v3.26.3
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2026
Sep. 30, 2025
OPERATING ACTIVITIES    
Net loss $ (23,780) $ (29,545)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:    
Goodwill and other intangible asset impairments 611 4,163
Depreciation and amortization 17,048 15,517
Stock-based compensation 12,592 13,362
Fair value adjustment of contingent consideration (814) 0
Accretion of acquisition installment payable 365 105
Deferred income taxes (393) 120
Non-cash other 695 (88)
Changes in certain operating assets and liabilities:    
Accounts receivable - trade (4,717) (8,270)
Inventories (4,922) (7,893)
Prepaid expenses and other current assets (579) 176
Accounts payable - trade 5,299 (1,961)
Accrued expenses and other liabilities 1,816 790
Other (1,074) (1,675)
Net cash provided by (used in) operating activities 2,147 (15,199)
INVESTING ACTIVITIES    
Other acquisitions, including clinics, net of cash acquired (8,410) (8,852)
Sale of short-term marketable securities 15,000 0
Investment in private companies and purchases of licenses (810) (2,007)
Purchase of short-term marketable securities 0 (15,000)
Purchases of property and equipment (8,716) (10,511)
Net cash used in investing activities (2,936) (36,370)
FINANCING ACTIVITIES    
Proceeds from issuance of debt 0 25,000
Payment on debt issuance costs (289) 0
Payments on mortgage notes (127) (119)
Payments on acquisition notes (2,464) (489)
Net cash (used in) provided by financing activities (2,880) 24,392
Effect of exchange rate changes on cash, cash equivalents and restricted cash (100) 284
NET DECREASE IN CASH, CASH EQUIVALENTS AND RESTRICTED CASH (3,769) (26,893)
Cash, cash equivalents and restricted cash, beginning of year 21,620 45,777
Cash, cash equivalents and restricted cash, end of period 17,851 18,884
SUPPLEMENTAL DISCLOSURES    
Cash paid for interest 5,646 4,562
Transfer of instruments between property and equipment and inventory 2,611 1,881
Right-of-use assets obtained in exchange for lease liabilities 2,838 4,812
Capital contribution associated with reclassification of MedTech liability to equity 0 2,062
Medtech    
SUPPLEMENTAL DISCLOSURES    
Issuance of common shares 2,398 226
LOC Acquisition    
SUPPLEMENTAL DISCLOSURES    
Issuance of common shares 1,656 0
Boston Brace International, Inc    
SUPPLEMENTAL DISCLOSURES    
Issuance of common shares 0 233
Vendor    
SUPPLEMENTAL DISCLOSURES    
Issuance of common shares $ 0 $ 1,261