I am thrilled to share the inaugural edition of The Tiger Dashboard with everyone—for this month only. These are my notes – unbiased, no ads, just unfiltered information as accurate as possible. I only wish I had a comprehensive dashboard of trends when I was working for ortho companies.
Quick Overview of Sections:
- General Trends in Ortho
- M&A Predictions (Future)
- M&A Recent (Actual YTD)
- Funding Trends
- Fundings Recent
- Public Company Performance (Q3 2025)
- Startups Orthos that I Like
- Struggling and Zombie Public Companies
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Buckle up, here we go.
General Trends in Ortho
↑ Orthopedist Employment Shift (+25-50% to large groups/hospitals): More surgeons moving to W2 salaried roles in consolidated systems, centralizing device purchasing and enabling bulk contracts.
↑ PE Acquisitions of Orthopedic Practices (+700% platforms since 2017): PE groups increasingly buying up independent orthopedic practices to build consolidated networks, providing financial stability, operational support, and monetization opportunities amid reimbursement pressures and market shifts.
↑ Sales roles are rapidly transforming, requiring reps to shift from focusing solely on the surgeon relationship to mastering complex value-based procurement and hospital finance strategies.
↑ Hospital Value Analysis Committees (VACs) (+36% adoption): Ubiquitous in large systems for cost control, requiring robust ROI data but creating opportunities for evidence-based innovations.
↑ Outpatient/ASC Migration (+20-30% annual growth): Procedures shifting to cost-efficient ASCs, demanding portable, modular devices with high price sensitivity.
↑ Surgical Robotics/Automation (+9.6-27% CAGR): Expanding to spine/shoulders, with AI integration for precision; high costs but spreading to smaller facilities.
↑ AI/AR/Digital Integration: Enhancing diagnostics, outcomes prediction, and visualization; focuses on interoperability for precision medicine and remote monitoring.
↑ 3D Printing/Personalized Implants: Growing for complex cases, reducing OR time/inventory via custom solutions with FDA clearances.
↑ Minimally Invasive/Value-Based Care: Driven by reimbursements, benefiting low-complication innovations with demonstrated cost-effectiveness.
↑ Workforce Shortages/Productivity Tools (+15-30k specialist shortfall): Increasing caseloads demand efficiency tech like robotics to boost volumes.
↑ Regenerative Therapies: Emerging biologics (e.g., cartilage implants) challenging traditional prosthetics, prompting pivots in regen med.
↑ Aging Population/Chronic Diseases (+73M seniors by 2030): Boosting spine/joint demand for durable, biocompatible devices.
↑ Outpatient Shifts: More procedures moving to ASCs to enhance cost efficiency and reduce high-cost inpatient surgeries.
↑ All-Suture Technology: Shift from metal-based anchors to all-suture innovations for better biocompatibility, such as SutureTech’s Rapid-Fix, which reduces procedure time by 70%.
↑ GLP-1s Impact: Growing adoption in the US, with dual effects on elective ortho joints—potentially reducing long-term hip/knee replacement volumes by addressing obesity-related deterioration, while improving surgical safety and outcomes through preoperative weight loss.
↑ Due to the burdensome EU MDR regulations, ortho device companies are increasingly prioritizing launches in the US or Asia, slashing R&D efforts, and abandoning innovations in the European market.
↓ Independent Private Practices (-50-60% decline): Falling solo/small groups due to burdens, pay drops (-20% inflation-adjusted), and consolidation pressures.
↓ Metal-Based Anchors: Declining in favor of more biocompatible alternatives.
↓ High-Cost Inpatient Surgeries: Being supplanted by outpatient efficiencies.
M&A Predictions (Future)
Trend Vectors:
↑ Spin-outs in spine
↑ Startup acquisitions in AI
→ Slow but building momentum in 2026
Orthofix will sell its Spine Business to Arthrex, in the next 3 months.
Arthrex will acquire UK-based Corin, in the next 4 months.
Medtronic will spin-out Spine division with future possible IPO, in the next 6 months.
M&A Recent (Actual YTD)
Trend Vectors:
↓ Deal volume (muted in 2025)
↑ Value in strategic buys
Acumed acquired TECHFIT Digital Surgery on November 5 for an undisclosed value as an asset acquisition focused on digital surgical planning and patient-specific implants in craniofacial procedures.
SK Capital acquired LISI Group’s Medical Division on November 3 for an undisclosed value and renamed it Precera Medical, specializing in orthopedic and trauma devices.
WRS Group acquired Avanos Medical’s Game Ready orthopedic rental business on October 23 for an undisclosed value, targeting pain management and rehab post-orthopedic surgery.
EmergeOrtho merged with Murphy Wainer Orthopedic Specialists and Guilford Orthopaedic and Sports Medicine Center in October for an undisclosed value, expanding services in the Triad region.
Boston Scientific acquired Nalu Medical on October 17 for approximately $533 million, focusing on neurostimulation for pain relief with orthopedic synergies in peripheral nerve stimulation.
Zimmer Biomet acquired Monogram Technologies on October 7 for $4.04 per share with an enterprise value of $168 million, expanding robotics with AI-driven autonomous solutions for knee arthroplasty.
Zydus Lifesciences acquired Amplitude Surgical SA in September/October for an undisclosed value, gaining a 100% stake in the designer and distributor of hip and knee orthopedic products.
Keensight Capital acquired a majority stake in Isto Biologics on September 17 for an undisclosed value, targeting biomaterials for tissue regeneration in orthopedics.
Highridge Medical acquired Accelus’ FlareHawk and Toro systems on September 2 for an undisclosed value, adding expandable interbody fusion for spine.
Driving Force acquired Wenzel Spine’s Vertebral Motion Analysis technology on August 27 for an undisclosed value, enhancing spinal instability diagnostics.
Tenon Medical acquired SiVantage’s SImmetry technologies on August 1 for an undisclosed value, bolstering sacroiliac joint fusion.
Channel-Markers Medical acquired Avanos Medical’s Hyaluronic Acid product line on July 31 for an undisclosed value, aimed at osteoarthritis knee pain treatment.
ARCHIMED acquired ZimVie on July 21 for $19 per share with an enterprise value of $730 million, covering dental and spine implants.
Companion Spine acquired Paradigm Spine on July 8 for an undisclosed value, adding spine implants for pain disorders.
Avista Healthcare Partners acquired Highridge Medical’s EBI Bone Healing business on June 4 for an undisclosed value, supporting orthopedic recovery.
Merit Medical acquired Biolife Delaware on May 20 for $120 million, gaining hemostatic devices for ortho procedures.
Resonetics acquired Medical Component Specialists’ nitinol gun drilling operations on May 19 for an undisclosed value, enhancing orthopedic device manufacturing.
Montagu acquired Tyber Medical on April 24 for an undisclosed value, combining it with Intech and Resolve Surgical Technologies for orthopedic device manufacturing.
Zimmer Biomet acquired Paragon 28 on April 21 for $30 per share with an enterprise value of $1.2 billion, adding foot and ankle surgical products.
Globus Medical acquired Nevro Corp. on April 3 for $250 million, gaining spinal cord stimulation for pain.
Viscogliosi Brothers (VB Spine) acquired Stryker’s U.S. spinal implants business on April 1 for an undisclosed value, forming a new spine company with Mako access.
moveUP.care acquired Deep Structure.ai on March 10 for an undisclosed value, adding AI for orthopedic surgery planning.
Forécreu acquired Grover Precision on March 4 for an undisclosed value, gaining cannulated bar technology for orthopedic devices.
Dementra Holding acquired a 51% stake in GetSet Surgical on February 27 for an undisclosed value, focusing on spine surgical solutions.
ARCH Medical Solutions acquired KISS Technologies on February 24 for an undisclosed value, adding prosthetic components for orthopedics.
Medtronic acquired Nanovis’ nano-surface technology assets on February 12 for an undisclosed value, enhancing spinal implants.
Stryker acquired Inari Medical on January 6 for $80 per share equating to approximately $4.9 billion, targeting vascular with ortho synergies in peripheral.
Fusion Orthopedics acquired Metalogix on January 3 for an undisclosed value, adding external fixation systems for orthopedics.
St. Joseph Regional Medical Center acquired Lewiston Orthopedics for an undisclosed value, incorporating it as part of Catalyst Medical Group.
Montecito Medical acquired an orthopedic medical office building and surgery center in Warwick, R.I., for an undisclosed value, leased to Ortho Rhode Island.
St. John’s Health acquired majority ownership of Teton Sports & Spine Imaging for an undisclosed value, partnering with six orthopedic surgeons.
Pace Surgical acquired compression distraction technology from Best Step Orthopedics for an undisclosed value, targeting foot and ankle applications.
Novant Health, with MedQuest Associates, acquired 18 locations from OrthoCarolina for an undisclosed value, expanding orthopedic facilities.
Orthopaedic Solutions Management acquired Orlando Hand Surgical Associates for an undisclosed value, marking its eighth acquisition.
Medacta acquired Parcus Medical for an undisclosed value, gaining sports medicine products for ortho surgery.
NYU Langone Health acquired Rothman Orthopaedics of Greater New York for an undisclosed value, expanding ortho services.
Funding Trends
Trend Vectors:
↑ Total funding volume (surpassing 2024 levels)
↑ Large rounds for AI/robotics
↓ Early-stage deal count
→ Concentration in mature platforms
Medtech VC investment hit $12B through Q3 2025 across 647 deals, on track to exceed last year’s totals and mark the second-best year since 2021.
Q1 set records with $2.6B in 132 rounds, while Q2 added $4.1B, driven by investor focus on high-growth areas like AI-enabled imaging, surgical navigation, and personalized devices.
Q3 saw a slowdown in momentum, with softer early-stage funding as VCs prioritize proven, late-stage startups amid economic headwinds.
Orthopedic-specific equity raises reached $1.03B across 55 rounds YTD through September, emphasizing 3D printing, regenerative tech, and minimally invasive innovations.
Standouts include restor3d’s $70M for AI-powered 3D-printed implants, OSSIO’s $27.6M to scale bio-integrative fixation, and Tetrous’ $6.5M Series A for bone-to-tendon healing post-surgery.
Private equity plays a growing role, with firms like Scrub Capital backing regenerative spine startups like Spark Spine.
Broader trends: 16% surge in VC overall, with average round sizes up 72% from the prior decade, fueled by robotics and cardiovascular synergies.
Top investors include SV Health Investors, LRVHealth, and Third Rock Ventures targeting medtech; for ortho, look to MB Venture Partners and Excelestar Ventures focusing on musculoskeletal tech.
Outlook: Momentum building into 2026, but pre-revenue firms face droughts—strategic spin-outs and AI acquisitions could unlock more capital.
Recent Fundings
Trend Vectors:
↑ Investor interest in AI and robotics
↑ Focus on personalized ortho tech
→ Moderate activity in late 2025
CustoMED: Raised $6M in seed funding on October 29, 2025; investors not disclosed in announcements; the company develops AI-powered 3D-printed solutions for orthopedic surgery, including patient-specific surgical guides and implants; funds will scale the platform and expand commercialization.
MediView XR: Closed $24M Series A round in October 2025; led by undisclosed investors; specializes in augmented reality (AR) for surgical navigation and guidance, with applications in orthopedics for precision procedures; proceeds to advance AR tech integration in ortho surgeries.
Precera Medical: Launched as a new platform following SK Capital’s acquisition of LISI Group’s Medical Division on November 3, 2025; value not disclosed, but involves private equity investment for growth; specializes in orthopedic and trauma devices; funds to support expansion in manufacturing and innovation.
Public Company Performance (Q3 2025)
Trend Vectors:
↑ Revenue growth (avg. 11%)
↑ EBITDA improvements
↓ OUS performance in select markets
Overall Sector: ~10% pro forma growth across public ortho firms, driven by US spine and orthopedics momentum amid innovation and synergies.
Bone Biologics (BBLG): Revenue flat at 0%; Net loss narrowed to ($1.6M) or ($0.37) per share, beating estimates; No EBITDA reported; Focus on NELL-1 bone regeneration trials.
Aurora Spine (ASG): Revenue -7% to $4.43M; Gross margin +40bps to 60.9%; EBITDAC $165k, down from $380k; Positive EBITDAC for second consecutive quarter
Kuros Biosciences (KURN): Revenue +77% on 9M basis (Q3 not isolated); Adjusted EBITDA $7.8M at 12.3% margin; Strong MagnetOs sales.
Anika Therapeutics (ANIK): Revenue -6% to $27.8M; Gross margin -1000bps to 56%; Adjusted EBITDA -3.7M decline; Commercial channel +22%.
Aclarion (ACON): Revenue $0.02M; Net loss ($0.93) per share; No EBITDA reported; Focus on NOCISCAN adoption.
MiMedx Group (MDXG): Revenue +35% to $114M; Gross margin 88%; Adjusted EBITDA $35M at 31% margin; Wound and surgical growth.
Integra LifeSciences (IART): Revenue +5.6% to $402.1M; Gross margin -10bps to 62.9%; Adjusted EBITDA $78.5M at 19.5% margin; CSS +4.3%.
Bonesupport (BONEX): Revenue +24% to SEK294M; Gross margin 92%; EBITDA SEK7.4M on 9M; US sales +40%.
Zimmer Biomet (ZBH): Revenue +9.7% to $2.001B; Organic +5%; Adjusted EBITDA not isolated; US knees +9%.
Globus Medical (GMED): Revenue +22.9% to $769M; Gross margin 66%; Adjusted EBITDA $252.6M at 32.8% margin; US spine +10%.
Si-Bone (SIBN): Revenue +21% to $48.7M; Gross margin +75bps to 79.8%; Adjusted EBITDA +$2.3M at 5% margin.
Enovis (ENOV): Revenue +9% to $549M; Gross margin +140bps; Adjusted EBITDA $95M at 17.3% margin; Recon +9%.
Stryker (SYK): Revenue +10.3% to $6.1B; Organic +9.5%; Adjusted operating margin 25.6%; Mako installations record.
Orthofix (OFIX): Revenue +6.3% to $205.6M; Gross margin 72.2%; Adjusted EBITDA $24.6M at 12.1% margin.
Smith & Nephew (SNN): Revenue +5% to $1.501B; Trading margin expansion; Orthopaedics +6.5%.
OrthoPediatrics (KIDS): Revenue +12% to $61.2M; Gross margin 78.3%; Adjusted EBITDA +56% to $6.2M.
Bioventus (BVS): Revenue flat at $139M; Organic +8%; Adjusted EBITDA +13% to $27M at 19% margin.
Treace Medical (TMCI): Revenue +11% to $50.2M; Gross margin 80.9%; Adjusted EBITDA loss narrowed 49% to ($2.6M).
Integrum (INTEG-B): No Q3 earnings announced; 9M revenue up ~40% to SEK104M; EBITDA SEK7.4M.
Xtant Medical (XTNT): Revenue +19% to $33.3M; Gross margin +670bps to 66.1%; Adjusted EBITDA $4.5M.
Patterns: US spine and orthopedics drove growth with innovation; International challenges in emerging markets; Margin expansion across most amid synergies; Acquisitions and new products key catalysts; Cash flow improvements widespread.
Startups I Like
Trend Vectors:
↑ Emerging AI & minimally invasive focus
→ High potential for M&A
VISIE: Austin-based medtech startup develops 3D optical scanners for pinless, ultra-precise navigation in robotic orthopedic, neurosurgical, and spine procedures ($8.2M Series A, 9 patents).
Green Sun Medical: Denver startup’s Whisper smart brace offers non-surgical scoliosis treatment for teens with custom-fit, corrective pressure, free movement, and Bluetooth-enabled real-time physician monitoring.
Icarus Medical: Virginia startup specializing in custom 3D-printed braces with patented unloading tech for knee/ankle pain relief, mobility enhancement, and non-surgical alternatives.
SutureTech: Surgeon-founded startup’s FDA-cleared RapidFix all-suture staple accelerates tendon repairs by 70% with biologics compatibility, user-friendly horizontal mattress technique, and minimized gap formation for enhanced healing.
Intellijoint Surgical: Compact, Wii-like optical nav for precise hip/knee implants (radiation-free, ASC-optimized, 100K+ procedures)
Lumaegis: LED-based RadBox for ultra-fast, chemical-free sterilization via UV-C/IR tech (FDA De Novo, 95% less energy than autoclaves).
Meduloc: Philadelphia orthopedic startup’s FDA-cleared Nitinol intramedullary implants offer minimally invasive fixation for small-bone trauma, providing rotational stability, joint preservation, and accelerated recovery.
Axial3D: AI-powered platform automating 3D medical imaging segmentation for scalable, patient-specific orthopedic implants and surgical planning via cloud-based solutions ($18.2M funding raised).
Struggling and Zombie Public Companies
Trend Vectors:
↓ Funding & demand struggles
→ Acquisition targets for turnaround
Hyperfine & Acutus Medical: Layoffs due to market pressures; struggling with adoption.
Staar Surgical & Cepheid: Cost-cutting amid weak demand; tariff impacts on supply chains.
Solventum: Spin-off challenges, layoffs in medtech ops.
Mid-tier ortho firms: Hit by US tariffs (e.g., small bone/joint devices up 25% costs); some pre-revenue startups facing funding droughts.
Beaten-down: Accuray (radiation ortho tech), LivaNova (neuro-ortho overlap) – potential rebound but currently undead.
Zombie Public company: Integrum AB, a Swedish firm specializing in osseointegrated prosthetic implants like the OPRA system, is grappling with persistent financial and operational hurdles amid efforts to expand in the U.S. and globally.
Zombie Public company SpineWay SA, a French company specializing in spinal implants and instruments, continues to face financial and operational challenges despite revenue growth and cost optimizations, as it strives for profitability in a competitive market.
Zombie Public company: Implanet SA, a French company founded in 2007 and specializing in spinal implants (e.g., JAZZ® system) and advanced medical equipment distribution, continues to face financial pressures despite revenue growth from U.S. expansion and partnerships, as it pursues profitability in the competitive spine market.