CONMED Corporation (CNMD) Earnings Call Transcript & Summary

Great. Welcome, everyone. I'm Robbie Marcus, MedTech Analyst at JPMorgan. Really happy to introduce our next session. It's going to be CONMED, introducing Curt Hartman, the CEO; and Todd Garner, the CFO. Curt, I'll turn it over to you, and we'll do some Q&A after.

Thank you, Robbie, and good afternoon, everybody. I appreciate you all being here with us today and our opportunity to present to you on behalf of CONMED Corporation. We have the forward-looking information slide. I'll let you peruse that for a moment, and then we'll jump right in here. And we always like to start our presentations with CONMED's vision. And at the essence of it is empowering healthcare providers worldwide with the ability to deliver exceptional outcomes. We underpin that with the focus behind the vision, which is really about our people, our products. And ultimately, that leads to profitability. And underneath that, we have the 5 pillars that CONMED operates under. These were created in collaboration with a broad executive team and review deeper into the organization. You go into any facility around the world in CONMED, you see these in the facility. They are prominently displayed in all of our business cards, et cetera. I want to pay particular attention to the 2 bookends. On one side, you see we do things the right way. On the other side, you see we deliver exceptional results. Those are the 2 bookends specifically for CONMED Corporation in the way we behave and the way we operate in the marketplace. I want to jump off on that, we deliver exceptional results because I go into the next slide, which is relevant to this audience, 'What are CONMED's objectives for our shareholders?' And I really want to spend some time on this slide to help everybody understand how we think about the business. We're not here to run it for 90 days. We're here to run this over time, deliver exceptional results over time, consistent, predictable delivery. And it starts with aggregating growth and profitability to significantly increase the valuation of the company. Hopefully, that resonates with you. Evolve our product mix towards higher growth, higher-margin offerings; and I'll bring that point back home in a few slides, but that is a very essential element of our promise and objectives for our shareholders. Increase our market share; if we're not growing our market share, that means we're not winning in the markets we serve, and we do serve large and attractive markets. I'll show you more detail on that momentarily. And finally, in doing that, we want to deliver above-market revenue and profitability growth over the long term. You notice the word 'long term' is dispersed throughout those objectives many times. And that above-market revenue, when we get to the slide that talks about markets that we serve; we think the markets we operate in are growing somewhere between 5% and 7% on an annualized, call it, normalized basis. Hard to look at that in 2020, '21, '22 with all the ups and downs. But on a normalized basis, the markets and categories we're in, about 5% to 7% globally. So important reminders for shareholders, what our objectives are, but also help cement you as you think about CONMED as an investment thesis. So let's start with the markets. If you look at orthopedics -- this is about a $13 billion market. I'm doing some rounding there in my math for CONMED Corporation, our results through September of 2023. -- about 37% of the revenue comes out of the U.S. About 63% comes internationally. 76% of global revenue is recurring single-use consumables, either implants left behind in the body or single-use accessories that are used in affecting the surgical procedure. You can see we break that down into 3 categories: Sports Medicine & Biologics, that is the repair of soft tissue and healing of soft tissue; Capital Equipment, visualization systems, saws, drills, for reshaping bone, cutting, shaping, bone; and then Foot & Ankle, an acquisition we did in 2022, it's the implants to restructure the foot, the ankle space, comprehensive Foot & Ankle solution. You can see about 60% to 70% of that revenue in the U.S. market occurs in surgery centers. And when you take the concept of gathering one share point across all those markets, it equates to about $136 million annually, which would be the equivalent of 11% growth for CONMED Corporation. So we just need to be in the markets with innovative products and there's a great market share capture opportunity. Jump over to general surgery, not quite as large of an addressable market, about $11 billion, again, rounding my numbers here. And for CONMED, through September 2023, about 70% of that revenue is in the U.S., kind of the inverse of our Orthopedics business, about 30% internationally and almost 90% of that is recurring single-use categories. We define the categories as Access, this is when you're doing minimally invasive surgery, how do you access the abdominal cavity. We do that through our AirSeal platform and other devices; the Energy, which is about cutting and affecting tissue; the Instruments category, which are the things that are used in those laparoscopic procedures and those MIS procedures. Endoscopic Technologies, we have a smaller business that focuses on therapeutic GI. And then ultimately, one of the legacy portfolios is our Critical Care business. But again, great markets, sizable markets, healthy competitors, both in orthopedics and in general surgery. This one is a little bit more pronounced in the hospital, about 90% to 95% of the revenue in the hospital. And again, a similar dynamic when you think about 1 percentage point of market share capture would be the equivalent of 9 percentage growth points for CONMED Corporation. So 2 very large markets, about $24 billion market opportunity, growing markets and CONMED has a great presence in all of those markets. I want to jump and remind you of our latest announcement, third quarter announcement. This is a year-to-date snapshot. And what you see here is very consistent growth rates. For total CONMED, 17.6% growth, General Surgery, 17.9%, Orthopedic 17.2%. If you look at the split, domestic was about 56% of revenue, international 44%. We're a little bit different in MedTech. Most MedTech companies are 70-30. We're a more balanced portfolio, and you see that from the definitions I gave on the earlier slide. Domestic revenue growth, 17%; international, 18%. So we have a good physical footprint in both markets. And then single-use for the total company is about 84% of the revenue. So through 9 months, we were on track for a very solid year. We'll report our fourth quarter and full year results here at the end of January, but this is the information we provided in our last quarterly earnings call. I want to go back to that statement that I made in the shareholder objectives, long-term performance. I joined the company in 2014. I came to JPMorgan in January of 2015. The company was actually shrinking on the top line. And that's pretty tough to do in MedTech. These are growth markets we serve. So there was a big turnaround that the initial management team undertook. We're very proud of the results since we affected that turnaround. You can see the impact of COVID in 2020; in 2022, if you were part of the story, in the fourth quarter, we implemented a new global distribution system. That did not go as smooth as we would have liked it; we fixed that subsequently in the first quarter of this year. And you can see our most recent guidance splits this year 2023 at $1.240 billion to $1.260 billion. You can see earnings have tracked pretty efficiently with the revenue. And again, this is our view; it's not about what we did last year or what we're going to do next year. It's about performance over time. We want to be one of those MedTech stories as a small or mid-cap however you wanted to find us, we think there is an outcome where you continue to grow and continue to be flourishing in this market. A lot of mid-cap companies wind up either as acquisition targets or they're unsuccessful. And we think we've got a management team here that can continue to drive growth in the markets we serve and continue to provide a trajectory similar to the one that we've demonstrated here since 2015. This is a very important slide. If you look at the mix shift of the portfolio in 2015, we had 79% of the portfolio that was declining, we had 21% that was growing single digits. That was our starting point. In 2019, we presented this slide and said, "Hey, we're now at 35% of the portfolio growing double digits, 48% growing single digits, and we've taken that 79% down to 17. And now we're updating that slide, April through September of this year; we are 41% of our global portfolio growing double digits, 47% growing single digits and 12% declining. I don't know if you ever get to 0 declining, but I sure like the upper 2 bars. And I think the note on the right here about these high-growth product lines, they're also highly margin accretive to the overall offering, which is the next part of the story, which is the growth in mix shift by category. We publicly report General Surgery and Orthopedics. In 2015, 100% of our general surgery portfolio was declining. As of September 23, 64% was a double-digit grower, 25% was single-digit grower, 11% declining. You look at Orthopedics, 34% back in 2015 was single digit, 66% was declining. As of September 23, we've got 10% now and double-digit grower, 77% single digit and down to 12% declining. So it's been a substantial mix shift by category for the company over this management tenure that the team has assembled both through organic R&D additions to the portfolio, but also some key inorganic acquisitions through the commercial leadership and our strategy and business development team. Some acquisitions we're very proud of, platform technologies that really differentiate us in the market and allow us to deliver real solutions to our customers and help their patients that they serve. We've also had an ongoing undertaking of our environmental, social and governance initiatives. Now we're trying to do this in a form that matches the scale of our company. We're not going to be the trend-setters on ESG, but we are doing it in a very methodical way. Some of the agenda items here that we're very proud of, our Board governance, I think we have best-in-class board governance. Our Board tenure, we have a 12-year term limit. Every chair rotates after 5 years. We have 33% of our Board that is diverse. I'm also very proud of some of our individual sites and the work that they have done around environmental, but is important around community and investment back into the community. One of the big agenda items we have in the U.S. is a United Way campaign. Every one of -- we had our highest participation rate ever in 2023 campaign. And every one of our sites invest back into their local community through volunteer activity and volunteer participation in local community work projects and benefits. Further, when we look at this, I'm going to point to the middle here on social. We partner, I mentioned United Way, but we also partner with TEAMFund, which is an investment that we make that helps provide medical technology to underserved markets around the world. And that is led by a former industry executive, Tim Ring, who used to run C.R. Bard, where Todd came from. And I've known Tim for a long time. So we think that's a really good place to put money to help expand healthcare to underserved populations. So a small snippet of what we're doing in our most recent report on ESG and our tear sheet is available on the CONMED website. We put that up in December. And we think it's just kind of something we'll continue to build year in and year out. So closing thoughts. We have an intense focus on the commercial side of our company about solving unmet needs and -- when we do that, we garner the attention of our healthcare customers, and we do that through platform technologies, things like AirSeal, Buffalo Filter, the Biorez platform that we acquired in '22 and the in2Bones platform that we acquired in '22. In addition to that, CONMED had some inherently wonderful portfolio technologies and it's implantable categories in sports medicine, but also in its general surgery categories. So all these platform technologies allow us to continue to position and grab market share with our health care customers. As demonstrated by the slides, we're not lacking for opportunity. The markets we serve, north of $20 billion global opportunity, they're growth markets, and we are well positioned to continue to take share year in and year out and continue to invest back in our portfolio. As the slides in the middle showed, our portfolio continues to evolve. Our most recent acquisitions in2Bones and Biorez, both have gross margins north of 80%. The AirSeal platform is in the 70s. The Buffalo Filter platform is in the 60s. And anything that we put out organically, we have a mandate that it will be accretive to overall company gross margins. Now we're willing to make exceptions and let products into the market as long as we see a clear path to exceeding the company gross margins, but it's a pretty high bar to get over, and our internal R&D teams and marketing teams to understand that. And then finally, I'd just underscore at all with this last statement. We're focused at CONMED on doing things the right way and being good corporate citizens in all the communities around the world that we compete in and that we serve. So with that said, I think Robbie is going to come back up. Perfect timing, Robbie, and we're going to go into Q&A.

Great. I want to start out -- you had a couple of different slides, and I want to try and tie this all together where you have the high-growth slides. You had all the M&A you've done over the years and how it's higher gross margin. Maybe just start with your philosophy on how cobbled is the wrong word. But how you cobble together all of these high-growth, high-margin assets and where you are in the process? Are you near done? Or are you still just at the beginning?

It's a great question, and I'm going to go back to 2015. And I said the CONMED journey, I think you can find those slides out there. It was a pretty ugly slide deck that I put up. It really did not paint a very good story of CONMED's history. And I said the only way to turn this around is with people. And we got to get the right people in the company. And if you look at my management team, if you look at the guy sitting on my left and his background in MedTech, if you look at the gentleman sitting up here, he's ran bigger businesses before he came to CONMED. If you look at the gentleman who runs our general surgery portfolio, got an extensive background in MedTech. If you look at my head of M&A sitting over there, extensive background in investment banking and then in venture investing and then with a large strategic doing M&A. And I could continue on. The leadership team here is what brings the proximity to the market. We've instilled that into the company's culture, and they are the people in the market day in, day out, saying what do our customers telling us we need. And so that portfolio mix really comes from their proximity to the marketplace and that specialization that we've driven. Part of it was also our design. We did a substantial change in the organizational design to create these focused specialty businesses. So they are spending time all day, every day with a customer base, learning what they need, trying to find products that address what they're asking for. And we have a very diligent process on M&A. We have -- we look at a lot of stuff every year. Even when our leverage was up over 5x, Pete and his team did not get time off because these deals take time to track down, to materialize and to put through our processes. And obviously, we exclude far more than we approve. But the 4 that we have found, knocking have been home runs. -- home runs in the marketplace, home runs with our customers. And I don't think that ever ends, Robbie. It's a journey. We're super excited about what we have. We're working on getting the leverage down. We never told the team to take a year off. Like they're still looking at stuff. So it's a journey. As we get bigger, we're going to keep going after the right portfolio mix. And as important, our internal marketing and R&D teams are doing the same thing every single day.

And remind me where you are now in terms of leverage and what target you're going for?

So we were about 4.8 at the end of Q3, and we said when Q4 is reported, it should be below 4.25. And then we'll be into the 3s in 2024.

And the goal is to get to 3.5, 3x.

Well, yes, I mean we'll -- we said we get down into the low 3s. That's our last disclosure. So we'll update expectations in a few weeks when we report.

So when I look at 2024, you have a good growth base business, Buffalo Filter and AirSeal continuing to grow probably 20% plus or so. In2Bones, now an organic growth, still double digits, I imagine. And this should be the first year that the Biorez acquisition starts to -- if I remember right, it was high single-digit millions contributing in 2024 and data maybe later this year…

Early 2023.

Oh, sorry -- with double-digit Imaging for this year -- with data later in '24 or early '25 that can really kick into gear if it's positive, the revenue growth for next year. So when you add all that up, would you be disappointed if you weren't close to 10% or so, high single digit, 10% when we end up?

Yes. I mean, obviously, it depends on how the underlying market is doing, right? But yes, I think that the way we define winning at CONMED, as Curt showed in his presentation, is gaining market share, which means you're growing faster than your markets, right? And so if our markets are growing 5% to 7%, we've got to be better than that. Now to your point, you called out a few -- we have some -- a few of our significant growth drivers that are growing 2x the market. And so if you take that part of the portfolio that we've talked quite a bit about, it's about 30% of the portfolio, if that's growing at 20% area, which we think it is, that 6 points of growth from 30% of the business. So to hit that magical 10%, you would need the other 70% of the portfolio to grow a little short of 6%, right, for the math to add up to 10 perfectly. So if the markets are 5 to 7 and the markets are healthy and if we're executing like we should, that's a reasonable expectation. If the markets are a little soft to given the quarter and if we end up in the 9s or I think we're still winning, right? And so we're excited that, again, we talked about a little history here compared to Curt's first presentation here where the company wasn't even growing. And now we really are -- whether we're double digits or just shy of that. It's a very healthy MedTech company. We're clearly growing faster than our markets. And with good durability and good balance across the portfolio. So we feel very good about the engine of the company now and where we're headed.

Maybe we could spend a minute there because it is the less sexy part of the business. I'm sure you get a lot less questions on the non-high-growth assets. I know you restructured the U.S. ortho sales force, what, almost a year ago now, plus or minus.

A little more...

A little more... Maybe just... Give us a quick highlight clip on some of the new products, some of the different initiatives you have in the base business just because we don't get that great a look at the details there?

Yes. Sports Medicine is a really sexy business, Robbie. I mean you go spend a day in a sports medicine OR, highly competitive. Every competitive rep is in the room. It is -- if you have a competitive ounce in your body, you walk in that room, it's super competitive. When CONMED Corporation walks in there, we have the full complement for rotator comp repair. We have an evolving portfolio around knee ACLM, CL, PCL. And then in the middle of that, we dropped this wonderful product called BioBrace. And it is a game changer in terms of getting clinicians attention. We supplement that with a comprehensive large and small bone power tool offering and a video platform. When you're doing arthroscopic procedures in the knee and shoulder, you have to have a video platform and the CONMED Linvatec brand is one of the legacy brands in video for arthroscopy. And it is about iterating, it is about next-generation technology. We're going to be back in the city in a month for Academy. And at Academy, I think if you come by our booth at the Moscone Center, you're going to see some new sports medicine technologies. And that is about constant innovation, moving the opportunity a little bit forward every time on your base platform. They don't get the headlines like AirSeal and Buffalo Filter and Biorez and in2bones, but they're every bit as important to the customer, the everyday user. So that's why we have internal R&D continue to work on these things and advance those portfolio offerings.

Over the course of '23 and prior years, there were some supply challenges in some of these businesses. How do you feel about supply today? And is it still impacting your availability to sell?

20 through 2022, we're probably the most volatile we've seen in supply chain, both from a pricing and inflationary pressure standpoint, but unpredictability. I think the company candidly did a very good job managing through that. I think there were some announcements by some larger strategics we said, "Hey, we're past that. I think there's still supply chain disruption in the marketplace for MedTech. And we actually talked about some of it in our business in the third quarter. So I don't think the category of MedTech supply chain challenges is completely back to 2019 and normal. It's certainly better than it was in '21 and '22. But I think our last disclosure on it, was we thought we would be passed through most of it by the end of Q1 of 2024.

Great. Todd, maybe before we dive into some of these high-growth opportunities in the pipeline, we can talk about your margin guidance that you gave and maybe just remind everyone the details of what you've said for 2024 and 2025, both on gross margin and operating margin.

Sure...

And your confidence on being able to hit the...

Yes. I'm going to start with the confidence actually and it comes from history. So like the rest of the world, we experienced all the inflationary pressures of the pandemic and related issues. If we might be unique in that our gross margin and for the full year 2022 was the same as our gross margin in 2019. Most companies, I think, saw a deceleration in the gross margin degradation in the gross margin. Ours was flat despite absorbing 400 basis points of inflationary cost from freight, labor and material. Material cost is the biggest portion. So in that 3-year period, we absorbed 400 basis points of inflation and our gross margins stayed flat. And that's because of the mix benefit, Curt talked about those high-growth product lines for us are also accretive to margins. And so we have this mixed tailwind that has been real and existed the last several years has been masked by inflation. So -- and that mix tailwind is not waning because those parts of the business are becoming a bigger part of the portfolio. So if we can just get cost to stabilize, then you'll see that margin benefit come through. And that's what you've started to see in Q3, and we've talked about Q4, we talked about some challenges specific to Q4. But even with those challenges, we're still seeing sequential growth we guided to still seeing sequential growth in our gross margin. And if you compare it to Q4 a year ago, it's meaningful growth. So that margin improvement story driven by mix is very much alive, very big part of our future. We think if those costs can stabilize; and then hopefully, in 2025, we think that we ought to get about 100 basis points of that 400 of inflation back through material costs, mostly that we said that we should have gross margins around 60% by the end of 2025. And so I think the improvements in '25 is bigger than the improvements in '24, but that mix is built into kind of the portfolio that Curt showed and the fact that all of those things that are growing faster also bring a higher relative margin to the corporate average.

Is there any way to tease out which products can what?

Sure. The 2022 acquisition, so that's In2Bones and Biorez, -- those products are both north of 80% gross margin. AirSeal, which is our biggest product line, is in the low 70s from a gross margin perspective and Buffalo Filter is in the low 60s.

Great. I would imagine R&D investment isn't going to go up materially as a percentage of sales. SG&A, you can probably continue to get leverage. So I'd expect fair to say operating margin grows more than the gross margin improvements you talked about?

That's exactly right, yes. I mean we're not guiding specifically to 24 here today, but the general approach to the P&L is exactly as you said, Robbie. We think R&D probably stays in that 4% to 5% of sales. And then we should -- as we grow, we should get leverage on SG&A. So the improvements that I talked about in gross margin, you should see a little better than that in the operating margin line.

Great. Maybe we can move it up to the top line here. Maybe starting with AirSeal, your biggest product line, as you just said, -- this has been a controversial topic for investors as I'm sure you've had a few questions over the past year or so. AirSeal is used primarily in laparoscopic and robotic surgery more robotic surgery. And people are expecting a new robot to come this year and the company that you sell into or it's used a lot with Intuitive Surgical has talked about insufflation is an area they'd like to get into. So I feel like there's 4 options that could happen. One, there's no new robot. 2, there's a new robot with no integrated insufflation, one with integrated insufflation, that's a direct low-pressure differentiated competitor with AirSeal and when that's a standard integrated insufflation. So -- maybe if you think about those options, I'm sure you're prepared for all of them. I know you remain confident through all of them, but maybe just give us a bit of background of why you're confident in how you think about those 4 different scenarios.

Well, I do want to correct one part of the premise of your question. Actually, Intuitive has not said anything. About insufflation -- this has been supposition from Novanta who makes -- they're the OEM supplier of standard insufflators to the market. They talked about that they're going to be working worth robotics coming. So the Street has connected those dots, Intuitive has actually been silent when it comes to insufflation being integrated with their new robot. But that is the supposition in the marketplace that Intuitive is going to come out with an integrated insufflator. We understand that people say, "Oh, CONMED's got a differentiated insufflator intuitive coming into that space can be good. I understand that logic. If you look at the details of what's in the marketplace, we compete with standard insufflation all day every day, have for a long time. The addition -- the features that Novanta is so excited about are actually not new to the they're certainly not new to us. We've been evacuating smoke continuously with our insufflator for a decade. This is something new to them that they're excited about, that they can now offer to their standard insufflation customers. We don't believe that reads at all to the differentiation that AirSeal has in the marketplace. If you go look at our Q2 earnings presentation, our IR deck, the last few slides show the proven benefits over dozens of studies, millions of patients that show that AirSeal provides 50% reduction in length of stay, 30-plus percent reduction in PACU time. We're the only insufflator on the market that has any data like that. And I would submit to you that no doctor is going to walk away from those benefits, 50% reduction in length of stay to something that doesn't have that, that's a standard insufflator with no data, no evidence of clinical performance just because of a company whoever sells it. That's not how medicine works. It's not how doctors make decisions. Length of stay is probably the biggest thing that hospitals consider when making purchase decisions. So it's very simplified to say, well, just because if Intuitive comes out with something, everybody is going to buy it because Intuitive sells it. Not if it doesn't perform as well as what they're using, that's very simple-minded.

What if there is an AirSeal competitor, would that overlap with some of your patents? Would you -- do you think you'd have advanced notice of something differentiated like that?

Yes. We -- so look, the thing about MedTech is there's lots of different ways to do things. Now what's unique about AirSeal, it uses an aerodynamic principle instead of valves to keep the gas from escaping. That's one of the main features that allows us to provide a stable working space that's not always going up and down. We don't -- and smarter people than me have looked at it we don't think you can do it without valves without stepping on our patents, which go out into the -- I think it's 2032 to 2039 is our current our key patents when they roll on. So we don't believe you can get to trocars without valves without stepping on our patents. If we're dreaming and imagining if somebody could, that's one part of the equation they would need to solve. The other part is AirSeal does all functions simultaneously. So we're insufflating we're measuring, we're removing constantly simultaneously. We're the only product on the market that does that. So if they could solve the valve issue and the aerodynamic principle, they still have to solve the simultaneous function, and there's no supposition in the market that anybody is working on that. And I'll just remind you what has been said from these competitors, nobody is talking about valveless; nobody is talking about low pressure, nobody. And so that is all imagination. But if we're speculating if somebody could actually get through that and make something that had all of those features, then it would probably be competitive to are. But nobody is talking about that.

Maybe zooming out to the broader smoke evacuation market. How do you feel about trends going into 2024 in that market? Any new states that are bringing on legislation, -- any other drivers that make you feel really good about this market?

So smoke evacuation it's a higher-growth market. It's really kind of the genesis is the OR worker and the safety of the OR staff. And if you go around the globe, markets like Canada have had long-standing legislation. In the U.S., the legislation has been more recent, and it's going state by state in different states at different levels of legislation. So there's the day they announce it, the day it becomes effective, then the day that they start measuring against that legislation. In states like Oregon, Colorado, they've had very solid legislation that has been announced and implemented, and you see more rapid adoption. Other states, there's not quite as much substance in the legislation. So you see a little bit softer -- there was some good movement in 2023 in the market for legislation. As you look at 2024, you have states like Texas, and I think Florida and North Carolina that have legislation that they're talking about advancing. But in 2023, you had states like Texas come on board, a very large health care market. So these -- as legislation comes in, it's a tailwind to the overall growth, which is really being driven by the health care worker and the safety for the health care worker. If you go outside the U.S., I've already talked about Canada, the Scandinavian countries have good smoke behavior. The Australian market has good behavior as it relates to surgical smoke removal and the safety of the staff and the well-being of the staff. So it's this combination of legislation, but I still think underwriting all as a health care worker and the overriding emphasis on safety.

Maybe in the last few minutes, we can talk about BioBrace. I remember AAOS last year is probably one of the best attended presentations I saw at the event, lots of buzz at the booth. We're going to get to your data? What is it end of this year or early next year?

It'll be 25.

Okay. 25 -- maybe just speak to what does the data allow you to do? Is it reimbursement? Is it really what's needed to drive adoption with physicians? And then how quickly do you think it could be adopted once that comes out?

Well, before I answer that, this is a second-generation product. So the market has familiarity with collagen applications. What BioBrace brings is a 3-dimensional construct that brings strength at time-zero. That's -- that with the collagen is a differentiation for anything else that's in the marketplace. -- the approval for the product gives us broad overall indication and application. So we have products that target rotator cuff, which is the largest single market. We also have a product for augmentation in the knee in the ACL case. But you see applications being pursued by the surgical community in foot and ankle space, and glutamate repair, subcap repair, which is highly encouraging to us because there's lots of places in the body with disease underlying tissue that needs a healing application. Our clinical study right now is focused on rotator cuff. And that clinical study is targeting indications of greater than 3 millimeter tears and larger because large massive rotator cuff are the ones that have the highest rate of failure, and it failed very quick post-surgically. So this is a critical piece of evidence that the clinical community wants to see, though they fundamentally understand the underlying strength of time-zero and collagen A applications. So the study will do that. It will help as it relates to reimbursement in select markets, and it will just help broader adoption. There are some surgeons who just will not adopt until they see that long-term clinical study.

And maybe with the last minute or so, so keeping it short. What's the direct comparison to the first-gen product and what makes it better?

What's the direct I'm not sure.

I'm on... Strength. Why is it better?

Strength of time-zero, strength the time-zero. That is an absolute game changer, differentiator, fully bio absorb within 2 years and strength of time-zero the collagen application.

Yes. The other product, Robbie, is just the collagen. So it doesn't provide any strength that -- so it provides the healing and it's been very effective and work, we provide the strength with the collagen. So it's kind of the best bolt...

Right... We're out of time. Appreciate it. We can end it there. Thanks for joining. Thanks, everyone, for attending.

Thank you.