Accrued vacation	2,447	2,184
Accrued bonus	5,279	4,259
Stock compensation	8,343	9,117
Deferred revenue	4,206	1,849
Net operating loss carryforwards	27,370	28,799
Capitalization of research and development expenses	68,311	61,138
Unrealized foreign exchange gain	8,655	13,907
Charitable contributions carryforward	212	206
Leases and Other	59,339	55,271
Total deferred tax assets	240,185	239,636
Less valuation allowance	(15,504)	(12,486)
Deferred tax assets after valuation allowance	224,681	227,150
Liabilities:
Intangible and fixed assets	(218,125)	(168,229)
Unrealized foreign exchange loss	(11,280)	(10,024)
Leases and Other	(21,186)	(38,134)
Total deferred tax liabilities	(250,591)	(216,387)
Total net deferred tax (liabilities) assets		$ 10,763
Total net deferred tax (liabilities) assets	$ (25,910)

DEBT (Tables)

12 Months Ended

Dec. 31, 2024

Debt Disclosure [Abstract]

Schedule of Long-term Debt Maximum Leverage Ratios


Fiscal Quarter Ending						Maximum Consolidated Total Leverage Ratio

March 31, 2023 through September 30, 2024						4.50 to 1.00
December 31, 2024 through September 30, 2025						5.00 to 1.00
December 31, 2025 through June 30, 2026						4.25 to 1.00
September 30, 2026 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, 2024	Principal Repayment
Dollars in thousands
2025	$	33,906
2026	38,750
2027	53,281
2028	634,532
	$	760,469

Schedule of Carrying Values and Estimated Fair Values of Debt Instruments

The carrying amounts and the estimated fair values of debt as of December 31, 2024 and 2023 are as follows:


		December 31, 2024				December 31, 2023
	Fair Value Measurement	Carrying Value		Estimated Fair Value		Carrying Value		Estimated Fair Value
Dollars in thousands
Senior credit facility - term loan	Level 2	$	760,469	$	751,143	$	775,000	$	762,869
Senior credit facility - revolving component	Level 2	365,000		360,144		70,000		68,902
2025 Notes	Level 1	575,000		555,594		575,000		541,219
Securitization	Level 2	108,100		105,831		89,200		87,069
Subtotal		$	1,808,569	$	1,772,712	$	1,509,200	$	1,460,059
Debt issuance costs		(5,476)				(9,651)
Total debt		$	1,803,093	$	1,772,712	$	1,499,549	$	1,460,059

- Definition

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

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(22))
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Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
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-Name Accounting Standards Codification
-Section 55
-Paragraph 69B
-Publisher FASB
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Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
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-Name Accounting Standards Codification
-Section 55
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-URI https://asc.fasb.org/1943274/2147481568/470-20-55-69E

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 235
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-Paragraph 3
-Subparagraph (SX 210.12-04(a))
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Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
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-SubTopic 30
-Name Accounting Standards Codification
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-Paragraph 2
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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
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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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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
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-Section 50
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-7

+ Details

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 24,122	$ 20,655
ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$ 3,565	$ 9,843

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Income	Retained Earnings
Balance, beginning of period (in shares) at Dec. 31, 2021		89,600,000
Balance, beginning of period at Dec. 31, 2021	$ 1,684,804	$ 896	$ (234,448)	$ 1,264,943	$ (45,155)	$ 698,568
Balance, beginning of period, treasury stock (in shares) at Dec. 31, 2021			(4,899,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	180,550					180,550
Other comprehensive income (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 and forfeitures	(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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	67,741					67,741
Other comprehensive income (loss), net of tax	(25,371)				(25,371)
Issuance of common stock through employee stock purchase plan (in shares)		21,000
Issuance of common stock through employee stock purchase plan	1,107			1,107
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)		423,000	18,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes and forfeitures	(2,654)	$ 1	$ 911	(3,566)
Share-based compensation	20,108	$ 3		20,105
Accelerated shares repurchased (in shares)			(5,946,000)
Accelerated shares repurchased	(277,450)		$ (285,311)	7,861
Balance, end of period (in shares) at Dec. 31, 2023		90,920,000
Balance, end of period at Dec. 31, 2023	$ 1,587,884	$ 909	$ (647,262)	1,302,484	(15,106)	946,859
Balance, end of period, treasury stock (in shares) at Dec. 31, 2023	(12,751,000)		(12,751,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	$ (6,944)					(6,944)
Other comprehensive income (loss), net of tax	(12,465)				(12,465)
Issuance of common stock through employee stock purchase plan (in shares)		23,000
Issuance of common stock through employee stock purchase plan	965			965
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes (in shares)		666,000	25,000
Issuance of common stock for vesting of share-based awards, net of shares withheld for taxes and forfeitures	1,925	$ 2	$ 1,269	654
Share-based compensation	24,436	$ 5		24,431
Accelerated shares repurchased (in shares)			(1,719,000)
Accelerated shares repurchased	(50,521)		$ (45,418)	(5,103)
Balance, end of period (in shares) at Dec. 31, 2024		91,609,000
Balance, end of period at Dec. 31, 2024	$ 1,545,280	$ 916	$ (691,411)	$ 1,323,431	$ (27,571)	$ 939,915
Balance, end of period, treasury stock (in shares) at Dec. 31, 2024	(14,445,000)		(14,445,000)

RETIREMENT BENEFIT PLANS (Schedule of Expected Benefit Payments and Minimum Contribution on Unfunded Plans) (Details) $ in Thousands	Dec. 31, 2024 USD ($)
Retirement Benefits [Abstract]
2025	$ 2,514
2026	2,230
2027	2,149
2028	2,332
2029	2,348
Next five years	$ 12,278

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)

12 Months Ended

Dec. 31, 2024

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, 2024:


Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2024	$	9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)
Contract asset, net of transferred to trade receivables on contracts during the period	6,146
Contract asset, December 31, 2024	$	6,146

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(10,307)
Contract liability, acquired with Acclarent	3,984
Contract liability, net of revenue recognized on contracts during the period	9,874
Foreign currency translation	(134)
Contract liability, December 31, 2024	$	19,669

Schedule of Disaggregation of Revenue

The following table presents revenues disaggregated by the major sources of revenues for years-ended December 31, 2024, 2023, and 2022 (dollar amounts in thousands):


	Year Ended December 31, 2024		Year Ended December 31, 2023		Year Ended December 31, 2022
Neurosurgery	$	803,816	$	818,101	$	794,017
Instruments	204,177		203,617		192,679
ENT(1)(2)	135,643		37,275		32,868
Total Codman Specialty Surgical	1,143,636		1,058,993		1,019,564

Wound Reconstruction and Care(3)(4)	350,565		373,986		406,689
Private Label	116,326		108,594		131,413
Total Tissue Technologies	466,891		482,580		538,102
Total revenue	$	1,610,527	$	1,541,573	$	1,557,666

(1) See Note 4. Acquisitions and Divestitures for details surrounding the acquisition of Acclarent on April 1, 2024.

(2) Prior period revenues included within our instruments business have been reclassified under the ENT business.

(3) See Note 4. Acquisitions and Divestitures for details surrounding the SIA acquisition on December 7, 2022.

(4) See Note 4. Acquisitions and Divestitures for details surrounding the sale of the Company’s non-core traditional wound care (“TWC”) business on August 31, 2022.

STOCK-BASED COMPENSATION

12 Months Ended

Dec. 31, 2024

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	2024		2023		2022
Cost of goods sold	$	649	$	588	$	549
Research and development	2,697		2,071		1,739
Selling, general and administrative	21,031		17,483		25,437
Total stock-based compensation expense	$	24,377	$	20,142	$	27,725
Total estimated tax benefit related to stock-based compensation expense	4,677		5,223		10,574
Net effect on net income	$	19,700	$	14,919	$	17,151

EQUITY AWARD PLANS

As of December 31, 2024, 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 Equity Incentive Plan and the 2001 Equity Incentive Plan 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 14.7 million shares under the 2003 Plan. The 2003 Plan permits 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 years 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 0.0% 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,
	2024	2023	2022
Dividend yield	0%	0%	0%
Expected volatility	33%	30%	30%
Risk free interest rate	4.09%	3.86%	2.01%
Expected life of option from grant date	7 years	7 years	7 years
Weighted average grant date fair value of options granted	$15.68	$21.58	$23.15

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, 2024	1,178	$	50.64	3.65	$	1,766
Granted	244	36.22		—	—
Exercised	(162)	33.46		—	—
Forfeited or Expired	(56)	50.21		—	—
Outstanding at December 31, 2024	1,204	$	50.06	4.01	$	—
Exercisable at December 31, 2024	798	$	52.51	2.71	$	—

The Company recognized $2.2 million, $1.4 million, and $3.5 million in expense related to stock options during the years ended December 31, 2024, 2023, and 2022, respectively. The intrinsic value of options exercised for the years ended December 31, 2024, 2023, and 2022 were $0.7 million, $1.8 million, and $4.0 million, respectively. Cash received from option exercises and employee stock purchase plan was $6.4 million, $4.3 million, and $5.5 million, for the years ended December 31, 2024, 2023, and 2022, respectively. The realized tax expense from options exercised was $0.5 million for the year ended December 31, 2024. Realized tax benefits of $0.1 million, and $0.6 million were recognized for the years ended December 31, 2023, and 2022, respectively.

As of December 31, 2024, there was approximately $2.9 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately three years.

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, 2024:


	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, 2024	584	$	55.37	335	$	57.53
Granted	650	33.28		387	36.05
Adjustments for performance achievement related to award target	—	—		(160)	49.71
Cancellations	(115)	46.31		(35)	49.23
Released	(248)	58.04		(107)	33.37
Unvested, December 31, 2024	871	$	39.33	420	$	41.83

The Company recognized $22.1 million, $18.7 million and $24.3 million in expense related to such awards during the years ended December 31, 2024, 2023, and 2022, respectively. The total fair market value of shares vested and released in 2024, 2023, and 2022 was $11.3 million, $18.2 million and $65.0 million, respectively. Vested awards include shares that have been fully earned but had not been delivered as of December 31, 2024.

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, 2024, there were no performance stock units (“PSUs”) subject to vest and be released based on 2024 performance achievement.

As of December 31, 2024, there was approximately $27.0 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, 2024, there were approximately 3.7 million shares available for grant under the 2003 Plan.

The Company capitalized share based compensation costs of $0.7 million, $0.6 million, and $0.6 million for the years ended December 31, 2024, 2023, and 2022, into inventory, respectively. Such share-based compensation was recognized as cost of goods sold when related inventory was sold.

CEO Separation

On February 27, 2024, the Company announced that Mr. De Witte would retire from his position as President and Chief Executive Officer and director of the Company following the completion of a succession process and entered into a letter agreement with Mr. De Witte to modify his current employment agreement and put forth the form of a post-employment consulting agreement. The Company applied modification accounting to the outstanding equity-based awards granted to Mr. De Witte as of that date, which revalued and accelerated stock-based compensation associated with equity-based awards granted to him over his expected service period to the Company. Pursuant to this letter agreement, Mr. De Witte’s unvested equity-based awards will continue to vest during his continued service period to the Company and vested stock options were modified such that they will remain exercisable until the earlier of (a) the stated term of the stock options and (b) six months following his cessation of continued service to the Company. As a result of the modifications, the Company recorded a total of $1.9 million in accelerated stock-based compensation expenses for the year ended December 31, 2024.

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, 2024, 1.9 million shares remain available for purchase under the ESPP. During the years ended December 31, 2024, 2023, and 2022, the Company issued 44,426 shares, 23,337 shares and 20,780 shares under the ESPP for $1.0 million, $1.0 million, and $1.1 million, respectively.

RETIREMENT BENEFIT PLANS

12 Months Ended

Dec. 31, 2024

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, 2024 and 2023 included the following (amounts in thousands):


	Year ended December 31,
	2024		2023
Service cost	$	3,113	$	2,226
Interest cost	866		1,157
Expected return on plan assets	(1,639)		(1,450)
Amortization of prior service cost (credit)	(585)		(389)
Settlements	(144)		—
Actuarial losses	6		(391)
Net periodic benefit cost	$	1,617	$	1,153


	As of December 31,
	2024		2023
Discount rate	1.14	%	1.51	%
Expected return on plan assets	3.65	%	3.67	%
Rate of compensation increase	2.12	%	2.00	%
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 2024 and 2023, the discount rates were prescribed as the current yield on corporate bonds with an average credit 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,
	2024		2023
Change In Projected Benefit Obligations
Projected benefit obligations, beginning of year	$	65,101	$	50,364
Interest cost	866		1,157
Service cost	3,113		2,226
Actuarial loss	4,219		8,229
Plan amendments	—		(1,772)
Plan settlements	(870)		(25)
Employee contribution	1,265		1,182
Premiums paid	(456)		(406)
Benefit payment	(1,607)		(812)
Net transfer in/(out)	584		—
Effect of foreign currency exchange rates	(4,953)		4,958
Projected benefit obligations, end of year	$	67,262	$	65,101

	Year Ended December 31,
	2024		2023
Change In Plan Assets
Plan assets at fair value, beginning of year	$	45,724	$	38,053
Actual return on plan assets	8,200		1,350
Employer contributions	2,874		2,700
Employee contributions	1,265		1,182
Plan settlements	(870)		—
Benefits paid	(1,581)		(812)
Premiums paid	(456)		(406)
Net transfer in/(out)	322		—
Effect of foreign currency exchange rates	(3,660)		3,657
Plan assets at fair value, end of year	$	51,818	$	45,724


	Year Ended December 31,
	2024		2023
Reconciliation Of Funded Status
Fair value of plan assets	$	51,818	$	45,724
Benefit obligations	67,262		65,101
Unfunded benefit obligations	$	15,444	$	19,377

The unfunded benefit obligations are included in other liabilities in the consolidated balance sheets at December 31, 2024 and 2023, respectively.

During the periods ended December 31, 2024 and 2023, the Company had a net gain of $1.3 million and a net loss of $6.6 million, respectively, recognized within accumulated other comprehensive loss that has not been recognized as a component of net periodic benefit cost. The combined accumulated benefit obligations for the defined benefit plans was $60.1 million and $62.8 million as of December 31, 2024 and 2023, 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, 2024.

As of December 31, 2024, 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):




2025	$	2,514
2026	$	2,230
2027	$	2,149
2028	$	2,332
2029	$	2,348
Next five years	$	12,278

As of December 31, 2024, contributions expected to be paid to the plan in 2025 is $3.1 million.

DEFINED CONTRIBUTION PLANS

The Company also has various defined contribution savings plans offered to our U.S. and non-U.S. employees. 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 $10.4 million, $10.4 million and $9.8 million for the years ended December 31, 2024, 2023, and 2022, 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, 2024 and 2023 was $6.7 million and $6.1 million. Offsetting liabilities relating to the deferred compensation plan are included in Other liabilities.

- Definition

The entire disclosure for retirement benefits.

+ References

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

GOODWILL AND OTHER INTANGIBLE ASSETS (Components of Company's Identifiable Intangible Assets) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,939,767	$ 1,729,837
Accumulated Amortization	(732,179)	(662,004)
Net	1,207,588	1,067,833
Codman trade name
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	168,202	174,531
Net	$ 168,202	$ 174,531
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	17 years	18 years
Cost	$ 1,452,545	$ 1,226,128
Accumulated Amortization	(525,959)	(448,519)
Net	$ 926,586	$ 777,609
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 166,038	$ 193,895
Accumulated Amortization	(137,186)	(152,160)
Net	$ 28,852	$ 41,735
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	27 years	28 years
Cost	$ 99,951	$ 98,892
Accumulated Amortization	(42,173)	(38,754)
Net	$ 57,778	$ 60,138
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	30 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(19,126)	(18,148)
Net	$ 11,085	$ 12,063
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	6 years	11 years
Cost	$ 22,820	$ 6,180
Accumulated Amortization	(7,735)	(4,423)
Net	$ 15,085	$ 1,757

DERIVATIVE INSTRUMENTS- (Schedule of Gains and (Loss) of Derivative Instruments) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 654	$ 566
Foreign currency forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	598	0
Foreign currency swaps
Derivative Instruments, Gain (Loss) [Line Items]
Derivative instruments not designated as hedging instruments, gain (loss), net	$ 56	$ 566

GOODWILL AND OTHER INTANGIBLE ASSETS (Schedule of Changes in Carrying Amount of Goodwill) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Goodwill [Roll Forward]
Beginning of period	$ 1,055,462	$ 1,038,881
Foreign currency translation	(20,992)	16,963
End of period	1,096,952	1,055,462
Surgical Innovations Associates, Inc.
Goodwill [Roll Forward]
SIA Acquisition		(382)
Acclarent, Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	62,482
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of period	666,937	656,219
Foreign currency translation	(13,689)	10,718
End of period	715,730	666,937
Codman Specialty Surgical \| Surgical Innovations Associates, Inc.
Goodwill [Roll Forward]
SIA Acquisition		0
Codman Specialty Surgical \| Acclarent, Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	62,482
Tissue Technologies
Goodwill [Roll Forward]
Beginning of period	388,525	382,662
Foreign currency translation	(7,303)	6,245
End of period	381,222	388,525
Tissue Technologies \| Surgical Innovations Associates, Inc.
Goodwill [Roll Forward]
SIA Acquisition		$ (382)
Tissue Technologies \| Acclarent, Inc.
Goodwill [Roll Forward]
Acclarent Acquisition	$ 0

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

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-URI https://asc.fasb.org/1943274/2147478546/942-210-S99-1

+ Details

SEGMENT AND GEOGRAPHIC INFORMATION - Revenue and Long-Lived Assets by Major Geographic Area (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
Total revenue, net	$ 1,610,527	$ 1,541,573	$ 1,557,666
Total long-lived assets	616,280	554,577	516,776
United States
Segment Reporting Information [Line Items]
Total revenue, net	1,192,675	1,100,730	1,126,810
Total long-lived assets	534,336	481,508	440,223
Europe
Segment Reporting Information [Line Items]
Total revenue, net	158,496	165,221	170,903
Total long-lived assets	52,385	51,730	60,857
Asia Pacific
Segment Reporting Information [Line Items]
Total revenue, net	176,614	193,096	176,477
Total long-lived assets	28,264	19,842	12,975
Rest of the World
Segment Reporting Information [Line Items]
Total revenue, net	82,742	82,526	83,476
Total long-lived assets	$ 1,295	$ 1,497	$ 2,721

- 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-41

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 4: http://fasb.org/us-gaap/role/ref/otherTransitionRef
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 5: http://fasb.org/us-gaap/role/ref/otherTransitionRef
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-Name Accounting Standards Codification
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 924
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479941/924-10-S99-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
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-URI https://asc.fasb.org/1943274/2147479806/606-10-50-5

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-30

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-42

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
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-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

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-Topic 280
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-40

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
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-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-4

+ Details

NET INCOME PER SHARE

12 Months Ended

Dec. 31, 2024

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	2024		2023		2022
Basic net (loss) income per share:
Net (loss) income	$	(6,944)	$	67,741	$	180,550
Weighted average common shares outstanding	77,010		80,089		82,997
Basic net (loss) income per common share	$	(0.09)	$	0.85	$	2.18

Diluted net (loss) income per share:
Net (loss) income	$	(6,944)	$	67,741	$	180,550

Weighted average common shares outstanding — Basic	77,010		80,089		82,997
Effect of dilutive securities:
Stock options and restricted stock	—		248		519
Weighted average common shares for diluted earnings per share	77,010		80,337		83,516
Diluted net (loss) income per common share	$	(0.09)	$	0.84	$	2.16

Common stock of approximately 1.3 million and 0.6 million shares at December 31, 2024, and 2023 that are issuable through exercise of dilutive securities, respectively, were not included in the computation of diluted net income per share because their effect would have been anti-dilutive.

DERIVATIVE INSTRUMENTS

12 Months Ended

Dec. 31, 2024

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 SOFR-indexed borrowings. In March 2023, the Company entered into a basis swap where the Company receives Term SOFR and pays daily compounded SOFR to convert the portfolio of swaps from daily compounded SOFR to Term SOFR.

The Company held the following interest rate swaps as of December 31, 2024 and 2023 (dollar amounts in thousands):


	December 31, 2024		December 31, 2023							December 31, 2024			December 31, 2023
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month Term SOFR Loan	$	—	$	150,000	December 13, 2017	July 1, 2019	June 28, 2024	2.423	%	$	—		$	2,105
1-month Term SOFR Loan	—		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	—			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	421			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	502			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	403			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	3,406			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	3,507			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	34,537			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	7,848			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(1,829)		0	(1,829)
	$	1,125,000	$	1,475,000						$	48,795		$	43,556
(1) The notional of the basis swap amortizes to match the total notional of the interest rate swap portfolio over time

The interest rate 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 accumulated other comprehensive income (“AOCI”). For the years ended December 31, 2024 and 2023, the Company recorded gains of $22.7 million and $4.9 million, respectively, in AOCI related to the change in fair value of the interest rate swaps.

For the years ended December 31, 2024 and 2023, the Company recorded gains of $17.5 million and $18.1 million, respectively, in interest income included in the consolidated statements of operations related to the interest rate differential of the interest rate swaps. The estimated gain that is expected to be reclassified to interest income from AOCI as of December 31, 2024 within the next twelve months is $11.6 million.

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 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 anticipated 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

The objective of the 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 (“CHFs”) and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in CHF and receive U.S. dollars from the counterparties.

On September 22, 2023, the Company amended the CHF-denominated intercompany loan to partially settle CHF 20.0 million and extend the termination date to September 2024 and as a result, the Company terminated the cross-currency swap designated as cash flow hedge of an intercompany loan with aggregate notional amount of $48.5 million. Simultaneously, the Company entered into a cross-currency swap agreement to hedge a notional amount of CHF 28.5 million equivalent to $31.5 million of this amended intercompany loan into U.S. dollars. Based on the closing exchange rates, the loss upon settlement was approximately $2.3 million which was offset by the gain on the settlement of the intercompany loan.

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.

On February 19, 2025, the Company amended the CHF-denominated intercompany loan to extend the maturity to December 2030. Concurrently, the Company amended the cross-currency swap agreement, with a notional amount of $368.4 million, equivalent to CHF 328.1 million, to extend the maturity to December 2030.

The Company held the following cross-currency rate swaps as of December 31, 2024 and 2023 (dollar amounts in thousands):


					December 31, 2024	December 31, 2023	December 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	328,136	351,137	$	(4,367)	$	(38,324)
Receive U.S.$			3.98%	$	368,362	394,183

Pay CHF	September 22, 2023	September 23, 2024	2.40%	CHF	—	28,500	—		(2,348)
Receive U.S.$			6.27%	$	—	31,457

Total							$	(4,367)	$	(40,672)

The cross-currency swaps are carried on the consolidated balance sheet at fair value, and changes in the fair values are recorded as unrealized gains or losses in AOCI. For the years ended December 31, 2024 and 2023 the Company recorded a gain of $41.0 million and a loss of $27.4 million, respectively, in AOCI related to change in fair value of the cross-currency swaps.

For the years ended December 31, 2024 and 2023, the Company recorded a gain of $32.2 million and a loss of $37.4 million in other income, net for the change in fair value related to the foreign currency rate translation to offset the gains and losses, respectively, recognized on the intercompany loans.

For the years ended December 31, 2024 and 2023, the Company recorded gains of $4.7 million and $5.5 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps.

The estimated loss that is expected to be reclassified to other income (expense), net from AOCI as of December 31, 2024 within the next twelve months is $4.4 million. As of December 31, 2024, the Company does not expect any gains or losses will be reclassified into earnings because the original forecasted transactions will not occur.

Net Investment Hedges

The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk from its international operations through foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business.

In May 2024, the Company entered into a cross-currency swap agreement with a notional amount of CHF 68.5 million, equivalent to $75.0 million, where the Company agreed with third-parties to sell CHF in exchange for U.S. dollars at a specified rate at the maturity of the contract. The new cross-currency swap agreement was designated as a net investment hedge to partially offset the effects of foreign currency on foreign subsidiaries.

In November 2023, May 2022, and October 2018, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries.

On February 21, 2025, the Company entered into a cross-currency swap agreement with a notional amount of CHF 67.8 million, equivalent to $75.0 million, to be designated as a net investment hedge 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, 2024 and 2023 (dollar amounts in thousands):


					December 31, 2024	December 31, 2023	December 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	$	4,827	$	2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	240,175	288,210	(27,951)		(48,047)
Receive U.S.$			1.94%	$	250,000	300,000

Pay CHF	November 17, 2023	December 17, 2029	—%	CHF	66,525	66,525	(3,248)		(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Pay CHF	May 6, 2024	December 18, 2030	—%	CHF	68,483	—	(4,741)		—
Receive U.S.$			2.74%	$	75,000	—

Total							$	(31,113)	$	(49,609)

The cross-currency swaps were carried on the consolidated balance sheet at fair value and changes in the fair values were recorded as unrealized gains or losses in AOCI. For the years ended December 31, 2024 and 2023, the Company recorded a gain of $24.5 million and a loss of $30.7 million, respectively, in AOCI related to the change in fair value of the cross-currency swaps.

For the years ended December 31, 2024 and 2023, the Company recorded gains of $10.1 million and $7.8 million, respectively, in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. The estimated gain that is expected to be reclassified to interest income from AOCI as of December 31, 2024 within the next twelve months is $9.4 million.

Foreign Currency Forward Contracts

The Company has entered into a hedge for forecasted intercompany purchases denominated in foreign currencies through the use of forward contracts designated as cash flow hedges. To the extent these forward contracts meet hedge accounting criteria, changes in their fair value are not included in accumulated comprehensive loss. These changes in fair value will be recognized into earnings as a component of cost of sales when the forecasted-transaction occurs.

Throughout 2024, the Company entered into foreign currency forwards to mitigate the exchange rate risk of CHF denominated intercompany purchases. These contracts typically settle at various dates within twelve months of execution. As of December 31, 2024 the notional amount of foreign currency forward contracts was CHF 16.9 million.

For the year ended December 31, 2024 and 2023 the Company recorded losses of $1.1 million and gains of $0.4 million, respectively, in AOCI related to the change in fair value of the foreign currency forward contracts.

For the year ended December 31, 2024 and 2023 the Company recorded losses of $0.4 million and gains of $0.4 million, respectively, in other income and cost of goods sold included in the consolidated statements of operations related to the amortization of forward points and rate translation on the foreign currency forward contracts.

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, 2024 and 2023:


	Fair Value as of December 31,
Dollars in thousands	2024		2023
Location on Balance Sheet (1):
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap	$	12,320	$	14,675
Cross-currency swap			537

Net Investment Hedges
Cross-currency swap	8,605		2,938
Other assets
Cash Flow Hedges
Interest rate swap	38,302		30,710


Net Investment Hedges
Cross-currency swap	—		1,470
Total derivatives designated as hedges — Assets	$	59,227	$	50,330

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap	$	684	$	579
Cross-currency swap	4,367		4,813
Foreign Currency Forward Contracts	914		—
Net Investment Hedges
Cross-currency swap	210		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap	1,145		1,250
Cross-currency swap	—		36,396

Net Investment Hedges
Cross-currency swap	39,507		51,114
Total derivatives designated as hedges — Liabilities	$	46,827	$	97,055

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

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, 2024 and 2023:


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, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	22,692	$	17,454	$	48,794	Interest expense
Cross-currency swap	(15,763)		41,013		36,871		(11,621)		Other income, net
Forward Currency Forward Contracts	—		(1,067)		(443)		(624)		Cost of sales and other income, net
Net Investment Hedges
Cross-currency swap	(45,498)		24,489		10,121		(31,130)		Interest income
	$	(17,705)	$	87,127	$	64,003	$	5,419
Year Ended December 31, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	4,899	$	18,055	$	43,556	Interest expense
Cross-currency swap	(20,271)		(27,406)		(31,914)		(15,763)		Other income, net
Forward Currency Forward Contracts	—		436		436		—		Cost of sales and other income, net
Net Investment Hedges
Cross-currency swap	(6,914)		(30,738)		7,846		(45,498)		Interest income
	$	29,527	$	(52,809)	$	(5,577)	$	(17,705)

Derivative Instruments Not Designated as Hedges:

During 2024, the Company entered into foreign currency forward contracts to mitigate risk from the fluctuations in foreign currency exchange rates associated with intercompany receivables in Chinese yuan (“CNH”). These contracts typically settle at various dates within twelve months of execution. As of December 31, 2024, the notional amounts totaled CNH 140.0 million.

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 Japanese Yen (“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 in the second quarter of 2023 and the second quarter of 2024, bringing the notional amount down to $4.6 million as of December 31, 2024.

The fair value of the derivative instruments not designated as hedges was $1.7 million and $1.2 million as of December 31, 2024 and 2023, respectively.

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


Dollars in thousands	December 31,
	2024		2023
Foreign currency forward contracts	$	598	$	—
Foreign currency swaps	56		566
Total	$	654	$	566

RETIREMENT BENEFIT PLANS (Scheduled of Funded Status) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Reconciliation Of Funded Status
Fair value of plan assets	$ 51,818	$ 45,724	$ 38,053
Benefit obligations	67,262	65,101	$ 50,364
Unfunded benefit obligations	$ 15,444	$ 19,377

- 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

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Schedule of Property, Plant and Equipment Balances and Corresponding Lives) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Total	$ 802,646	$ 707,646
Less: Accumulated depreciation	(396,923)	(367,447)
Property, plant and equipment, net	405,723	340,199
Land
Property, Plant and Equipment [Line Items]
Total	952	978
Buildings and building improvements
Property, Plant and Equipment [Line Items]
Total	$ 19,748	14,859
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	$ 179,904	171,062
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 equipment
Property, Plant and Equipment [Line Items]
Total	$ 214,786	202,023
Machinery and equipment \| Minimum
Property, Plant and Equipment [Line Items]
Useful Lives	3 years
Machinery and equipment \| Maximum
Property, Plant and Equipment [Line Items]
Useful Lives	20 years
Information systems and hardware
Property, Plant and Equipment [Line Items]
Total	$ 171,739	160,899
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	$ 18,887	20,549
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	$ 196,630	$ 137,276

STOCK-BASED COMPENSATION (Summary of Vested and Unvested Restricted Stock, Performance Stock, and Contract Stock) (Details) shares in Thousands	12 Months Ended
	Dec. 31, 2024 $ / shares shares
Restricted Stock Awards
Shares
Unvested at beginning of year (in shares) \| shares	584
Granted (in shares) \| shares	650
Adjustments for performance achievement related to award target (in shares) \| shares	0
Cancellations (in shares) \| shares	(115)
Released (in shares) \| shares	(248)
Unvested at end of year (in shares) \| shares	871
Weighted Average Grant Date Fair Value Per Share
Unvested at beginning of year (in dollars per share) \| $ / shares	$ 55.37
Granted (in dollars per share) \| $ / shares	33.28
Adjustments for performance achievement related to award target (in dollars per share) \| $ / shares	0
Cancellations (in dollars per share) \| $ / shares	46.31
Released (in dollars per share) \| $ / shares	58.04
Unvested at end of year (in dollars per share) \| $ / shares	$ 39.33
Performance Stock and Contract Stock Awards
Shares
Unvested at beginning of year (in shares) \| shares	335
Granted (in shares) \| shares	387
Adjustments for performance achievement related to award target (in shares) \| shares	(160)
Cancellations (in shares) \| shares	(35)
Released (in shares) \| shares	(107)
Unvested at end of year (in shares) \| shares	420
Weighted Average Grant Date Fair Value Per Share
Unvested at beginning of year (in dollars per share) \| $ / shares	$ 57.53
Granted (in dollars per share) \| $ / shares	36.05
Adjustments for performance achievement related to award target (in dollars per share) \| $ / shares	49.71
Cancellations (in dollars per share) \| $ / shares	49.23
Released (in dollars per share) \| $ / shares	33.37
Unvested at end of year (in dollars per share) \| $ / shares	$ 41.83

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative, Revenue Remaining Performance Obligation) (Details) $ in Millions	Dec. 31, 2024 USD ($)
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	$ 10.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Performance obligations expected to be satisfied	$ 10.5
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	$ 5.1
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Performance obligations expected to be satisfied	$ 5.1
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	$ 2.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Performance obligations expected to be satisfied	$ 2.9
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	$ 0.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Performance obligations expected to be satisfied	$ 0.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01
Revenue from Contract with Customer [Abstract]
Performance obligations expected to be satisfied	$ 0.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Performance obligations expected to be satisfied, expected timing	1 year
Performance obligations expected to be satisfied	$ 0.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2030-01-01
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
Performance obligations expected to be satisfied	$ 0.1

DEBT

12 Months Ended

Dec. 31, 2024

Debt Disclosure [Abstract]

DEBT

Amendment to the Seventh Amended and Restated Senior Credit Agreement

On March 24, 2023, the Company entered into the seventh amendment and restatement (the “March 2023 Amendment”) of the Senior Credit Facility (the “Senior Credit Facility”) with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The March 2023 Amendment extended the maturity date to March 24, 2028, amended the contractual repayments of the term loan component, and amended the interest rate from LIBOR to SOFR-indexed interest. The Company continues to have the ability to borrow an aggregate principal amount of up to approximately $2.1 billion through the following facilities: (i) a $775.0 million term loan facility, and (ii) a $1.3 billion revolving credit facility, which includes a $60.0 million sublimit for the issuance of standby letters of credit and a $60.0 million sublimit for swingline loans. The terms of the Senior Credit Facility limit the amount of dividends we may pay.

The Company’s maximum Consolidated Total Leverage Ratio (as defined in the March 2023 Amendment) in the financial covenants is outlined below. Concurrent with the Durepair acquisition (see Note 4. Acquisitions and Divestitures), in accordance with the terms of the March 2023 Amendment, the Company elected to increase the maximum Consolidated Total Leverage Ratio to 5.00 from the fiscal quarter ending December 31, 2024 through the fiscal quarter ending September 30, 2025.


Fiscal Quarter Ending						Maximum Consolidated Total Leverage Ratio

March 31, 2023 through September 30, 2024						4.50 to 1.00
December 31, 2024 through September 30, 2025						5.00 to 1.00
December 31, 2025 through June 30, 2026						4.25 to 1.00
September 30, 2026 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.Term SOFR in effect from time to time plus 0.10% plus the applicable rate (ranging from 1.00% to 1.75%), or

ii.the highest of:

1.the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50%

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

3.the one-month Term SOFR plus 1.00%

The applicable rates are based on the Company’s Consolidated Total Leverage Ratio (defined, as of any date of determination, as the ratio of (a) Consolidated Funded Indebtedness as of such date (as defined in the Seventh Amended and Restated Credit Agreement (the “Credit Agreement”)) less cash that is not subject to any restriction on the use or investment thereof to (b) Consolidated EBITDA (as defined by the Credit Agreement)), 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 component of the Senior 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, 2024, the Company was in compliance with all such covenants. The Company capitalized $7.6 million in deferred financing costs in connection with the March 2023 Amendment and wrote off $0.2 million of previously capitalized financing costs during the first quarter of 2023.

At December 31, 2024 and 2023 there was $365.0 million and $70.0 million, respectively, outstanding under the revolving credit facility component of the Senior Credit Facility. At December 31, 2024 and 2023, there was $760.5 million and $775.0 million outstanding under the term loan component of the Senior Credit Facility. At December 31, 2024 and 2023, the weighted average interest rate of both the revolving credit facility component and term loan component of the Senior Credit Facility was 6.0% and 6.8%, respectively. As of December 31, 2024 and 2023 there was $33.9 million and $14.5 million, respectively, of the term loan component of the Senior Credit Facility classified as current on the consolidated balance sheet.

The fair value of the term loan and revolving portion of the Senior Credit Facility at December 31, 2024 was $751.1 million, and $360.1 million, respectively. The fair value was 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, 2024 and 2023 totaled $1.7 million. There were no amounts drawn as of December 31, 2024.

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


Year Ended December 31, 2024	Principal Repayment
Dollars in thousands
2025	$	33,906
2026	38,750
2027	53,281
2028	634,532
	$	760,469

Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $44.7 million in 2025, $42.4 million in 2026, $39.9 million in 2027, and $8.7 million in 2028. Interest is calculated on the term loan portion of the Senior Credit Facility based on SOFR plus the certain amounts set forth in the Credit Agreement. As the revolving credit facility and Securitization Facility (defined below) can be repaid at any time, no interest has been included in the calculation.

Any outstanding borrowings on the revolving credit facility component of the Senior Credit Facility are due on March 24, 2028.

Convertible Senior Notes

On February 7, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the “2025 Notes”) pursuant to an indenture, dated as of February 7, 2020 (the “Original Indenture”), between the Company and Citibank, N.A., as trustee. 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. 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 an 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 specified in the Original Indenture; (3) if the Company calls the notes for optional redemption as described in the Original Indenture; or (4) if specified corporate transactions occur. As of December 31, 2024, none of these conditions existed and the 2025 Notes are classified as current convertible securities on the consolidated balance sheet, as they are due within one year.

On December 9, 2020, the Company entered into the first supplemental indenture to the Original Indenture (the “First Supplemental Indenture” and, together with Original Indenture, the “Indenture”), pursuant to which 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 (as defined in the First Supplemental Indenture) for a conversion of the 2025 Notes, the Specified Dollar Amount (as defined in the First Supplemental Indenture) 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 2025 Notes will have the right to require the Company to repurchase for cash all or a portion of their 2025 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). The Company will also be required to increase the conversion rate for holders who convert their 2025 Notes in connection with certain Fundamental Changes (as defined in the Original Indenture) 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, 2024, the carrying amount of the liability of the 2025 Notes was $575.0 million. The fair value of the 2025 Notes at December 31, 2024 was $555.6 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quotes. The 2025 Notes are valued based on Level 1 measurements in the fair value hierarchy. Level 1 inputs represent quoted prices in active markets for identical assets or liabilities.

Securitization Facility

In 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, 2024, the Company was in compliance with the covenants and none of the termination events had occurred.

On December 15, 2023, the Company entered into an amendment (the “December 2023 Amendment”) of the Securitization Facility which extended the maturity date from May 28, 2024 to December 15, 2026. The Company incurred approximately $0.3 million of new issuance costs associated with the December 2023 Amendment which will be amortized over 3 years, the length of the Securitization Agreement as amended by the December 2023 Amendment. Due to the increase in borrowing capacity, the remaining $0.1 million of unamortized costs from the previous agreement will also be amortized over the length of the amended agreement, three years. In addition, on April 17, 2023 the Company entered into an amendment (the “April 2023 Amendment”) of the Securitization Facility and amended the interest rate from LIBOR to SOFR-indexed rate. The December 2023 Amendment and April 2023 Amendment did not increase the Company’s total indebtedness.

At December 31, 2024 and 2023, the Company had $108.1 million and $89.2 million, respectively, of outstanding borrowings under its Securitization Facility at an interest rate of 5.4% and 6.4%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at December 31, 2024 was $105.8 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.

Estimated Fair Value of Debt Measurements

The carrying amounts and the estimated fair values of debt as of December 31, 2024 and 2023 are as follows:


		December 31, 2024				December 31, 2023
	Fair Value Measurement	Carrying Value		Estimated Fair Value		Carrying Value		Estimated Fair Value
Dollars in thousands
Senior credit facility - term loan	Level 2	$	760,469	$	751,143	$	775,000	$	762,869
Senior credit facility - revolving component	Level 2	365,000		360,144		70,000		68,902
2025 Notes	Level 1	575,000		555,594		575,000		541,219
Securitization	Level 2	108,100		105,831		89,200		87,069
Subtotal		$	1,808,569	$	1,772,712	$	1,509,200	$	1,460,059
Debt issuance costs		(5,476)				(9,651)
Total debt		$	1,803,093	$	1,772,712	$	1,499,549	$	1,460,059

- 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://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481544/470-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481544/470-10-50-6

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 405
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 405
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)(3)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 405
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 405
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)(1)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 405
-SubTopic 40
-Name Accounting Standards Codification
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-Paragraph 1
-Subparagraph (a)
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-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1B

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org/470/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 835
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482925/835-30-45-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1B

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1B

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1B

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481139/470-20-50-1E

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
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Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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+ Details

DERIVATIVE INSTRUMENTS (Schedule of Cross-Currency Swap Derivatives) (Details) SFr in Thousands, $ in Thousands	Dec. 31, 2024 USD ($)	Dec. 31, 2024 CHF (SFr)	Dec. 31, 2023 USD ($)	Dec. 31, 2023 CHF (SFr)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-Currency Interest Rate Swap
Derivative [Line Items]
Aggregate Notional Amount					$ 471,600	SFr 420,100
Cash Flow Hedges \| Designated as Hedging Instrument
Derivative [Line Items]
Aggregate Notional Amount	$ 1,125,000		$ 1,475,000
Fair Value Asset (Liability)	48,795		43,556
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (4,367)		(38,324)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One \| Long
Derivative [Line Items]
Fixed Rate	3.00%	3.00%
Aggregate Notional Amount \| SFr		SFr 328,136		SFr 351,137
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap One \| Short
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 368,362		394,183
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 0		(2,348)
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two \| Long
Derivative [Line Items]
Fixed Rate	2.40%	2.40%
Aggregate Notional Amount \| SFr		SFr 0		SFr 28,500
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap Two \| Short
Derivative [Line Items]
Fixed Rate	6.27%	6.27%
Aggregate Notional Amount	$ 0		31,457
Cash Flow Hedges \| Designated as Hedging Instrument \| Cross-Currency Interest Rate Swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ (4,367)		$ (40,672)

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details)	12 Months Ended
	Dec. 31, 2024 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

FAIR VALUE MEASUREMENTS

12 Months Ended

Dec. 31, 2024

Fair Value Disclosures [Abstract]

FAIR VALUE MEASUREMENTS

ASC 820 defines fair value as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which it would transact and considers assumptions that market participants would use when pricing the asset or liability.

Valuation techniques used to measure fair value should maximize the use of observable inputs and minimize the use of unobservable inputs. ASC 820 establishes a three-level hierarchy of the inputs (i.e., assumptions that market participants would use in pricing an asset or liability) used to measure fair value, giving the highest priority to quoted prices in active markets and the lowest priority to unobservable inputs in measuring fair value. The categorization within the valuation hierarchy is based on the lowest level of input that is significant to the entire fair value measurement. The three levels of the valuation hierarchy are defined as follows:

Level 1: Inputs to the valuation methodology are quoted prices in active markets for identical assets or liabilities.

Level 2: Inputs to the valuation methodology are other observable inputs, including quoted market prices for similar assets or liabilities in active markets; quoted prices for identical or similar assets or liabilities in markets that are not active; inputs other than quoted prices that are observable for the asset or liability; and inputs that are derived principally from or corroborated by observable market data by correlation or other means.

Level 3: Inputs to the valuation methodology are unobservable inputs that are supported by little or no market activity and are based on management’s best estimate of inputs market participants would use in pricing the asset or liability at the measurement date, including assumptions about risk.

Assets and Liabilities Measured at Fair Value on a Recurring Basis

The Company has investments in time deposits that are classified within Level 1 of the fair value hierarchy because they are valued using quoted market prices, as well as certain debt obligations that are classified within Level 1 of the fair value hierarchy because they are valued using quoted market prices. The investments in time deposits are classified as cash and cash equivalents and short-term investments on the consolidated balance sheets which is determined based on maturities at the time of purchase and re-evaluated at each balance sheet date.

The Company also has investments in derivative instruments, which are comprised of interest rate swaps, cross currency swaps, net investment hedges, and forward foreign currency contracts that are classified within Level 2 of the fair value hierarchy because they are valued using analyses obtained from independent third-party valuation specialists based on market observable inputs. The fair values of these derivative contracts represent the estimated amounts the Company would receive or pay to terminate the contracts. Refer to Note 6. Derivative Instruments for further discussion and information on these derivative contracts.

In addition, the Company has contingent consideration liabilities that are classified within Level 3 of the fair value hierarchy because they are measured at fair value using significant unobservable inputs, including management’s forecast of future revenues for the acquired businesses as well as management’s estimates of the likelihood of achieving the other specified criteria. Refer to Note 15. Commitments and Contingencies for additional information on these contingent consideration liabilities.

Assets and liabilities measured and recorded at fair value on a recurring basis as of December 31, 2024, 2023, and 2022 consisted of the following:


		Years Ended
Dollars in thousands	Fair Value Measurement	2024		2023		2022
Assets:
Cash and cash equivalents	Level 1	$	246,375	$	276,402	$	456,661
Short-term investments	Level 1	27,192		32,694		—
Interest rate swaps	Level 2	48,795		43,556		56,712
Pension plan assets	Level 2	51,818		45,724		38,053
Foreign currency forward contracts (not designated as hedges)	Level 2	1,700		1,200		1,100
Total Assets:		$	375,880	$	399,576	$	552,526

Liabilities:
Cross currency rate swaps	Level 2	$	4,367	$	40,672	$	7,769
Net investment hedges	Level 2	31,113		49,609		5,643
Foreign currency forward contracts	Level 2	914		—		—
Contingent consideration	Level 3	69,657		87,312		74,432
Pension project benefit obligation	Level 2	67,262		65,101		50,364
Total Liabilities:		$	173,313	$	242,694	$	138,208


	Years Ended
Dollars in thousands	2024		2023		2022
Balance at beginning of period	$	87,312	$	74,432	$	37,129
Change in fair value	(5,255)		12,880		37,303
Payments	(12,400)		—		—
Balance at end of period	$	69,657	$	87,312	$	74,432

There were no transfers into or out of Level 3 during the years ended December 31, 2024, December 31, 2023, and December 31, 2022.

Assets and Liabilities Measured at Fair Value on a Non-Recurring Basis

The Company remeasures the fair value of certain assets and liabilities, including property, plant and equipment; operating lease - right of use assets; and goodwill and other intangible assets, upon the occurrence of certain events. The amounts recognized were recorded to remeasure the carrying amount of assets to the assets’ fair values, which were generally estimated, based upon a market participant’s perspective, using Level 3 measurements, including values estimated using the income approach.

Other than the fair value estimates disclosed in Note 4. Acquisitions and Divestitures, Note 7. Goodwill and Other Intangibles, and Note 11. Lease and Related Party Leases, there were no non-recurring fair value measurements during the years ended December 31, 2024, December 31, 2023, and December 31, 2022.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 107
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-107

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-100

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(3)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2E
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2E

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6A
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-6A

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482106/820-10-50-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 940
-SubTopic 820
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478119/940-820-50-1

+ Details

RETIREMENT BENEFIT PLANS (Schedule of Net Periodic Benefit Costs) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Retirement Benefits [Abstract]
Service cost	$ 3,113	$ 2,226
Interest cost	866	1,157
Expected return on plan assets	(1,639)	(1,450)
Amortization of prior service cost (credit)	(585)	(389)
Settlements	(144)	0
Actuarial losses	6	(391)
Net periodic benefit cost	$ 1,617	$ 1,153
Defined Benefit Plan, Net Periodic Benefit (Cost) Credit, Amortization of Gain (Loss), Statement of Income or Comprehensive Income, Not Disclosed Flag	Net periodic benefit costs
Defined Benefit Plan, Net Periodic Benefit Cost (Credit), Amortization of Prior Service Cost (Credit), Statement of Income or Comprehensive Income, Not Disclosed Flag	Net periodic benefit costs
Defined Benefit Plan, Net Periodic Benefit Cost (Credit) Expected Return (Loss) Statement Of Income Or Comprehensive Income Extensible List, Not Disclosed Flag	Net periodic benefit costs
Defined Benefit Plan, Net Periodic Benefit Cost (Credit), Interest Cost, Statement of Income or Comprehensive Income, Not Disclosed Flag	Net periodic benefit costs
Defined Benefit Plan, Net Periodic Benefit (Cost) Credit, Settlement Gain (Loss), Statement of Income or Comprehensive Income, Not Disclosed Flag	Net periodic benefit costs

INCOME TAXES (Schedule of Provision for Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Current:
Federal	$ (257)	$ 10,973	$ 24,201
State	1,330	2,851	3,835
Foreign	8,365	11,389	9,893
Total current	9,438	25,213	37,929
Deferred:
Federal	(27,148)	(19,060)	(11,591)
State	(4,093)	93	(2,316)
Foreign	10,510	7,082	9,322
Total deferred	(20,731)	(11,885)	(4,585)
Provision for income taxes	$ (11,293)	$ 13,328	$ 33,344

DERIVATIVE INSTRUMENTS (Fair Value of Derivative Instruments By Balance Sheet Location) (Details) - Designated as Hedging Instrument - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 59,227	$ 50,330
Total derivatives designated as hedges — Liabilities	46,827	97,055
Interest rate swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	12,320	14,675
Interest rate swap \| Cash Flow Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	38,302	30,710
Interest rate swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	684	579
Interest rate swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	1,145	1,250
Cross-currency swap \| Cash Flow Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets		537
Cross-currency swap \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	4,367	4,813
Cross-currency swap \| Cash Flow Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	0	36,396
Cross-currency swap \| Net Investment Hedges \| Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	8,605	2,938
Cross-currency swap \| Net Investment Hedges \| Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	0	1,470
Cross-currency swap \| Net Investment Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	210	2,903
Cross-currency swap \| Net Investment Hedges \| Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	39,507	51,114
Forward Currency Forward Contracts \| Cash Flow Hedges \| Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 914	$ 0

SUBSEQUENT EVENTS	12 Months Ended
SUBSEQUENT EVENTS	Dec. 31, 2024
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS On January 15, 2025, the Company completed the purchase of its manufacturing facility located in Plainsboro, New Jersey. The Company made a cash payment of $10.4 million upon closing.

NET INCOME PER SHARE (Tables)

12 Months Ended

Dec. 31, 2024

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	2024		2023		2022
Basic net (loss) income per share:
Net (loss) income	$	(6,944)	$	67,741	$	180,550
Weighted average common shares outstanding	77,010		80,089		82,997
Basic net (loss) income per common share	$	(0.09)	$	0.85	$	2.18

Diluted net (loss) income per share:
Net (loss) income	$	(6,944)	$	67,741	$	180,550

Weighted average common shares outstanding — Basic	77,010		80,089		82,997
Effect of dilutive securities:
Stock options and restricted stock	—		248		519
Weighted average common shares for diluted earnings per share	77,010		80,337		83,516
Diluted net (loss) income per common share	$	(0.09)	$	0.84	$	2.16

INCOME TAXES (Tables)

12 Months Ended

Dec. 31, 2024

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	2024		2023		2022
United States operations	$	(172,273)	$	(31,649)	$	92,642
Foreign operations	154,036		112,718		121,252
Total	$	(18,237)	$	81,069	$	213,894

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,
	2024		2023		2022
Federal statutory rate	21.0	%	21.0	%	21.0	%
Increase (decrease) in income taxes resulting from:
State income taxes, net of federal tax benefit	15.3	%	2.9	%	0.1	%
Benefit derived from foreign operations	22.4	%	(17.2)	%	(1.6)	%
Nondeductible meals and entertainment	(5.0)	%	1.1	%	0.1	%

Intercompany profit in inventory	4.2	%	3.3	%	0.3	%


Research and development credit	24.1	%	(5.7)	%	(1.4)	%


Nondeductible executive compensation & stock compensation shortfall	(19.7)	%	2.3	%	(0.6)	%
Transaction and deal related costs	(4.1)	%	3.3	%	(1.8)	%

Changes in valuation allowances	(6.0)	%	4.9	%	—	%
Return to provision	10.1	%	(0.8)	%	(0.5)	%
Other	(0.4)	%	1.3	%	—	%
Effective tax rate	61.9	%	16.4	%	15.6	%

Schedule of Provision for Income Taxes

The provision for income taxes consisted of the following:


	Years Ended December 31,
Dollars in thousands	2024		2023		2022
Current:
Federal	$	(257)	$	10,973	$	24,201
State	1,330		2,851		3,835
Foreign	8,365		11,389		9,893
Total current	$	9,438	$	25,213	$	37,929
Deferred:
Federal	(27,148)		(19,060)		(11,591)
State	(4,093)		93		(2,316)
Foreign	10,510		7,082		9,322
Total deferred	$	(20,731)	$	(11,885)	$	(4,585)
Provision for income taxes	$	(11,293)	$	13,328	$	33,344

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	2024		2023
Assets:
Doubtful accounts	$	3,370	$	2,581
Inventory related items	34,731		41,466
Tax credits	17,922		18,859
Accrued vacation	2,447		2,184
Accrued bonus	5,279		4,259
Stock compensation	8,343		9,117
Deferred revenue	4,206		1,849
Net operating loss carryforwards	27,370		28,799
Capitalization of research and development expenses	68,311		61,138
Unrealized foreign exchange gain	8,655		13,907
Charitable contributions carryforward	212		206

Leases and Other	59,339		55,271
Total deferred tax assets	240,185		239,636
Less valuation allowance	(15,504)		(12,486)
Deferred tax assets after valuation allowance	$	224,681	$	227,150
Liabilities:
Intangible and fixed assets	(218,125)		(168,229)
Unrealized foreign exchange loss	(11,280)		(10,024)
Leases and Other	(21,186)		(38,134)
Total deferred tax liabilities	$	(250,591)	$	(216,387)

Total net deferred tax (liabilities) assets	$	(25,910)	$	10,763

Summary of Valuation Allowance


	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, 2024
Deferred tax assets valuation allowance	17,823	5,330	(429)	(367)	22,357
Year ended December 31, 2023
Deferred tax assets valuation allowance	14,672	3,069	26	56	17,823
Year ended December 31, 2022
Deferred tax assets valuation allowance	15,258	(515)	—	(71)	14,672

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	2024		2023		2022
	(In thousands)
Balance, beginning of year	$	812	$	713	$	676
Gross increases:
Current year tax positions	—		—		37
Prior years' tax positions	35		372		—
Lapse of statute	(21)		(273)		—

Balance, end of year	$	826	$	812	$	713

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2024
Audit Information [Abstract]
Auditor Name	PricewaterhouseCoopers LLP
Auditor Location	Florham Park, New Jersey
Auditor Firm ID	238

REVENUES FROM CONTRACTS WITH CUSTOMERS (Schedule of Revenues Disaggregated by Major Source) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Disaggregation of Revenue [Line Items]
Total revenue	$ 1,610,527	$ 1,541,573	$ 1,557,666
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total revenue	1,143,636	1,058,993	1,019,564
Codman Specialty Surgical \| Neurosurgery
Disaggregation of Revenue [Line Items]
Total revenue	803,816	818,101	794,017
Codman Specialty Surgical \| Instruments
Disaggregation of Revenue [Line Items]
Total revenue	204,177	203,617	192,679
Codman Specialty Surgical \| ENT
Disaggregation of Revenue [Line Items]
Total revenue	135,643	37,275	32,868
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total revenue	466,891	482,580	538,102
Tissue Technologies \| Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total revenue	350,565	373,986	406,689
Tissue Technologies \| Private Label
Disaggregation of Revenue [Line Items]
Total revenue	$ 116,326	$ 108,594	$ 131,413

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- Definition

+ References

+ Details

INCOME TAXES (Schedule of Effective Tax Rate Reconciliation) (Details)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
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	15.30%	2.90%	0.10%
Benefit derived from foreign operations	22.40%	(17.20%)	(1.60%)
Nondeductible meals and entertainment	(5.00%)	1.10%	0.10%
Intercompany profit in inventory	4.20%	3.30%	0.30%
Research and development credit	24.10%	(5.70%)	(1.40%)
Nondeductible executive compensation & stock compensation shortfall	(19.70%)	2.30%	(0.60%)
Transaction and deal related costs	(0.041)	0.033	(0.018)
Changes in valuation allowances	(6.00%)	4.90%	0.00%
Return to provision	10.10%	(0.80%)	(0.50%)
Other	(0.40%)	1.30%	0.00%
Effective tax rate	61.90%	16.40%	15.60%

COMMITMENTS AND CONTINGENCIES - Narrative (Details) $ in Thousands			3 Months Ended	12 Months Ended
	Jan. 15, 2025 USD ($)	Dec. 06, 2022 USD ($) payment	Jun. 30, 2024 USD ($)	Dec. 31, 2024 USD ($) liability	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Jan. 31, 2021 USD ($)	Dec. 31, 2019 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Payment for contingent consideration				$ 11,923	$ 0	$ 0
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain milestones								$ 25,500
Contingent consideration								13,100
Arkis \| Milestone Payment One
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain milestones								10,000
Arkis \| Milestone Payment Two
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain milestones								$ 15,500
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
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
ACell, Inc.
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)							$ 23,900
ACell, Inc. \| Revenue-Based Performance Milestones In 2023
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)							$ 100,000
Surgical Innovations Associates, Inc.
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration		$ 57,607
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)		$ 90,000
Business acquisition, number of payments \| payment		2
Surgical Innovations Associates, Inc. \| Revenue Based Performance Milestones
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain milestones		$ 32,600
Payment for contingent consideration			$ 12,400
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)		50,000
Surgical Innovations Associates, Inc. \| FDA Approval Of Premarket Approval
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Contingent consideration, cash payments due upon achievement of certain milestones		25,000
Contingent consideration, cash payments due upon achievement of certain revenue-based performance milestones (up to)		$ 40,000
Plainsboro, New Jersey Manufacturing Facility \| Subsequent Event
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Purchase price of business acquisition	$ 10,400

FAIR VALUE MEASUREMENTS - Schedule of Contingent Consideration Liabilities (Details) - Contingent Consideration Liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, beginning of period	$ 87,312	$ 74,432	$ 37,129
Change in fair value	(5,255)	12,880	37,303
Payments	(12,400)	0	0
Balance, end of period	$ 69,657	$ 87,312	$ 74,432

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands				3 Months Ended	12 Months Ended
	May 16, 2024	Aug. 15, 2023	Jan. 26, 2023	Dec. 31, 2024	Dec. 31, 2024	Dec. 31, 2023	Jul. 31, 2024	Oct. 18, 2023	Jul. 18, 2023	Jun. 30, 2023	Apr. 26, 2022
Class of Stock [Line Items]
Treasury stock outstanding (in shares)				14,445	14,445	12,751
Treasury stock				$ 691,411	$ 691,411	$ 647,262
Treasury stock, average cost per share (in dollars per share)					$ 47.86	$ 50.76
Accelerated share repurchase program, receipt (payment)	$ 50,000	$ 125,000	$ 150,000
Accelerated share repurchases, shares received at inception	1,300	2,300	2,100
Accelerated share repurchases, percentage of expected total repurchased	70.00%	80.00%	80.00%
Accelerated share repurchases, additional shares received							400	900		600
Excise tax payable on share repurchases				2,500
Stock repurchase program, authorized amount (up to)									$ 225,000
Stock repurchase program, remaining authorized amount				$ 50,000	$ 50,000
2022 Share Repurchase Program
Class of Stock [Line Items]
Stock repurchase program, authorized amount (up to)											$ 225,000

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Pay vs Performance Disclosure
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-9

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
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+ Details

GOODWILL AND OTHER INTANGIBLE ASSETS

12 Months Ended

Dec. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

GOODWILL AND OTHER INTANGIBLE ASSETS

Goodwill

In accordance with FASB Topic 350, Intangibles—Goodwill and Other (“ASC 350”), goodwill is not subject to amortization but is tested for impairment at the reporting unit level annually in the third quarter. Additionally, the Company may perform interim tests of goodwill for impairment if an event occurs or circumstances change that could potentially reduce the fair value of a reporting unit below its carrying amount. The carrying value of each reporting unit is determined by assigning the assets and liabilities, including the existing goodwill and intangible assets, to those reporting units.

The Company tests for impairment by either performing a qualitative evaluation or a quantitative test. The qualitative evaluation is an assessment of factors, including reporting unit specific operating results as well as industry, market and general economic conditions, to determine whether it is more likely than not that the fair values of a reporting unit is less than its carrying amount, including goodwill. The Company may elect to bypass this qualitative evaluation for some or all of its reporting units and perform a quantitative test. The quantitative test uses a combination of both an income approach and a market approach to determine the fair value of the reporting unit. The income approach utilizes the estimated discounted cash flows for the reporting unit, while the market approach utilizes comparable publicly-traded companies’ revenue and earnings before interest, taxes, depreciation, and amortization (“EBITDA”) multiples. Estimates and assumptions used in the income approach to calculate projected future discounted cash flows included revenue growth rates, cost of sales, terminal growth rates, and a discount rate for each reporting unit. Discount rates are determined using a weighted average cost of capital for risk factors specific to each reporting unit and other market and industry data. The assumptions used are inherently subject to uncertainty and slight changes in these assumptions could have a significant impact on the concluded value. The estimates and assumptions applied represent a Level 3 measurement in the fair value hierarchy. Level 3 inputs are supported by limited or no market activity and reflect the Company’s assumptions in measuring fair value.

The key assumptions impacting the valuation included the following:

•The reporting unit’s financial projections, including revenue growth rates and cost of sales, 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 2024, the Company elected to bypass the qualitative evaluations of its Tissue Technologies, Neurosurgery, and Instruments and ENT reporting units and perform quantitative tests. The quantitative test for the Tissue Technologies reporting unit utilized a terminal growth rate of 2.5% and a discount rate of 12.5% in the income approach. The Company determined, after performing the quantitative analysis, that the fair value of the Tissue Technologies reporting unit was not less than its carrying amount, with 21.2% headroom. The quantitative test for the Neurosurgery reporting unit utilized a terminal growth rate of 2.5% and a discount rate of 12.0% in the income approach. The Company determined, after performing the quantitative analysis, that the fair value of the Neurosurgery reporting unit was not less than its carrying amount, with 11.7% headroom. The quantitative test for the Instruments and ENT reporting unit utilized a terminal growth rate of 2.5% and a discount rate of 11.5% in the income approach. The Company determined, after performing the quantitative analysis, that the fair value of the Instruments and ENT reporting unit was not less than its carrying amount, with 22.1% headroom. Based on the results of these quantitative tests, the Company recorded no impairment of goodwill for Tissue Technologies, Neurosurgery, or Instruments and ENT reporting units.

The Company performed a hypothetical sensitivity analysis of the fair value for each reporting unit by increasing the discount rate by 50 basis points, decreasing the terminal growth rate by 50 basis points, and holding all other assumptions constant, which resulted in a decrease to the estimated fair value of the Tissue Technology reporting unit by 4.5%, a decrease to the estimated fair value of the Neurosurgery reporting unit by 3.8%, and a decrease to the estimated fair value of the Instruments and ENT reporting unit by 3.5%. Based on the results of the hypothetical sensitivity analyses, the Company would still not have recorded an impairment of goodwill for Tissue Technologies, Neurosurgery, or Instruments and ENT reporting units.

During the first quarter of 2024, due to third-party audit findings and an update to the estimated timeframe to resume the commercial distribution of products manufactured in the Company’s manufacturing facility located in Boston, Massachusetts (the “Boston facility”), the Company elected to perform a quantitative analysis of its Tissue Technologies reporting unit. The

quantitative test utilized a terminal growth rate of 2.0% and a discount rate of 14.5% in the income approach. An impairment loss is recognized when the reporting unit’s carrying amount exceeds its estimated fair value. The Company determined, after performing the quantitative analysis, that the fair value of the Tissue Technologies reporting unit was not less than its carrying amount, with 19.9% headroom.

Changes in the carrying amount of goodwill in 2024 and 2023 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at January 1, 2023	$	656,219	$	382,662	$	1,038,881

SIA Acquisition	—		(382)		(382)
Foreign currency translation	10,718		6,245		16,963
Balance at December 31, 2023	$	666,937	$	388,525	$	1,055,462


Acclarent Acquisition	62,482		—		62,482
Foreign currency translation	(13,689)		(7,303)		(20,992)
Balance at December 31, 2024	$	715,730	$	381,222	$	1,096,952

Other Intangible Assets

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


	December 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,452,545	$	(525,959)	$	926,586
Customer relationships	12 years	166,038		(137,186)		28,852
Trademarks/brand names	27 years	99,951		(42,173)		57,778
Codman trade name	Indefinite	168,202		—		168,202
Supplier relationships	30 years	30,211		(19,126)		11,085
All other	6 years	22,820		(7,735)		15,085
		$	1,939,767	$	(732,179)	$	1,207,588


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman trade name	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

Intangible Assets with Indefinite Lives

The Company does not amortize intangible assets with indefinite lives but tests its intangible assets with indefinite lives for impairment annually in the third quarter in accordance with ASC 350. Additionally, the Company performs interim tests of its intangible assets with indefinite lives for impairment 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.

The quantitative test uses an income approach to determine the fair value of the indefinite-lived intangible asset. The income approach utilizes the estimated discounted cash flows for the indefinite-lived intangible asset. Estimates and assumptions used in the income approach to calculate projected future discounted cash flows included revenue growth rates, operating margins, and a discount rate for each indefinite-lived intangible asset. Discount rates are determined using a weighted average cost of capital 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. The assumptions used are inherently subject to uncertainty and slight changes in these assumptions could have a significant impact on the concluded value. The estimates and assumptions applied represent a Level 3 measurement in the fair value hierarchy described in ASC 820. Level 3 inputs are supported by limited or no market activity and reflect the Company’s assumptions in measuring fair value.

For intangible assets with indefinite lives, the Company elected to bypass the qualitative evaluation for its Codman trade name intangible asset and perform a quantitative test during the third quarter 2024. In performing this test, the Company utilized a discount rate of 13.0%. The assumptions used in evaluating the Codman trade name for impairment are subject to change and are tracked against historical results by management. Based on the results of the quantitative test, the Company recorded no impairment to the Codman trade name intangible asset.

Intangible Assets with Definite Lives

Developed technologies and other definite-lived intangible assets are amortized over their estimated useful lives either using the straight-line method or, if reliably determinable, based on the pattern of which the economic benefit of the asset is expected to be utilized. Definite-lived intangible assets are periodically evaluated for impairment in accordance with FASB Topic 360, Property, Plant and Equipment, (“ASC 360”) whenever events or changes in circumstances indicate that a definite-lived intangible asset’s carrying value may not be recoverable. The evaluation for recoverability involves comparing the carrying amount of the definite-lived intangible asset to the Company’s expectations of the future undiscounted cash flows derived from the definite-lived intangible asset. In the event the carrying value of the definite-lived intangible asset exceeds the undiscounted future cash flows expected to be derived from the definite-lived intangible asset over its remaining estimated useful life, the definite-lived intangible asset is considered not recoverable and the definite-lived intangible asset is tested for impairment. An impairment loss is measured as the excess of the definite-lived intangible asset’s carrying value over its fair value, calculated using market participant assumptions pursuant to ASC 820 using discounted future cash flows based on the present value of estimated future cash flows to be generated by the definite-lived intangible asset using a risk-adjusted discount rate. The impairment loss is recognized in the period that the impairment occurs.

In the first quarter of 2024, due to third-party audit findings and an update to the estimated timeframe to resume the commercial distribution of products manufactured in the Boston facility, the Company elected to perform quantitative impairment testing on certain definite-lived intangible assets including completed technology and customer relationships in accordance with ASC 360. The Company recorded an impairment charge related to the definite-lived intangible asset associated with the customer relationships of $7.1 million in intangible asset amortization in the consolidated statement of operations. With respect to the definite-lived intangible assets associated with the completed technology of SurgiMend® and PriMatrix®, the Company determined that the carrying amount of these definite-lived intangible assets were recoverable and, therefore, the intangible assets were not deemed to be impaired. In the second quarter of 2024, the Company approved a plan to transition the commercial distribution of SurgiMend® and PriMatrix® from the Boston facility to the Company’s manufacturing facility in Braintree, Massachusetts (the “Braintree facility”). The Company considered the impact to the update to the estimated timeframe to resume the commercial distribution of products manufactured in the Boston facility on the assumptions used in the quantitative assessment of the definite-lived intangible assets completed in the first quarter of 2024, which did not require further evaluation for impairment. The carrying values of SurgiMend® and PriMatrix® are $32.8 million and $24.4 million, respectively, as of December 31, 2024.

Amortization expense (including amounts reported in cost of product revenues) for the years ended December 31, 2024, 2023, and 2022 was $105.2 million, $82.8 million, and $78.3 million, respectively.

Annual amortization expense is expected to approximate $106.0 million in 2025, $105.8 million in 2026, $104.9 million in 2027, $101.3 million in 2028, $96.0 million in 2029, and $528.2 million thereafter. Amortization of product technology based intangible assets totaled $84.0 million, $70.4 million and $64.4 million for the years ended December 31, 2024, 2023, and 2022, respectively, and is presented by the Company within cost of goods sold.

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases Current Period (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Operating Leased Assets [Line Items]
2025	$ 23,346
2026	20,137
2027	19,701
2028	17,945
2029	17,726
Thereafter	169,433
Total minimum lease payments	268,288
Less: Imputed interest	86,818
Total lease liabilities	181,470	$ 182,133
Less: Current lease liabilities	14,540	15,284
Long-term lease liabilities	166,930	$ 166,849
Related Parties
Operating Leased Assets [Line Items]
2025	296
2026	296
2027	296
2028	296
2029	246
Thereafter	0
Total minimum lease payments	1,430
Third Parties
Operating Leased Assets [Line Items]
2025	23,050
2026	19,841
2027	19,405
2028	17,649
2029	17,480
Thereafter	169,433
Total minimum lease payments	$ 266,858

RETIREMENT BENEFIT PLANS (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Defined Benefit Plan Disclosure [Line Items]
Gain (loss) recognized within accumulated other comprehensive loss	$ 1,300,000	$ (6,600,000)
Accumulated benefit obligation	60,100,000	62,800,000
Benefit plans, assets	51,818,000	45,724,000	$ 38,053,000
Contributions expected to be paid to plan	3,100,000
Total contributions made	$ 10,400,000	10,400,000	$ 9,800,000
Defer payment and taxation, base salary, percentage (up to)	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%
Deferred compensation plan, fair value of assets	$ 6,700,000	$ 6,100,000
FRANCE
Defined Benefit Plan Disclosure [Line Items]
Benefit plans, assets	0
GERMANY
Defined Benefit Plan Disclosure [Line Items]
Benefit plans, assets	$ 0

REVENUES FROM CONTRACTS WITH CUSTOMERS

12 Months Ended

Dec. 31, 2024

Revenue from Contract with Customer [Abstract]

REVENUES FROM CONTRACTS WITH CUSTOMERS

Summary of Accounting Policies on Revenue Recognition

Performance Obligations

Significant Estimates

Contract Assets and Liabilities

The following table summarized the changes in the contract asset and liability balances for the year ended December 31, 2024:


Dollars in thousands	Total
Contract Asset
Contract asset, January 1, 2024	$	9,233
Transferred to trade receivable from contract asset included in beginning of the year contract asset	(9,233)
Contract asset, net of transferred to trade receivables on contracts during the period	6,146
Contract asset, December 31, 2024	$	6,146

Contract Liability
Contract liability, January 1, 2024	$	16,252
Recognition of revenue included in beginning of year contract liability	(10,307)
Contract liability, acquired with Acclarent	3,984
Contract liability, net of revenue recognized on contracts during the period	9,874
Foreign currency translation	(134)
Contract liability, December 31, 2024	$	19,669

At December 31, 2024, the short-term portion of the contract liability of $10.5 million and the long-term portion of $9.2 million is included in current liabilities and other liabilities, respectively, in the consolidated balance sheet.

As of December 31, 2024, the Company is expected to recognize revenue from unsatisfied or partially satisfied performance obligations of approximately $10.5 million in 2025, $5.1 million in 2026, $2.9 million in 2027, $0.8 million in 2028, $0.2 million in 2029, and $0.1 million thereafter.

Shipping and Handling Fees

Product Warranties

Taxes Collected from Customers

Disaggregated Revenue

The following table presents revenues disaggregated by the major sources of revenues for years-ended December 31, 2024, 2023, and 2022 (dollar amounts in thousands):


	Year Ended December 31, 2024		Year Ended December 31, 2023		Year Ended December 31, 2022
Neurosurgery	$	803,816	$	818,101	$	794,017
Instruments	204,177		203,617		192,679
ENT(1)(2)	135,643		37,275		32,868
Total Codman Specialty Surgical	1,143,636		1,058,993		1,019,564

Wound Reconstruction and Care(3)(4)	350,565		373,986		406,689
Private Label	116,326		108,594		131,413
Total Tissue Technologies	466,891		482,580		538,102
Total revenue	$	1,610,527	$	1,541,573	$	1,557,666

(1) See Note 4. Acquisitions and Divestitures for details surrounding the acquisition of Acclarent on April 1, 2024.

(2) Prior period revenues included within our instruments business have been reclassified under the ENT business.

(3) See Note 4. Acquisitions and Divestitures for details surrounding the SIA acquisition on December 7, 2022.

(4) See Note 4. Acquisitions and Divestitures for details surrounding the sale of the Company’s non-core traditional wound care (“TWC”) business on August 31, 2022.

Note 16. Segment and Geographic 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-13

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org/606/tableOfContent

+ Details

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

12 Months Ended

Dec. 31, 2024

Equity [Abstract]

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)

Comprehensive income for the years ended December 31, 2024 and 2023:


Dollars in thousands	2024		2023		2022
Net (loss) income	$	(6,944)	$	67,741	$	180,550
Foreign currency translation adjustment, net of tax	(18,904)		(12,103)		(17,807)
Change in unrealized loss/(gain) on derivatives, net of tax	5,123		(6,658)		65,798
Pension liability adjustment, net of tax	1,316		(6,610)		7,429
Comprehensive income, net	$	(19,409)	$	42,370	$	235,970

Changes in accumulated other comprehensive loss by component between December 31, 2024 and 2023 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, 2023	$	21,489	$	2,712	$	(39,307)	$	(15,106)
Other comprehensive gain (loss)	50,119		2,040		(11,123)		41,036
Less: Amounts reclassified from accumulated other comprehensive income, net	44,996		724		7,781		53,501
Net current-period other comprehensive gain (loss)	5,123		1,316		(18,904)		(12,465)
Balance at December 31, 2024	$	26,612	$	4,028	$	(58,211)	$	(27,571)

For the year ended December 31, 2024, the Company reclassified gains of $32.3 million and $21.2 million from accumulated other comprehensive loss to other income, net and interest income, respectively.

ACQUISITIONS AND DIVESTITURES (Tables)

12 Months Ended

Dec. 31, 2024

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

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	Estimated Fair Value		Estimated Useful Life
Current assets:
Cash	$	—
Trade accounts receivable, net of allowances of $3,885	23,716
Inventories, net	20,294
Prepaid expenses	273
Other current assets	476
Total current assets	$	44,759
Property, plant and equipment, net	7,716
Right of use asset - operating leases	989
Intangible assets, net
Completed technology	202,000		12 years
Trademarks/brand names	3,000		5 years
All other	17,000		4 years
Goodwill	62,482
Deferred tax assets	6,895
Total assets acquired	$	344,841

Current liabilities:
Accounts payable, trade	$	3,989
Contract liabilities	3,984
Accrued compensation	1,037
Accrued expenses and other current liabilities	2,278
Current portion of lease liability - operating leases	365
Total current liabilities	$	11,653
Lease liability - operating leases	624
Deferred tax liabilities	54,753
Total liabilities assumed	$	67,030

Net assets acquired	$	277,811

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


Dollars in thousands	Final Valuation		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, net	75,000		14 years
Goodwill	41,380
Total assets acquired	$	126,923

Current liabilities:
Accounts payable and accrued expenses	$	2,044
Total current liabilities	$	2,044
Deferred tax liabilities	11,325
Contingent consideration	57,607
Total liabilities assumed	70,976

Net assets acquired	$	55,947

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Equity [Abstract]
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Foreign currency translation adjustment, net of tax	(18,904)	(12,103)	(17,807)
Change in unrealized loss/(gain) on derivatives, net of tax	5,123	(6,658)	65,798
Pension liability adjustment, net of tax	1,316	(6,610)	7,429
Comprehensive income, net	$ (19,409)	$ 42,370	$ 235,970

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income, attributable to parent entity. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

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

+ References

+ Details

DEBT (Schedule of Debt Maturity) (Details) $ in Thousands	Dec. 31, 2024 USD ($)
Debt Disclosure [Abstract]
2025	$ 33,906
2026	38,750
2027	53,281
2028	634,532
Principal Repayment	$ 760,469

- Definition

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

+ References + Details

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Restructuring Reserve [Roll Forward]
Balance, beginning of the year	$ 2,113	$ 5,107
Payments and other adjustments	(1,909)	(4,042)
Balance, end of the year	5,151	2,113
Cost of goods sold
Restructuring Reserve [Roll Forward]
Charges:	$ 377	$ 0
Restructuring Charges, Statement of Income or Comprehensive Income [Extensible Enumeration]	Cost of goods sold	Cost of goods sold
Research and development
Restructuring Reserve [Roll Forward]
Charges:	$ 602	$ 0
Restructuring Charges, Statement of Income or Comprehensive Income [Extensible Enumeration]	Research and development	Research and development
Selling, general and administrative
Restructuring Reserve [Roll Forward]
Charges:	$ 3,968	$ 1,048
Restructuring Charges, Statement of Income or Comprehensive Income [Extensible Enumeration]	Selling, general and administrative	Selling, general and administrative

SUBSEQUENT EVENTS (Narrative) (Details) $ in Millions	Jan. 15, 2025 USD ($)
Plainsboro, New Jersey Manufacturing Facility \| Subsequent Event
Subsequent Event [Line Items]
Purchase price of business acquisition	$ 10.4

SEGMENT AND GEOGRAPHIC INFORMATION - Segment Reporting Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	$ 1,610,527	$ 1,541,573	$ 1,557,666
Cost of goods sold	728,466	656,838	587,355
Research and development	115,377	104,192	101,193
Selling, general and administrative	716,983	656,641	616,316
Intangible asset amortization	21,290	12,376	13,882
Total costs and expenses	1,582,116	1,430,047	1,318,746
Operating income	28,411	111,526	238,920
Interest income	20,040	17,202	11,917
Interest expense	(70,632)	(51,377)	(49,594)
Gain on sale of business	0	0	644
Other income, net	3,944	3,718	12,007
(Loss) income before income taxes	(18,237)	81,069	213,894
Codman Specialty Surgical
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	1,143,636	1,058,993	1,019,564
Tissue Technologies
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	466,891	482,580	538,102
Operating Segments \| Codman Specialty Surgical
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	1,143,636	1,058,993	1,019,564
Cost of goods sold	384,422	364,144	345,742
Research and development	30,770	29,984	35,902
Selling, general and administrative	224,370	214,335	220,047
Intangible asset amortization	0	0	0
Total costs and expenses	639,562	608,463	601,691
Operating income	504,074	450,530	417,873
Operating Segments \| Tissue Technologies
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	466,891	482,580	538,102
Cost of goods sold	162,535	164,966	120,937
Research and development	18,140	24,202	28,936
Selling, general and administrative	147,047	159,364	154,427
Intangible asset amortization	0	0	0
Total costs and expenses	327,722	348,532	304,300
Operating income	139,169	134,048	233,802
Corporate and Other
Segment Reporting Information, Operating Income (Loss) [Abstract]
Total revenue, net	0	0	0
Cost of goods sold	181,509	127,728	120,676
Research and development	66,467	50,006	36,355
Selling, general and administrative	345,566	282,942	241,842
Intangible asset amortization	21,290	12,376	13,882
Total costs and expenses	614,832	473,052	412,755
Operating income	$ (614,832)	$ (473,052)	$ (412,755)

SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)

12 Months Ended

Dec. 31, 2024

Accounting Policies [Abstract]

Accounts Receivable, Allowance for Credit Loss

The below table shows the roll forward of the allowance for doubtful accounts for the years ended December 31, 2024, 2023, and 2022:


	Balance at Beginning of Period		Charged to Costs and Expenses	Acquisition	Deductions	Balance at End of Period
Dollars in thousands
Year Ended:
December 31, 2024	$	4,879	3,416	2,162	(3,540)	$	6,917
December 31, 2023	$	4,304	2,963	—	(2,388)	$	4,879
December 31, 2022	$	4,735	238	—	(669)	$	4,304

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

Schedule of Inventories

Inventories consisted of the following:


	December 31,
Dollars in thousands	2024		2023
Finished goods	$	223,729	$	196,402
Work in process	79,423		74,035
Raw materials	125,938		119,171
Total inventories, net	$	429,090	$	389,608

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	2024		2023		Useful Lives
Land	$	952	$	978
Buildings and building improvements	19,748		14,859		5-40 years
Leasehold improvements	179,904		171,062		1-20 years
Machinery and equipment	214,786		202,023		3-20 years

Information systems and hardware	171,739		160,899		1-7 years
Furniture, fixtures, and office equipment	18,887		20,549		1-15 years
Construction-in-progress	196,630		137,276
Total	802,646		707,646
Less: Accumulated depreciation	(396,923)		(367,447)
Property, plant and equipment, net	$	405,723	$	340,199

Restructuring and Related Costs

The following table summarizes the restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the years ended December 31, 2024 and 2023.


	Years Ended December 31,
(Dollars in thousands)	2024		2023
Balance, beginning of the year	$	2,113	$	5,107
Charges:
Cost of Goods Sold	377		—
Research and development	602		—
Selling, general and administrative	3,968		1,048
Payments and other adjustments	(1,909)		(4,042)
Balance, end of the year	$	5,151	$	2,113

STOCK-BASED COMPENSATION (Summary of Stock Option Activity) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Outstanding at beginning of year (in shares)	1,178
Granted (in shares)	244
Exercised (in shares)	(162)
Forfeited or Expired (in shares)	(56)
Outstanding at end of year (in shares)	1,204	1,178
Exercisable at end of year (in shares)	798
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)	$ 50.64
Weighted Average Exercise Price, Granted (in dollars per share)	36.22
Weighted Average Exercise Price, Exercised (in dollars per share)	33.46
Weighted Average Exercise Price, Forfeited or Expired (in dollars per share)	50.21
Weighted Average Exercise Price, Outstanding at end of year (in dollars per share)	50.06	$ 50.64
Weighted Average Exercise Price, Exercisable at end of year (in dollars per share)	$ 52.51
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 3 days	3 years 7 months 24 days
Weighted Average Contractual Term in Years, Exercisable at end of year	2 years 8 months 15 days
Aggregate Intrinsic Value, Outstanding	$ 0	$ 1,766
Aggregate Intrinsic Value, Exercisable at end of year	$ 0

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, 2024	Dec. 31, 2023	Dec. 31, 2022
Basic net (loss) income per share:
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Weighted average common shares outstanding - Basic (in shares)	77,010	80,089	82,997
Basic net (loss) income per common share (in dollars per share)	$ (0.09)	$ 0.85	$ 2.18
Diluted net (loss) income per share:
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Weighted average common shares outstanding - Basic (in shares)	77,010	80,089	82,997
Effect of dilutive securities:
Stock options and restricted stock (in shares)	0	248	519
Weighted average common shares for diluted earnings per share (in shares)	77,010	80,337	83,516
Diluted net income per common share (in dollars per share)	$ (0.09)	$ 0.84	$ 2.16

- Definition

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

+ References

+ Details

- Definition

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

+ References

+ Details

- Definition

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

+ References

+ Details

BUSINESS	12 Months Ended
BUSINESS	Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS	BUSINESS Integra 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, Ear, Nose, Throat (“ENT”) 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 salesforces and through a variety of other distribution channels.

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Lessee, Lease, Description [Line Items]
ROU assets	$ 144,042	$ 156,184
Current lease liabilities	14,540	15,284
Non-current lease liabilities	166,930	166,849
Total lease liabilities	$ 181,470	$ 182,133
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	16 years 1 month 6 days	16 years 3 months 18 days
Weighted average discount rate	5.40%	5.90%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 3 months 18 days	1 year 10 months 24 days
Weighted average discount rate	2.80%	2.70%

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Statement of Comprehensive Income [Abstract]
Net (loss) income	$ (6,944)	$ 67,741	$ 180,550
Other comprehensive (loss) income, before tax:
Change in foreign currency translation adjustments	(15,860)	(20,821)	(17,807)
Unrealized gain (loss) on derivatives
Unrealized derivative gain (loss) arising during period	62,638	(22,071)	104,351
Less: Reclassification adjustments for gain (loss) included in net income	53,882	(13,423)	18,859
Unrealized gain (loss) on derivatives	8,756	(8,648)	85,492
Defined benefit pension plan - net gain (loss) arising during period	1,557	(6,610)	7,429
Total other comprehensive (loss) gain, before tax	(5,547)	(36,079)	75,114
Income tax (expense) benefit related to items in other comprehensive gain (loss)	(6,918)	10,708	(19,694)
Total other comprehensive gain (loss), net of tax	(12,465)	(25,371)	55,420
Comprehensive (loss) income, net of tax	$ (19,409)	$ 42,370	$ 235,970

LEASES AND RELATED PARTY LEASES (Tables)

12 Months Ended

Dec. 31, 2024

Leases [Abstract]

Supplemental Balance Sheet Information

Supplemental balance sheet information related to operating leases at December 31, 2024 were as follows:


	December 31, 2024			December 31, 2023
	(In thousands, except lease term and discount rate)

ROU assets	$	144,042		$	156,184

Current lease liabilities	14,540			15,284
Non-current lease liabilities	166,930			166,849
Total lease liabilities	$	181,470		$	182,133

Weighted average remaining lease term (in years):

Leased facilities	16.1 years			16.3 years
Leased vehicles	2.3 years			1.9 years

Weighted average discount rate:
Leased facilities	5.4		%	5.9		%
Leased vehicles	2.8		%	2.7		%

Supplemental Cash Flow Information

Supplemental cash flow information related to leases was as follows:


	December 31, 2024		December 31, 2023
	(In thousands)
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$	24,122	$	20,655

ROU assets obtained in exchange for lease liabilities, net of modifications:
Operating leases	$	3,565	$	9,843

Schedule of Operating Lease Maturities

Future minimum lease payments under operating leases at December 31, 2024 were as follows:


	Related Parties		Third Parties		Total
	(In thousands)
2025	$	296	$	23,050	$	23,346
2026	296		19,841		20,137
2027	296		19,405		19,701
2028	296		17,649		17,945
2029	246		17,480		17,726
Thereafter	—		169,433		169,433
Total minimum lease payments	$	1,430	$	266,858	$	268,288
Less: Imputed interest					86,818
Total lease liabilities					181,470
Less: Current lease liabilities					14,540
Long-term lease liabilities					$	166,930

STOCK-BASED COMPENSATION (Tables)

12 Months Ended

Dec. 31, 2024

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	2024		2023		2022
Cost of goods sold	$	649	$	588	$	549
Research and development	2,697		2,071		1,739
Selling, general and administrative	21,031		17,483		25,437
Total stock-based compensation expense	$	24,377	$	20,142	$	27,725
Total estimated tax benefit related to stock-based compensation expense	4,677		5,223		10,574
Net effect on net income	$	19,700	$	14,919	$	17,151

Summary Of Weighted-Average Assumptions

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


	Years Ended December 31,
	2024	2023	2022
Dividend yield	0%	0%	0%
Expected volatility	33%	30%	30%
Risk free interest rate	4.09%	3.86%	2.01%
Expected life of option from grant date	7 years	7 years	7 years
Weighted average grant date fair value of options granted	$15.68	$21.58	$23.15

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, 2024	1,178	$	50.64	3.65	$	1,766
Granted	244	36.22		—	—
Exercised	(162)	33.46		—	—
Forfeited or Expired	(56)	50.21		—	—
Outstanding at December 31, 2024	1,204	$	50.06	4.01	$	—
Exercisable at December 31, 2024	798	$	52.51	2.71	$	—

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, 2024:


	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, 2024	584	$	55.37	335	$	57.53
Granted	650	33.28		387	36.05
Adjustments for performance achievement related to award target	—	—		(160)	49.71
Cancellations	(115)	46.31		(35)	49.23
Released	(248)	58.04		(107)	33.37
Unvested, December 31, 2024	871	$	39.33	420	$	41.83

ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) (Narrative) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCL	$ 53,501
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCL	44,996
Other Income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCL	32,300
Interest income \| Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCL	$ 21,200

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

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, 2024	Dec. 31, 2023	Dec. 31, 2022
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 4,879	$ 4,304	$ 4,735
Charged to Costs and Expenses	3,416	2,963	238
Acquisition	2,162	0	0
Deductions	(3,540)	(2,388)	(669)
Balance at End of Period	$ 6,917	$ 4,879	$ 4,304

INCOME TAXES (Schedule of Income Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
United States operations	$ (172,273)	$ (31,649)	$ 92,642
Foreign operations	154,036	112,718	121,252
(Loss) income before income taxes	$ (18,237)	$ 81,069	$ 213,894

- 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/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 48
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-48

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-30

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 7: http://fasb.org/us-gaap/role/ref/otherTransitionRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(11))
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Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-31

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477314/942-235-S99-1

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 220
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-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483621/220-10-S99-2

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

+ Details

DERIVATIVE INSTRUMENTS (Tables)

12 Months Ended

Dec. 31, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Derivative Instruments

The Company held the following interest rate swaps as of December 31, 2024 and 2023 (dollar amounts in thousands):


	December 31, 2024		December 31, 2023							December 31, 2024			December 31, 2023
Hedged Item	Notional Amount				Designation Date	Effective Date	Termination Date	Fixed Interest Rate		Estimated Fair Value
										Asset (Liability)
1-month Term SOFR Loan	$	—	$	150,000	December 13, 2017	July 1, 2019	June 28, 2024	2.423	%	$	—		$	2,105
1-month Term SOFR Loan	—		200,000		December 13, 2017	January 1, 2018	December 31, 2024	2.313	%	—			4,978
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.220	%	421			1,349
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.199	%	502			1,312
1-month Term SOFR Loan	75,000		75,000		October 10, 2018	July 1, 2020	June 30, 2025	3.209	%	403			1,346
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.885	%	3,406			3,015
1-month Term SOFR Loan	100,000		100,000		December 18, 2018	December 30, 2022	December 31, 2027	2.867	%	3,507			3,052
1-month Term SOFR Loan	575,000		575,000		December 15, 2020	July 31, 2025	December 31, 2027	1.415	%	34,537			22,965
1-month Term SOFR Loan	125,000		125,000		December 15, 2020	July 1, 2025	December 31, 2027	1.404	%	7,848			5,263
Basis Swap (1)	—		—		March 31, 2023	March 24, 2023	December 31, 2027	N/A		(1,829)		0	(1,829)
	$	1,125,000	$	1,475,000						$	48,795		$	43,556
(1) The notional of the basis swap amortizes to match the total notional of the interest rate swap portfolio over time

The Company held the following cross-currency rate swaps as of December 31, 2024 and 2023 (dollar amounts in thousands):


					December 31, 2024	December 31, 2023	December 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay CHF	December 21, 2020	December 22, 2025	3.00%	CHF	328,136	351,137	$	(4,367)	$	(38,324)
Receive U.S.$			3.98%	$	368,362	394,183

Pay CHF	September 22, 2023	September 23, 2024	2.40%	CHF	—	28,500	—		(2,348)
Receive U.S.$			6.27%	$	—	31,457

Total							$	(4,367)	$	(40,672)

The Company held the following cross-currency rate swaps designated as net investment hedges as of December 31, 2024 and 2023 (dollar amounts in thousands):


					December 31, 2024	December 31, 2023	December 31, 2024		December 31, 2023
	Effective Date	Termination Date	Fixed Rate	Aggregate Notional Amount			Fair Value Asset (Liability)

Pay EUR	October 3, 2018	September 30, 2025	—%	EUR	38,820	38,820	$	4,827	$	2,475
Receive U.S.$			2.19%	$	45,000	45,000

Pay CHF	May 26, 2022	December 16, 2028	—%	CHF	240,175	288,210	(27,951)		(48,047)
Receive U.S.$			1.94%	$	250,000	300,000

Pay CHF	November 17, 2023	December 17, 2029	—%	CHF	66,525	66,525	(3,248)		(4,037)
Receive U.S.$			2.54%	$	75,000	75,000

Pay CHF	May 6, 2024	December 18, 2030	—%	CHF	68,483	—	(4,741)		—
Receive U.S.$			2.74%	$	75,000	—

Total							$	(31,113)	$	(49,609)

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, 2024 and 2023:


	Fair Value as of December 31,
Dollars in thousands	2024		2023
Location on Balance Sheet (1):
Derivatives designated as hedges — Assets:
Prepaid expenses and other current assets
Cash Flow Hedges
Interest rate swap	$	12,320	$	14,675
Cross-currency swap			537

Net Investment Hedges
Cross-currency swap	8,605		2,938
Other assets
Cash Flow Hedges
Interest rate swap	38,302		30,710


Net Investment Hedges
Cross-currency swap	—		1,470
Total derivatives designated as hedges — Assets	$	59,227	$	50,330

Derivatives designated as hedges — Liabilities
Accrued expenses and other current liabilities
Cash Flow Hedges
Interest rate swap	$	684	$	579
Cross-currency swap	4,367		4,813
Foreign Currency Forward Contracts	914		—
Net Investment Hedges
Cross-currency swap	210		2,903
Other liabilities
Cash Flow Hedges
Interest rate swap	1,145		1,250
Cross-currency swap	—		36,396

Net Investment Hedges
Cross-currency swap	39,507		51,114
Total derivatives designated as hedges — Liabilities	$	46,827	$	97,055

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

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


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, 2024
Cash Flow Hedges
Interest rate swap	$	43,556	$	22,692	$	17,454	$	48,794	Interest expense
Cross-currency swap	(15,763)		41,013		36,871		(11,621)		Other income, net
Forward Currency Forward Contracts	—		(1,067)		(443)		(624)		Cost of sales and other income, net
Net Investment Hedges
Cross-currency swap	(45,498)		24,489		10,121		(31,130)		Interest income
	$	(17,705)	$	87,127	$	64,003	$	5,419
Year Ended December 31, 2023
Cash Flow Hedges
Interest rate swap	$	56,712	$	4,899	$	18,055	$	43,556	Interest expense
Cross-currency swap	(20,271)		(27,406)		(31,914)		(15,763)		Other income, net
Forward Currency Forward Contracts	—		436		436		—		Cost of sales and other income, net
Net Investment Hedges
Cross-currency swap	(6,914)		(30,738)		7,846		(45,498)		Interest income
	$	29,527	$	(52,809)	$	(5,577)	$	(17,705)

Derivatives Not Designated as Hedging Instruments

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


Dollars in thousands	December 31,
	2024		2023
Foreign currency forward contracts	$	598	$	—
Foreign currency swaps	56		566
Total	$	654	$	566

- 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 + Details

STOCK-BASED COMPENSATION (Narrative) (Details) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	May 31, 2017	May 31, 2010	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Dividend yield			0.00%	0.00%	0.00%
Total stock-based compensation expense			$ 24,377	$ 20,142	$ 27,725
Intrinsic value, options exercised			700	1,800	4,000
Cash received from option exercises and employee stock purchase plan			6,400	4,300	5,500
Tax expense realized from stock options exercised			$ 500
Tax benefit realized from stock options exercised				100	600
Shares available for purchase (in shares)			3,700,000
Capitalized share-based compensation cost			$ 700	600	600
Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Plan modification, expiration period (in months)			6 months
Plan modification, compensation expense			$ 1,900
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			4 years
Total stock-based compensation expense			$ 2,200	1,400	3,500
Total unrecognized compensation costs related to unvested awards			$ 2,900
Weighted-average period for cost recognition, in years			3 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]
Total stock-based compensation expense			$ 22,100	18,700	24,300
Total unrecognized compensation costs related to unvested awards			$ 27,000
Weighted-average period for cost recognition, in years			2 years
Fair value of shares vested			$ 11,300	$ 18,200	$ 65,000
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for issuance (in shares)			3,000,000.0
Shares available for purchase (in shares)			1,900,000
Shares issued (in shares)			44,426	23,337	20,780
ESPP proceeds received			$ 1,000	$ 1,000	$ 1,100
2003 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Increase in authorized shares (in shares)	1,700,000	3,500,000
Common stock reserved for issuance (in shares)			14,700,000

INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax [Line Items]
Effective tax rate	61.90%	16.40%	15.60%
Effective income tax rate reconciliation, tax credit, research	$ 4,400
Effective income tax reconciliation, tax benefit, excess stock-based compensation deductions		$ 5,800	$ 5,100
Effective income tax rate reconciliation, prior year income taxes, amount			$ 2,400
Effective income tax rate reconciliation, foreign income tax rate differential, increase (decrease), amount	$ 400
Effective foreign income tax rate	12.30%	16.40%
Deferred tax asset, increase	$ 10,400	$ 14,400
Valuation allowance, period increase (decrease)	3,000	$ 2,800
Unrecognized tax benefits that would impact effective tax rate	800
Swiss Tax Credit
Income Tax [Line Items]
Valuation allowance, period increase (decrease)	1,100
Federal
Income Tax [Line Items]
Operating loss carryforwards	51,200
Operating loss carryforwards, subject to expiration	51,200
Foreign Tax Jurisdiction
Income Tax [Line Items]
Operating loss carryforwards	106,700
Operating loss carryforwards, subject to expiration	87,500
Operating loss carryforwards, not subject to expiration	19,100
State and Local Jurisdiction
Income Tax [Line Items]
Operating loss carryforwards	$ 46,500

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)

12 Months Ended

Dec. 31, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

Changes in the carrying amount of goodwill in 2024 and 2023 were as follows:


Dollars in thousands	Codman Specialty Surgical		Tissue Technologies		Total
Goodwill at January 1, 2023	$	656,219	$	382,662	$	1,038,881

SIA Acquisition	—		(382)		(382)
Foreign currency translation	10,718		6,245		16,963
Balance at December 31, 2023	$	666,937	$	388,525	$	1,055,462


Acclarent Acquisition	62,482		—		62,482
Foreign currency translation	(13,689)		(7,303)		(20,992)
Balance at December 31, 2024	$	715,730	$	381,222	$	1,096,952

Schedule of Components of Indefinite-Lived Intangible Assets

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


	December 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,452,545	$	(525,959)	$	926,586
Customer relationships	12 years	166,038		(137,186)		28,852
Trademarks/brand names	27 years	99,951		(42,173)		57,778
Codman trade name	Indefinite	168,202		—		168,202
Supplier relationships	30 years	30,211		(19,126)		11,085
All other	6 years	22,820		(7,735)		15,085
		$	1,939,767	$	(732,179)	$	1,207,588


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman trade name	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

Schedule of Components of Finite-Lived Intangible Assets

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


	December 31, 2024
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	17 years	$	1,452,545	$	(525,959)	$	926,586
Customer relationships	12 years	166,038		(137,186)		28,852
Trademarks/brand names	27 years	99,951		(42,173)		57,778
Codman trade name	Indefinite	168,202		—		168,202
Supplier relationships	30 years	30,211		(19,126)		11,085
All other	6 years	22,820		(7,735)		15,085
		$	1,939,767	$	(732,179)	$	1,207,588


	December 31, 2023
Dollars in thousands	Weighted Average Life	Cost		Accumulated Amortization		Net
Completed technology	18 years	$	1,226,128	$	(448,519)	$	777,609
Customer relationships	12 years	193,895		(152,160)		41,735
Trademarks/brand names	28 years	98,892		(38,754)		60,138
Codman trade name	Indefinite	174,531		—		174,531
Supplier relationships	30 years	30,211		(18,148)		12,063
All other	11 years	6,180		(4,423)		1,757
		$	1,729,837	$	(662,004)	$	1,067,833

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
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-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
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-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

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+ Details

REVENUES FROM CONTRACTS WITH CUSTOMERS (Narrative) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
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	$ 10,483	$ 8,540
Long-term portion of contract liability	$ 9,200
Product warranty period (up to)	2 years