0001376339-22-000127 | 10-Q | XBRL Viewer

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Cover - shares	9 Months Ended
Cover - shares	Sep. 30, 2022	Oct. 26, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2022
Document Transition Report	false
Entity File Number	001-35887
Entity Registrant Name	MIMEDX GROUP, INC.
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-2792552
Entity Address, Address Line One	1775 West Oak Commons Ct NE
Entity Address, City or Town	Marietta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30062
City Area Code	770
Local Phone Number	651-9100
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	MDXG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		113,668,179
Entity Central Index Key	0001376339
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 73,217	$ 87,083
Accounts receivable, net	40,830	40,353
Inventory	13,976	11,389
Prepaid expenses	4,679	6,146
Income tax receivable	756	743
Other current assets	2,582	2,809
Total current assets	136,040	148,523
Property and equipment, net	7,912	9,165
Right of use asset	3,728	4,696
Goodwill	19,976	19,976
Intangible assets, net	4,992	5,383
Other assets	150	186
Total assets	172,798	187,929
Current liabilities:
Accounts payable	8,820	7,385
Accrued compensation	24,090	23,595
Accrued expenses	10,986	9,812
Other current liabilities	1,962	1,565
Total current liabilities	45,858	42,357
Long term debt, net	48,475	48,127
Other liabilities	5,491	4,869
Total liabilities	99,824	95,353
Commitments and contingencies (Note 13)
Convertible preferred stock Series B; $0.001 par value; 100,000 shares authorized, issued and outstanding at September 30, 2022 and December 31, 2021	92,494	92,494
Stockholders' (deficit) equity
Preferred stock Series A; $0.001 par value; 5,000,000 shares authorized, 0 issued and outstanding at September 30, 2022 and December 31, 2021	$ 0	$ 0
Common stock, shares issued (in shares)	113,670,017	112,703,926
Common stock, shares authorized (in shares)	187,500,000	187,500,000
Common stock; $0.001 par value; 187,500,000 shares authorized; 113,670,017 issued and 113,668,179 outstanding at September 30, 2022 and 112,703,926 issued and 111,925,216 outstanding at December 31, 2021	$ 114	$ 113
Additional paid-in capital	171,865	165,695
Treasury stock at cost; 1,838 shares at September 30, 2022 and 778,710 shares at December 31, 2021	(7)	(4,017)
Accumulated deficit	(191,492)	(161,709)
Total stockholders' (deficit) equity	(19,520)	82
Total liabilities, convertible preferred stock, and stockholders’ (deficit) equity	$ 172,798	$ 187,929

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2022	Dec. 31, 2021
LIABILITIES, CONVERTIBLE PREFERRED STOCK, AND STOCKHOLDERS’ (DEFICIT) EQUITY
Series B convertible preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Series B convertible preferred stock, shares authorized (in shares)	100,000	100,000
Series B convertible preferred stock, shares issued (in shares)	100,000	100,000
Series B convertible preferred stock, shares outstanding (in shares)	100,000	100,000
Stockholders' equity:
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	187,500,000	187,500,000
Common stock, shares issued (in shares)	113,670,017	112,703,926
Common stock, shares outstanding (in shares)	113,668,179	111,925,216
Treasury stock, shares (in shares)	1,838	778,710

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Statement [Abstract]
Net sales	$ 67,689	$ 63,074	$ 193,466	$ 191,206
Cost of sales	12,188	10,129	33,947	32,530
Gross profit	55,501	52,945	159,519	158,676
Operating expenses:
Selling, general and administrative	53,475	46,289	158,838	145,291
Research and development	5,953	4,368	17,429	12,770
Investigation, restatement and related	3,001	3,170	8,771	8,304
Amortization of intangible assets	175	193	519	647
Operating loss	(7,103)	(1,075)	(26,038)	(8,336)
Other expense, net
Interest expense, net	(1,270)	(963)	(3,566)	(3,806)
Other expense, net	0	0	(1)	(3)
Loss before income tax provision	(8,373)	(2,038)	(29,605)	(12,145)
Income tax provision expense	(53)	(301)	(178)	(355)
Net loss	(8,426)	(2,339)	(29,783)	(12,500)
Net loss available to common stockholders - basic	(10,096)	(3,913)	(34,667)	(17,039)
Net loss available to common stockholders - diluted	$ (10,096)	$ (3,913)	$ (34,667)	$ (17,039)
Net loss per common share - basic (in dollars per share)	$ (0.09)	$ (0.04)	$ (0.31)	$ (0.15)
Net loss per common share - diluted (in dollars per share)	$ (0.09)	$ (0.04)	$ (0.31)	$ (0.15)
Weighted average common shares outstanding - basic (in shares)	113,448,251	110,717,073	112,650,713	110,136,517
Weighted average common shares outstanding - diluted (in shares)	113,448,251	110,717,073	112,650,713	110,136,517

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' (DEFICIT) EQUITY - USD ($) $ in Thousands	Total	Common Stock Issued	Additional Paid-in Capital	Treasury Stock	Accumulated Deficit
Balance beginning of period (in shares) at Dec. 31, 2020		112,703,926
Balance, beginning of period at Dec. 31, 2020	$ (150)	$ 113	$ 158,610	$ (7,449)	$ (151,424)
Treasury stock, beginning balance (in shares) at Dec. 31, 2020				1,773,683
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Deemed dividends	(926)		(926)
Share-based compensation expense	11,115		11,115
Exercise of stock options (in shares)				482,361
Exercise of stock options	1,404		(1,184)	$ 2,588
Issuance of restricted stock (in shares)				810,405
Issuance of restricted stock	0		(4,053)	$ 4,053
Restricted stock canceled/forfeited (in shares)				66,374
Restricted stock shares canceled/forfeited	0		450	$ (450)
Shares repurchased for tax withholding (in shares)				469,239
Shares repurchased for tax withholding	(4,751)			$ (4,751)
Net loss	(12,500)				(12,500)
Other (in shares)				239,502
Other	0		(2,009)	$ 2,009
Balance end of period (in shares) at Sep. 30, 2021		112,703,926
Balance, end of period at Sep. 30, 2021	(5,808)	$ 113	162,003	$ (4,000)	(163,924)
Treasury stock, ending balance (in shares) at Sep. 30, 2021				777,028
Balance beginning of period (in shares) at Jun. 30, 2021		112,703,926
Balance, beginning of period at Jun. 30, 2021	(7,137)	$ 113	158,720	$ (4,385)	(161,585)
Treasury stock, beginning balance (in shares) at Jun. 30, 2021				821,988
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	3,811		3,811
Exercise of stock options (in shares)				30,032
Exercise of stock options	45		(250)	$ 295
Issuance of restricted stock (in shares)				48,630
Issuance of restricted stock	0		(477)	$ 477
Restricted stock canceled/forfeited (in shares)				18,348
Restricted stock shares canceled/forfeited	0		199	$ (199)
Shares repurchased for tax withholding (in shares)				15,354
Shares repurchased for tax withholding	(188)			$ (188)
Net loss	(2,339)				(2,339)
Balance end of period (in shares) at Sep. 30, 2021		112,703,926
Balance, end of period at Sep. 30, 2021	$ (5,808)	$ 113	162,003	$ (4,000)	(163,924)
Treasury stock, ending balance (in shares) at Sep. 30, 2021				777,028
Balance beginning of period (in shares) at Dec. 31, 2021	112,703,926	112,703,926
Balance, beginning of period at Dec. 31, 2021	$ 82	$ 113	165,695	$ (4,017)	(161,709)
Treasury stock, beginning balance (in shares) at Dec. 31, 2021	778,710			778,710
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	$ 10,798		10,798
Exercise of stock options (in shares)	285,001	133,762		151,239
Exercise of stock options	$ 574		(697)	$ 1,271
Issuance of restricted stock (in shares)		832,329		880,749
Issuance of restricted stock	0	$ 1	(3,960)	$ 3,959
Restricted stock canceled/forfeited (in shares)				5,338
Restricted stock shares canceled/forfeited	0		29	$ (29)
Shares repurchased for tax withholding (in shares)				249,778
Shares repurchased for tax withholding	(1,191)			$ (1,191)
Net loss	$ (29,783)				(29,783)
Balance end of period (in shares) at Sep. 30, 2022	113,670,017	113,670,017
Balance, end of period at Sep. 30, 2022	$ (19,520)	$ 114	171,865	$ (7)	(191,492)
Treasury stock, ending balance (in shares) at Sep. 30, 2022	1,838			1,838
Balance beginning of period (in shares) at Jun. 30, 2022		113,609,274
Balance, beginning of period at Jun. 30, 2022	$ (13,603)	$ 114	169,352	$ (3)	(183,066)
Treasury stock, beginning balance (in shares) at Jun. 30, 2022				1,003
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	2,372		2,372
Exercise of stock options (in shares)		49,666		1,001
Exercise of stock options	137		132	$ 5
Issuance of restricted stock (in shares)		11,077
Issuance of restricted stock	0
Restricted stock canceled/forfeited (in shares)				1,836
Restricted stock shares canceled/forfeited	0		9	$ (9)
Net loss	$ (8,426)				(8,426)
Balance end of period (in shares) at Sep. 30, 2022	113,670,017	113,670,017
Balance, end of period at Sep. 30, 2022	$ (19,520)	$ 114	$ 171,865	$ (7)	$ (191,492)
Treasury stock, ending balance (in shares) at Sep. 30, 2022	1,838			1,838

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash flows from operating activities:
Net loss	$ (29,783)	$ (12,500)
Adjustments to reconcile net loss to net cash flows (used in) provided by operating activities:
Share-based compensation	10,798	11,115
Depreciation expense	2,549	3,390
Bad debt expense	2,817	0
Amortization of intangible assets	519	647
Amortization of deferred financing costs	348	943
Non-cash lease expenses	931	724
Accretion of asset retirement obligation	69	57
(Gain) loss on fixed asset disposal	(17)	236
Increase (decrease) in cash resulting from changes in:
Accounts receivable	(3,295)	(1,113)
Inventory	(2,586)	(835)
Prepaid expenses	1,467	3,527
Income taxes	(13)	9,420
Other assets	(287)	1,990
Accounts payable	1,090	(828)
Accrued compensation	495	2,085
Accrued expenses	1,724	(16,768)
Other liabilities	905	(840)
Net cash flows (used in) provided by operating activities	(12,269)	1,250
Cash flows from investing activities:
Purchases of equipment	(847)	(2,893)
Patent application costs	(128)	(263)
Principal payments from note receivable	0	75
Proceeds from sale of equipment	24	0
Net cash flows used in investing activities	(951)	(3,081)
Cash flows from financing activities:
Stock repurchased for tax withholdings on vesting of restricted stock	(1,191)	(4,751)
Proceeds from exercise of stock options	574	1,404
Principal payments on finance lease	(29)	(27)
Net cash flows used in financing activities	(646)	(3,374)
Net change in cash	(13,866)	(5,205)
Cash and cash equivalents, beginning of period	87,083	95,812
Cash and cash equivalents, end of period	$ 73,217	$ 90,607

Nature of Business	9 Months Ended
Nature of Business	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Business	Nature of Business MiMedx Group, Inc. (together with its subsidiaries, except where the context otherwise requires, “MIMEDX,” or the “Company”) is a transformational placental biologics company, developing and distributing placental tissue allografts with patent-protected, proprietary processes for multiple sectors of healthcare. As a pioneer in placental biologics, the Company is focused on addressing unmet clinical needs in the areas of advanced wound care, surgical recovery applications, and musculoskeletal conditions. The Company derives its products from human placental tissues and processes these tissues using its proprietary methods, including the PURION® process. The Company applies Current Good Tissue Practices, Current Good Manufacturing Practices, and terminal sterilization to produce its allografts. MIMEDX provides products primarily in the wound care, burn, and surgical recovery sectors of healthcare. All of its products are regulated by the U.S. Food & Drug Administration (“FDA”). As of September 30, 2022, the Company manages itself as two reportable segments: Wound & Surgical and Regenerative Medicine. Information regarding the principal operations and results of these segments can be found in Note 15, Segment Information. The Company’s business is currently focused primarily in the United States. The Company is pursuing opportunities for international expansion, with specific focus on the launch of its placental tissue products in Japan. Enforcement Discretion In November 2017, the FDA published a series of guidances that established an updated framework for the regulation of cellular and tissue-based products. These guidances clarified the FDA’s views about the criteria that differentiate those products subject to regulation solely under Section 361 of the Public Health Service Act (“Section 361”) from those considered to be drugs, devices, and/or biological products subject to licensure under Section 351 of the Public Health Service Act and related regulations. The Company identified its micronized and certain other products (collectively, the “Section 351 products”) as being subject to regulation under Section 351, requiring pre-market approval from the FDA for a specified indication with demonstrated clinical efficacy. The FDA exercised enforcement discretion with respect to Investigational New Drug applications and pre-market approval requirements through May 31, 2021. As of May 31, 2021, the Company stopped marketing its Section 351 products in the United States and is precluded from marketing such products until a Biologics License Application (“BLA”) is granted. If and when the FDA approves a BLA, the Company expects to be allowed to market its Section 351 products in the United States again, but only for specific indications as permitted by the FDA. Sales of the Company’s Section 351 products were $0.8 million and $0.5 million for the three months ended September 30, 2022 and 2021, respectively, and $1.8 million and $17.2 million for the nine months ended September 30, 2022 and 2021, respectively. Sales of Section 351 products during the three and nine months ended September 30, 2022 were derived from sales outside the United States. The Company currently markets EPICORD® and AMNIOCORD® tissue products derived from human umbilical cord as providing a protective environment or as a barrier. If the FDA were to determine that EPICORD and AMNIOCORD do not meet the requirements for regulation solely under Section 361, then pre-market clearance or approval would be required for these products. The loss of the Company’s ability to market and sell its umbilical cord-derived products could have an adverse effect on the Company’s revenue, business, financial condition, and results of operations. Net sales of the Company’s umbilical cord-derived products were $5.7 million and $6.2 million for the three months ended September 30, 2022 and 2021 and $17.2 million and $17.1 million for the nine months ended September 30, 2022 and 2021, respectively. The Company’s cord inventory, which would be at risk for write-down in the case of such a determination by the FDA, was $1.8 million and $1.9 million as of September 30, 2022 and December 31, 2021, respectively.

Significant Accounting Policies	9 Months Ended
Significant Accounting Policies	Sep. 30, 2022
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting PoliciesPlease see Note 2 to the Company’s Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 (the “2021 Form 10-K”), filed with the Securities and Exchange Commission (“SEC”) on February 28, 2022 for a description of all significant accounting policies. Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three and nine months ended September 30, 2022 and 2021 are not necessarily indicative of the results that may be expected for the full fiscal year. The balance sheet as of December 31, 2021 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2021 Form 10-K. Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, estimates related to the Company’s assessment of goodwill impairment, the measurement of right of use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, estimate for allowance for doubtful accounts, estimates of sales returns and allowances, and valuation of deferred tax assets. Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. Segment Reporting The application of GAAP requires the use of the “management approach” model for segment reporting. The management approach model is based on the way a company’s chief operating decision maker (“CODM”) organizes segments within the Company for which separate, discrete financial information is available regarding resource allocation and assessing performance. The Company has concluded that its Chief Executive Officer (“CEO”) is its CODM. Prior to June 30, 2022, the Company assessed that it operated as one operating and reportable segment. The Company reassesses the existence of operating segments when facts and circumstances suggest that there may have been a change in the way that the Company was managed. On September 30, 2022, the Company reassessed its operating segments, concluding that the CODM assesses performance and allocates resources between two, distinct reportable segments: Wound & Surgical and Regenerative Medicine. Information regarding the principal operations and results of these segments can be found in Note 15, Segment Information. Goodwill The Company assesses goodwill for impairment at least annually on October 1 and more frequently whenever events or substantive changes in circumstances indicate that it is more likely than not that goodwill is impaired. In performing the goodwill impairment test, the Company first assesses qualitative factors to determine the existence of impairment. If the qualitative factors indicate that the carrying value of a reporting unit exceeds its fair value, the Company proceeds to a quantitative test to measure the existence and amount, if any, of goodwill impairment. The Company may also choose to bypass the qualitative assessment and proceed directly to the quantitative test. In performing the quantitative test, impairment loss is recorded to the extent that the carrying value of the reporting unit exceeds its assessed fair value. The Company determines the fair value using the income and market approaches. Under the income approach, the fair value of a reporting unit is the present value of its future cash flows as viewed from the lens of a hypothetical market participant in an orderly transaction. These future cash flows are derived from expectations of revenue, expenses, tax deductions and credits, working capital flows, capital expenditures, and other projected sources and uses of cash, as applicable. Value indications are developed by discounting expected cash flows to their present value using a discount rate commensurate with the risks associated with the reporting unit subject to testing. Under the market approach, the Company uses market multiples derived from the various comparable companies based on measures salient to investors in those companies. If the Company concludes that a reporting unit is being managed on the basis of multiple reporting units, the goodwill assigned to the original reporting unit is allocated to the new reporting units based on the relative fair value of the new reporting units. As indicated above, on September 30, 2022, the Company changed its operating segments, determining that it operates as three operating segments. In concert with this re-evaluation, the Company concluded that it has three reporting units. Management performed a goodwill impairment test as of that date on its previous reporting unit, concluding that goodwill was not impaired as of that date. Management subsequently allocated the goodwill assigned to its previous reporting unit to its new reporting units. Refer to Note 6, Goodwill and Intangible Assets, Net for information regarding the reallocation of goodwill to the new reporting units. Recently Adopted Accounting Standards In November 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)”, which provides disclosure requirements regarding government grants and contributions. The ASU requires disclosure of the nature of transactions and related accounting policies used to account for transactions, the effect, including amounts, of government assistance on individual line items on the financial statements, and significant terms and conditions of the transactions, including commitments and contingencies. This ASU is effective for fiscal years beginning after December 15, 2021. The Company adopted the provisions of this ASU effective January 1, 2022. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted All ASUs issued and not yet effective for the three and nine months ended September 30, 2022, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position and results of operations.

Accounts Receivable, Net

9 Months Ended

Sep. 30, 2022

Receivables [Abstract]

Accounts and Nontrade Receivable

Accounts Receivable, Net

Accounts receivable, net, consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Accounts receivable, gross	$	44,660	$	41,540
Less: allowance for doubtful accounts	(3,830)		(1,187)
Accounts receivable, net	$	40,830	$	40,353

Bad debt expense, included in selling, general and administrative expense on the condensed consolidated statements of operations, for the three and nine months ended September 30, 2022 was $0.4 million and $2.8 million, respectively. Bad debt expense for the three and nine months ended September 30, 2021 was not significant in either period.

Inventory

9 Months Ended

Sep. 30, 2022

Inventory Disclosure [Abstract]

Inventory

Inventory consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Raw materials	$	670	$	364
Work in process	7,604		6,112
Finished goods	5,702		4,913


Inventory	$	13,976	$	11,389

As a result of the conclusion of the FDA’s period of Enforcement Discretion on May 31, 2021, the Company wrote-off $1.0 million of its Section 351 product inventory during the nine months ended September 30, 2021. In addition, during the three and nine months ended September 30, 2021, the Company wrote-down $0.5 million and $0.7 million, respectively, for inventory related to product lines which had been discontinued. These amounts are included as part of cost of sales on the unaudited condensed consolidated statements of operations for those periods.

There were no significant, unusual write-downs of inventory during the three or nine months ended September 30, 2022

Property and Equipment, Net

9 Months Ended

Sep. 30, 2022

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

Property and equipment, net, consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Leasehold improvements	$	9,190	$	9,052
Laboratory and clean room equipment	16,302		16,567
Furniture and equipment	14,997		14,975
Construction in progress	1,383		397
Asset retirement cost	982		863
Finance lease right-of-use asset	189		189
Property and equipment, gross	43,043		42,043
Less: accumulated depreciation and amortization	(35,131)		(32,878)
Property and equipment, net	$	7,912	$	9,165

Depreciation expense for the three and nine months ended September 30, 2022 and 2021 is summarized in the table below (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Depreciation expense	$	831	$	923	$	2,549	$	3,390

Depreciation expense is allocated amongst cost of sales, research and development expense, and selling, general, and administrative expense on the unaudited condensed consolidated statements of operations.

Goodwill and Intangible Assets, Net

9 Months Ended

Sep. 30, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets, Net

Goodwill

Historically, the Company had concluded that it operated as a single operating segment and single reporting unit. During the three and nine months ended September 30, 2022, as a result of changes in the management of the Company’s business, management concluded that the Company operates as three operating segments, including two distinct reportable segments: Wound & Surgical and Regenerative Medicine. See Note 15 for a description of the Company’s operating segments. Management further concluded that it had three reporting units.

The Company allocated the $20.0 million of consolidated goodwill, which was entirely allocated to its previous reporting unit, to each of Wound & Surgical and Regenerative Medicine based on their relative fair values from a market participant standpoint. The result was $19.5 million and $0.5 million allocated to Wound & Surgical and Regenerative Medicine, respectively. A third reporting unit associated with the Company’s third operating segment was deemed immaterial and no goodwill was assigned to it.

The Company performed goodwill impairment tests using the Company’s single reporting unit and the new reporting units. In all cases, the Company concluded that the estimated fair values of each reporting unit exceeded their respective carrying values. Therefore, the Company did not record impairment for goodwill during the three or nine months ended September 30, 2022. There was no other activity related to goodwill during the three or nine months ended September 30, 2022.

Intangible Assets, Net

Intangible assets, net, are summarized as follows (in thousands):


	September 30, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,810	$	(6,928)	$	2,882	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,102				1,102		1,205				1,205
Total intangible assets	$	11,920			$	4,992	$	11,791			$	5,383

Amortization expense for the three and nine months ended September 30, 2022 and 2021 is summarized in the table below (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Amortization expense	$	175	$	193	$	519	$	647

Expected future amortization of intangible assets as of September 30, 2022, is as follows (in thousands):


Year ending December 31,	Estimated Amortization Expense
2022 (excluding the nine months ended September 30, 2022)	$	174
2023	698
2024	698
2025	303
2026	148
Thereafter	861
Total amortized intangible assets	$	2,882

Accrued Expenses

9 Months Ended

Sep. 30, 2022

Payables and Accruals [Abstract]

Accrued Expenses

Accrued expenses consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Legal and settlement costs	$	4,185	$	2,806

Commissions to sales agents	2,238		2,630
Accrued rebates	878		1,343
Accrued group purchasing organization fees	616		559
Estimated sales returns	999		788
Accrued travel	402		385
Accrued clinical trials	214		694
Other	1,454		607
Accrued expenses	$	10,986	$	9,812

Long Term Debt, Net

9 Months Ended

Sep. 30, 2022

Debt Disclosure [Abstract]

Long Term Debt, Net

Hayfin Loan Agreement

On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services, LLP (“Hayfin”), an affiliate of Hayfin Capital Management LLP (the “Hayfin Loan Agreement”), which Hayfin funded on July 2, 2020 (the “Closing Date”), providing the Company with a senior secured term loan in an aggregate amount of $50 million (the “Term Loan”). The Term Loan matures on June 30, 2025 (the “Maturity Date”). Interest is payable on the Term Loan for the principal balance outstanding quarterly through the Maturity Date. No principal payments on the Term Loan are due and payable until the Maturity Date.

The Hayfin Loan Agreement also provided the Company an option to draw on an additional delayed draw term loan (the “DD TL,” collectively with the Term Loan, the “Credit Facilities”) in the form of a committed but undrawn facility until June 30, 2021. The Company did not exercise the option.

On February 28, 2022 (the “Amendment Date”), the Company executed an Amendment to the Hayfin Loan Agreement (the “Amendment”). The Amendment was accounted for as a modification. No gain or loss was recognized nor was there a change to the carrying amount of the debt as a result of the Amendment.

Interest on any borrowings under the Hayfin Loan Agreement, as amended (the “Amended Hayfin Loan Agreement”), is equal to the London Interbank Offered Rate (“LIBOR”) (subject to a floor of 1.5%), plus a margin of 6.75% per annum. If LIBOR is unavailable, the Term Loan will carry interest at the 6.75% margin plus the greatest of the Prime Rate, the Federal Funds Rate plus 0.5% per annum, and 2.5%.

An additional 3.0% margin is applied to the interest rate in the event of a default as defined in the Amended Hayfin Loan Agreement. The Term Loan carried an interest rate of 8.3% at issuance and 10.4% as of September 30, 2022.

The Amended Hayfin Loan Agreement, contains financial covenants requiring the Company, on a consolidated basis, to maintain the following:

•Minimum Consolidated Total Net Sales (as defined in the Amended Hayfin Loan Agreement) of varying amounts, required to be calculated on a quarterly basis, and

•Minimum Liquidity (as defined in the Amended Hayfin Loan Agreement) of $20 million, an at-all-times financial covenant tested monthly.

As of September 30, 2022, the Company is in compliance with all applicable financial covenants under the Amended Hayfin Loan Agreement.

The Amended Hayfin Loan Agreement also includes certain negative covenants and events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, the Term Loan may be accelerated or the lenders’ commitments terminated. Mandatory prepayments are also required in the event of a change in control, incurring other indebtedness, certain proceeds from disposal of assets and insured casualty event (as defined in the Amended Hayfin Loan Agreement). Annually, beginning with the fiscal year ended December 31, 2021, the Company is required to prepay the outstanding loans based on a percentage of Excess Cash Flow (as defined in the Amended Hayfin Loan Agreement), if such is generated. No such prepayments have been required as of September 30, 2022.

A breach of a financial covenant in the Amended Hayfin Loan Agreement, if uncured or unable to be cured, would likely result in an event of default that could trigger the lender’s remedies, including acceleration of the entire principal balance of the loan as well as any applicable prepayment premiums.

The Amended Hayfin Loan Agreement also specifies that any prepayment of the Term Loan, voluntary or mandatory, will subject the Company to a prepayment premium applicable as of the date of the prepayment as follows:

•On or before July 2, 2023: 2% of the principal balance repaid.

•After July 2, 2023 and on or before July 2, 2024: 1% of the principal balance repaid.

•After July 2, 2024: no premium.

Hayfin maintains a first-priority security interest in substantially all of the Company’s assets.

Original issue discount and deferred financing costs were allocated between the sale of the Series B Preferred Stock (which occurred on the same day as the funding of the Hayfin Loan Agreement as described in Note 10) and the Hayfin Loan Agreement on the basis of the relative fair values of the transactions. The costs allocated to the Hayfin Loan Agreement were further allocated between the Term Loan and the DD TL on the basis of the maximum potential principal outstanding between the Credit Facilities. The allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (in thousands):


	July 2, 2020
	Term Loan		DD TL		Total

Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

Deferred financing costs and original issue discount associated with the Term Loan are amortized using the effective interest method through the Maturity Date. The amortization of such amounts is presented as part of interest expense, net on the unaudited condensed consolidated statement of operations. Unamortized deferred financing costs and original issue discount associated with the Term Loan are presented as a reduction to the principal balance on the Term Loan as part of long term debt, net on the unaudited condensed consolidated balance sheets as of September 30, 2022 and December 31, 2021.

Deferred financing costs and original issue discount associated with the DD TL were amortized using the straight-line method through the expiration of the DD TL commitment term on June 30, 2021. Amortization of these amounts is presented as part of interest expense, net on the unaudited condensed consolidated statement of operations for the nine months ended September 30, 2021. The DD TL was subject to a commitment fee of 1% per annum of the amount undrawn, which was recognized as interest expense.

The balances of the Term Loan as of September 30, 2022 and December 31, 2021 were as follows (in thousands):


	September 30, 2022		December 31, 2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,322)		(1,624)
Original issue discount	(203)		(249)
Long term debt, net	$	48,475	$	48,127

Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Stated interest	$	1,151	$	1,054	$	3,225	3,116
Amortization of deferred financing costs	103		95		302		276
Accretion of original issue discount	16		15		46		42
Interest expense	$	1,270	$	1,164	$	3,573	$	3,434

Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Commitment fee	$	—	$	—	$	—	$	126
Amortization of deferred financing costs	—		—		—		542
Accretion of original issue discount	—		—		—		83
Interest expense	$	—	$	—	$	—	$	751

A summary of principal payments due on the Term Loan, by year, from September 30, 2022 through maturity are as follows (in thousands):


Year ending December 31,	Principal
2022 (excluding the nine months ended September 30, 2022)	$	—
2023	—
2024	—
2025	50,000
2026	—
Thereafter	—
Total long term debt	$	50,000

As of September 30, 2022, the fair value of the Term Loan was $44.7 million. This valuation was calculated based on a series of Level 2 and Level 3 inputs, including a discount rate based on the credit risk spread of debt instruments of similar risk character in reference to U.S. Treasury instruments with similar maturities, with an incremental risk premium for risk factors specific to the Company. The remaining cash flows associated with the Term Loan were discounted to September 30, 2022 using this discount rate to determine fair value.

- Definition

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

+ References

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

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

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Publisher FASB
-Name Accounting Standards Codification
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

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-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI https://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Net Loss Per Common Share

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Net Loss Per Common Share

Net loss per common share is calculated using two methods: basic and diluted.

Basic Net Loss Per Common Share

Basic net loss per common share is calculated as net loss available to common stockholders divided by weighted average common shares outstanding. Net loss available to common stockholders is calculated as net loss less (i) dividends accumulated on the Company’s Series B Convertible Preferred Stock during the period, and (ii) periodic accretion of the increasing-rate dividend feature.

The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three and nine months ended September 30, 2022 and 2021 (in thousands, except share and per share amounts):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net loss	$	(8,426)	$	(2,339)	$	(29,783)	$	(12,500)
Adjustments to reconcile to net loss available to common stockholders
Accumulated dividend on Series B Preferred Stock	1,670		1,574		4,884		3,613
Accretion of increasing-rate dividend feature	—		—		—		926
Total adjustments	1,670		1,574		4,884		4,539
Net loss available to common stockholders	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Weighted average common shares outstanding	113,448,251		110,717,073		112,650,713		110,136,517
Basic net loss per common share	$	(0.09)	$	(0.04)	$	(0.31)	$	(0.15)

Diluted Net Loss Per Common Share

Diluted net loss per common share is calculated as net loss available to common stockholders, adjusted for dividends on convertible preferred stock (to the extent conversion would be dilutive), divided by weighted average common shares outstanding plus potential common shares. The calculation of potential common shares considers incremental shares resulting from certain transactions, including the exercise of stock options and the issuance of restricted stock, using the treasury stock method, as well as the hypothetical conversion of the Company’s Series B Convertible Preferred Stock using the if-converted method. The treasury stock method assumes that proceeds from the transaction are used to purchase common stock at the average market price throughout the period. The if-converted method adds back periodic accrued or deemed dividends on the Company’s Series B Convertible Preferred Stock, and assumes conversion as of the beginning of the period.

Each individual transaction is assessed for its dilutive effect on net loss per common share. To the extent that the transaction is antidilutive or does not reduce net loss per common share, the effect is excluded from the calculation.

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net loss available to common stockholders	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,670		1,574		4,884		4,539
Less: antidilutive adjustments	(1,670)		(1,574)		(4,884)		(4,539)
Total adjustments	—		—		—		—
Numerator	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Weighted average shares outstanding	113,448,251		110,717,073		112,650,713		110,136,517
Adjustments
Potential common shares	29,269,481		30,658,193		28,858,049		30,185,813
Less: antidilutive potential common shares (a)	(29,269,481)		(30,658,193)		(28,858,049)		(30,185,813)
Total adjustments	—		—		—		—
Weighted average shares outstanding adjusted for potential common shares	113,448,251		110,717,073		112,650,713		110,136,517
Diluted net loss per common share	$	(0.09)	$	(0.04)	$	(0.31)	$	(0.15)

(a) Weighted average common shares outstanding for the calculation of diluted net loss per common share does not include the following adjustments for potential common shares below because their effects were determined to be antidilutive for the periods presented.


	Three Months Ended September 30,		Nine Months Ended September 30,
	2022	2021	2022	2021
Series B Convertible Preferred Stock	28,685,739	27,027,252	27,850,916	26,497,570
Restricted stock unit awards	474,355	1,840,483	574,507	1,500,674
Restricted stock awards	22,327	974,687	293,778	1,287,635
Outstanding stock options	22,528	805,437	97,190	875,714
Performance stock unit awards	59,996	10,334	40,141	24,220
Employee Stock Purchase Plan	4,536	—	1,517	—
Potential common shares	29,269,481	30,658,193	28,858,049	30,185,813

Equity

9 Months Ended

Sep. 30, 2022

Equity [Abstract]

Equity

Series B Convertible Preferred Stock

The Series B Convertible Preferred Stock of the Company (the “Series B Preferred Stock”) paid a 4.0% cumulative dividend per annum prior to the quarterly dividend payment ending on June 30, 2021, and pays a 6.0% cumulative dividend per annum thereafter. Dividends, if declared, are paid at the end of each quarter based on dividend amounts that accumulate beginning on the last payment date through the day prior to the end of each quarter. In lieu of paying a dividend, the Company may elect to accrue the dividend owed to shareholders. Accrued dividend balances accumulate dividends at the prevailing dividend rate for each dividend period for which they are outstanding.

Each share of Series B Preferred Stock is convertible into the Company’s common stock at any time at the option of the holder. Shares are converted based on the liquidation preference of $1,000 per share (the “Liquidation Preference”) plus any accrued or accumulated dividends through the date of the conversion at a conversion price of $3.85 per common share. The Series B Preferred Stock, including any accumulated and unpaid dividends, automatically converts into common stock at any time after

July 2, 2023, provided that the common stock has traded at $7.70 per share or more for (i) 20 out of the preceding 30 consecutive trading days and (ii) on such date of conversion.

The holders of the Series B Preferred Stock, voting as a class, are entitled to appoint two members to the board of directors. The holders of the Series B Preferred Stock are entitled to vote on all matters to be voted on by the Company’s shareholders on an as-converted basis as a single class with the common stock; provided that the votes represented by the Series B Preferred Stock cannot exceed 19.9% of the total voting stock of the Company and their votes cannot exceed a number of shares equal to the Liquidation Preference divided by $5.25 per share.

Holders of the Series B Preferred Stock are also entitled to the Liquidation Preference plus all accumulated and unpaid dividends in the event of a liquidation, dissolution, or winding-up of the Company.

If the Company undergoes a change of control (as defined), the Company will have the option to repurchase some or all of the then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus any accumulated and unpaid dividends, subject to the rights of the holders of the Series B Preferred Stock in connection with such change in control. If the Company does not exercise such repurchase right, holders of the Series B Preferred Stock will have the option to (1) require the Company to repurchase any or all of their then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus accumulated and unpaid dividends or (2) convert the Series B Preferred Stock into common stock and receive their pro rata consideration thereunder. Since the contingent redemption of the Series B Preferred Stock by the holders in the event of a change in control is outside the Company’s control, the Series B Preferred Stock is classified as temporary equity.

There was no change in the balance of Series B Preferred Stock for the three or nine months ended September 30, 2022 or the three months ended September 30, 2021. The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2021 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2020	100,000	$	91,568

Deemed dividends	—	926
Balance at September 30, 2021	100,000	$	92,494

The Company has not declared or paid any dividends on the Series B Preferred Stock since issuance. Dividends accumulated but not paid as of September 30, 2022 were $12.1 million. As this amount has not been declared, the Company has not recorded this amount on its unaudited condensed consolidated balance sheet as of September 30, 2022.

Based on accumulated dividends as of September 30, 2022, the Series B Preferred Stock was convertible into an aggregate of 29,119,562 shares of the Company’s common stock.

Restricted Stock Awards

The Company has issued restricted stock awards (“RSAs”), restricted stock unit awards (“RSUs”), and performance stock unit awards (“PSUs”) to its employees. The following is summary information for restricted stock awards for the nine months ended September 30, 2022.

As of September 30, 2022, there was $26.7 million of unrecognized share-based compensation expense related to share-based payment arrangements. This expense is expected to be recognized over a weighted-average period of 1.93 years, which approximates the remaining vesting period of these grants. The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2022 through September 30, 2022. Unvested RSAs noted below are included in issued and outstanding common stock as of September 30, 2022, while unvested RSUs and unvested PSUs are not included in issued or outstanding common stock as of September 30, 2022.


	RSA			RSU			PSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64	—	$	—
Granted	—	—		4,181,885	4.82		441,964	4.62
Vested	(703,405)	3.77		(1,713,078)	8.34		—	—
Forfeited	(5,338)	5.11		(1,274,985)	6.40		(200,893)	4.62
Unvested at September 30, 2022	168,454	$	6.32	5,422,741	$	6.32	241,071	$	4.62

Performance Stock Units

The Company granted PSUs to certain executive officers during the nine months ended September 30, 2022. These PSUs vest only to the extent that stipulated cumulative net sales targets are achieved for the year ending December 31, 2022, the two-year period ending December 31, 2023, and the three-year period ending December 31, 2024. Performance factors range from 50% to 150% of the net sales targets; if performance is below 50%, the PSUs do not vest. If total shareholder return (“TSR”), as defined below, is negative, vesting is limited to 100% of the award. All of the PSUs require recipients to continue employment with the Company through the vesting date, which will occur upon approval of the results with respect to the established targets by the Compensation Committee of the Board of Directors after December 31, 2024, but no later than March 15, 2025.

The TSR is calculated as the average trading price of the Company’s common stock during the final 30 trading days of 2024, adjusted for dividends paid on the Company’s common stock, less the average trading price during the final 30 trading days of 2021.

Since TSR is based on the Company’s share price, it represents a market condition, which is incorporated in the grant date fair value of shares in excess of 100% vesting. These awards were valued on the date of grant using a Monte Carlo simulation, the inputs for which were informed by a Black-Scholes option pricing model. The assumptions used in determining the fair value of these PSUs were as follows:


	Assumption
Risk-free interest rate	2.68		%
Expected term (years)	2.74
Expected volatility (annualized)	63.7		%
Dividend yield	—		%
Closing stock price on grant date	$	4.62
Grant date fair value	$	2.78

The expected term was derived from the date of the grant through the latest date of the resolution of the market condition. The risk-free interest rate was derived based on the U.S. Treasury Yield curve in effect at the date of grant for maturities of similar periods to the concluded term. The expected volatility was based on the Company’s historical daily stock price movements for a term similar in length to the expected term. The dividend yield was based on the Company’s history of dividends on its common stock.

Expense related to PSUs is recognized, straight-line, based on the grant date fair value of the relevant shares, over the requisite service period related to each individual tranche, limited to the extent that the achievement of the associated performance condition associated with that tranche is probable. These expectations are derived from the Company’s latest budget and forecasts for net sales in the associated periods. The fair value of the awards subject to a market condition and expense recognized on such awards are not subsequently reconsidered based on the probability of achievement or ultimate resolution of the market condition. Accordingly, the Company may recognize share-based compensation expense for awards that do not ultimately vest.

Stock Options

A summary of stock option activity for the nine months ended September 30, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(285,001)	2.01
Unvested options forfeited	—	—
Vested options expired	(109,500)	4.00
Outstanding at September 30, 2022	1,050,344	6.14		1.07	700
Exercisable at September 30, 2022	1,050,344	$	6.14	1.07	$	700

Employee Stock Purchase Plan

On June 7, 2022, the Company adopted the MiMedx, Inc. Employee Stock Purchase Plan (the “ESPP”). The ESPP is intended to qualify as an “employee stock purchase plan” under Section 423 of the Internal Revenue Code. All regular full-time employees of the Company (including officers) and all other employees who meet the eligibility requirements of the plan may participate in the ESPP. The ESPP provides eligible employees an opportunity to acquire the Company’s common stock on a semi-annual basis at a purchase price of 85% of the lower of the closing price per share of the Company’s common stock on the first day and the last day of each six-month purchase period (the “Purchase Period”). The aggregate number of shares which may be issued and sold under the ESPP is 3 million shares of Common Stock. The first Purchase Period under the ESPP commenced on August 1, 2022 and will result in a purchase of shares on January 31, 2023.

For the three and nine months ended September 30, 2022, the Company recorded $0.1 million in stock-based compensation related to the ESPP. As of the nine months ended September 30, 2022, the Company had cumulative payroll deferrals under the ESPP for future share purchases of $0.2 million. This amount is included in accrued compensation in the unaudited condensed balance sheet. No shares have been issued under the plan to date.

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-URI https://asc.fasb.org/topic&trid=2208762

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 13
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-URI https://asc.fasb.org/extlink&oid=126973232&loc=SL123496158-112644

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
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-Section 50
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-URI https://asc.fasb.org/extlink&oid=126973232&loc=SL123496158-112644

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Income Taxes	9 Months Ended
Income Taxes	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The effective tax rates for the Company were (0.6)% and (14.8)% for the three months ended September 30, 2022 and 2021, respectively. The effective tax rates for the Company were (0.6)% and (2.9)% for the nine months ended September 30, 2022 and 2021, respectively. There were no material discrete items affecting the effective tax rate in any period. Net operating losses incurred were offset by a valuation allowance.

- Definition

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

+ References

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

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities

9 Months Ended

Sep. 30, 2022

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Nine Months Ended September 30,
	2022		2021
Cash paid for interest	$	3,233	$	3,269
Income taxes paid	184		157
Non-cash activities:
Purchases of equipment in accounts payable	353		6
Right of use assets arising from operating lease liabilities	(37)		—
Deemed dividends on Series B Preferred Stock	—		926
Fair value of non-cash consideration received for option exercises	—		380
Right of use assets arising from finance lease liabilities	—		189
Note receivable for sale of property and equipment	—		75

Commitments and Contingencies	9 Months Ended
Commitments and Contingencies	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Separation Agreement with Timothy R. Wright On September 15, 2022, the Company entered into a Separation Agreement and General Release with Timothy R. Wright, the former Chief Executive Officer of the Company (the “Separation Agreement”). Pursuant to the terms of the Separation Agreement and Mr. Wright’s general release of all claims against the Company, the Company will pay Mr. Wright a total of $3.1 million in cash in a series of installments through September 2024. The terms of the severance benefits provided in the Separation Agreement were the same as those provided for in the original employment Letter Agreement between Mr. Wright and the Company dated April 8, 2019. The $3.1 million was recorded as part of selling, general, and administrative expense on the condensed consolidated statements of operations for the three and nine months ended September 30, 2022. Of the $3.1 million, $1.6 million is reflected in accrued compensation and the remainder is reflected in other liabilities in the unaudited condensed consolidated balance sheet as of September 30, 2022. No payments were required to Mr. Wright under the terms of the Separation Agreement during the nine months ended September 30, 2022. Nordic Agreement In June 2022, the Company entered into a collaboration agreement (the “Nordic Agreement”) with Nordic Bioscience Clinical Development A/S (“NBCD”) to provide full operational support for the Company’s upcoming Knee Osteoarthritis (“KOA”) clinical trial program. As part of the agreement, NBCD will perform site selection and monitoring, manage patient recruitment and enrollment, data management, statistical analysis and reporting activities for the duration of the trial. Under the terms of the Nordic Agreement, the Company is obligated to pay $13.3 million upon the achievement of specified milestones over the course of the clinical trial. The milestones are based upon various factors including, but not limited to, site selection and enrollment, patient enrollment, patient completion, and certain other activities related to clinical trial operations. The milestone payments are revised semi-annually based on fluctuations in the consumer price index. The Company has the ability to terminate the Nordic Agreement with 30 days written notice to NBCD. At such time, the Company would be required to pay for services performed through the date of termination and any non-cancelable obligations. As of September 30, 2022, the Company has paid $2.0 million under the Nordic Agreement, relating to milestones which have been achieved from inception through that date. During each of the three and nine months ended September 30, 2022, the Company recognized $0.6 million of expense. This amount is included as part of research and development expense in the unaudited condensed consolidated statements of operations for those periods. The remaining $1.4 million is reflected in prepaid expenses on the consolidated balance sheet as of September 30, 2022. Litigation and Regulatory Matters In the ordinary course of business, the Company and its subsidiaries are parties to numerous civil claims and lawsuits and subject to regulatory examinations, investigations, and requests for information. Some of these matters involve claims for substantial amounts. The Company’s experience has shown that the damages alleged by plaintiffs or claimants are often overstated, based on unsubstantiated legal theories, unsupported by facts, and/or bear no relation to the ultimate award that a court might grant. Additionally, the outcome of litigation and regulatory matters and the timing of ultimate resolution are inherently difficult to predict. These factors make it difficult for the Company to provide a meaningful estimate of the range of reasonably possible outcomes of claims in the aggregate or by individual claim. However, on a case-by-case basis, reserves are established for those legal claims for which it is probable that a loss will be incurred and the amount of such loss can be reasonably estimated. The Company's unaudited condensed consolidated balance sheet as of September 30, 2022 reflects the Company's current best estimate of probable losses associated with these matters, including costs to comply with various settlement agreements, where applicable. The actual costs of resolving these claims, as well as the cost to resolve claims that are either not probable or not estimable at this time, may be substantially higher or lower than the amounts reserved. For more information regarding the Company’s legal proceedings, refer to Note 14, “Commitments and Contingencies” in the 2021 Form 10-K. The Company paid $0.7 million toward the resolution of legal matters involving the Company during the nine months ended September 30, 2022. In addition, insurance providers paid $0.6 million on the Company’s behalf to settle legal matters. The Company also recovered amounts from certain former officers and directors of the Company relating to legal fees previously advanced on their behalf. These funds were recognized as a reduction to investigation, restatement, and related expense on the condensed consolidated statement of operations for the nine months ended September 30, 2022. The following is a description of certain litigation and regulatory matters to which the Company is a party: Securities Class Action On January 16, 2019, the United States District Court for the Northern District of Georgia entered an order consolidating two purported securities class actions (MacPhee v. MiMedx Group, Inc., et al. filed February 23, 2018 and Kline v. MiMedx Group, Inc., et al. filed February 26, 2018). The order also appointed Carpenters Pension Fund of Illinois (“CPFI”) as lead plaintiff. On May 1, 2019, CPFI filed a consolidated amended complaint, naming as defendants the Company, Michael J. Senken, Parker H. “Pete” Petit, William C. Taylor, Christopher M. Cashman and Cherry Bekaert & Holland LLP. The amended complaint (the “Securities Class Action Complaint”) alleged violations of Section 10(b) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 10b-5 promulgated thereunder, and Section 20(a) of the Exchange Act. It asserted a class period of March 7, 2013 through June 29, 2018. Following the filing of motions to dismiss by the various defendants, CPFI was granted leave to file an amended complaint. CPFI filed its amended complaint against the Company, Michael J. Senken, Parker H. Petit, William C. Taylor, and Cherry Bekaert & Holland (Christopher Cashman was dropped as a defendant) on March 30, 2020. The defendants filed motions to dismiss on May 29, 2020. On March 25, 2021, the Court granted defendants’ respective motions to dismiss, finding that CPFI lacked standing to bring the underlying claims and also could not establish loss causation because it sold all of its shares in MIMEDX prior to any corrective disclosures, and dismissed the case. On April 22, 2021, CPFI filed a motion for reconsideration of the dismissal and for leave to amend to add a new plaintiff to attempt to cure the standing and loss causation issues. On January 28, 2022, the Court denied CPFI’s motion to reconsider and motion to substitute class representative. On February 25, 2022, CPFI filed a Notice of Appeal in the 11th Circuit Court of Appeals, Case No. 22-10633-CC. The parties have completed their briefings on the issues on the appeal. Former Employee Litigation and Related Matters On January 12, 2021, the Company filed suit in the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida (MiMedx Group, Inc. v. Petit, et. al.) against its former CEO, Parker H. “Pete” Petit, and its former COO, William C. Taylor, seeking a determination of its rights and obligations under indemnification agreements with Petit and Taylor following a federal jury’s guilty verdict against Petit for securities fraud and Taylor for conspiracy to commit securities fraud. The Company is seeking a declaratory judgment that it is not obligated to indemnify or advance expenses to Petit and Taylor in connection with certain cases to which Petit and Taylor are parties and also seeking to recoup amounts previously paid on behalf of Petit and Taylor in connection with such cases. On April 22, 2021, Petit and Taylor filed an answer and asserted counterclaims against the Company alleging breach of their indemnification agreements, breach of the covenant of good faith and fair dealing with respect to their indemnification agreements, and seeking a declaration that the Company remains obligated to indemnify and advance fees in connection with certain cases. Petit and Taylor simultaneously also filed a motion seeking to compel the Company to advance and reinstate its payments of Petit and Taylor’s legal expenses. The Company opposed Petit and Taylor’s motion and a hearing was set for June 23, 2021. At the joint request of the parties, the hearing was cancelled to allow the parties to attend a mediation to attempt a resolution of this matter; such mediation was held on August 11, 2021. Following the mediation, the Company and Mr. Taylor reached an agreement to settle the matter between them. Negotiations with Mr. Petit are ongoing. Other Matters Under the Florida Business Corporation Act and agreements with its current and former officers and directors, the Company is obligated to indemnify its current and former officers and directors who are made party to a proceeding, including a proceeding brought by or in the right of the corporation, with certain exceptions, and to advance expenses to defend such matters. The Company has already borne substantial costs to satisfy these indemnification and expense advance obligations and may continue to do so in the future. In addition to the matters described above, the Company is a party to a variety of other legal matters that arise in the ordinary course of the Company’s business, none of which are deemed to be individually material at this time. Due to the inherent uncertainty of litigation, there can be no assurance that the resolution of any particular claim or proceeding would not have a material adverse effect on the Company’s business, results of operations, financial position or liquidity.

Revenue

9 Months Ended

Sep. 30, 2022

Revenue from Contract with Customer [Abstract]

Revenue

Disaggregation of Revenue by Product

MIMEDX has two primary classes of products: (1) Advanced Wound Care, or Section 361, products, consisting of its tissue and cord sheet allograft products as well as certain particulate products regulated under Section 361, and (2) Section 351 products, consisting of the Company’s micronized and certain other particulate products. Advanced Wound Care is further disaggregated between the Company’s Tissue/Other and Cord products.

Information regarding the business units responsible for the sale of each of these classes of product can be found in Note 15, Segment Information.

Below is a summary of net sales by class of product (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Advanced Wound Care
Tissue/Other	$	61,131	$	56,035	$	174,256	$	156,012
Cord	5,678		6,247		17,165		17,093
Total Advanced Wound Care	66,809		62,282		191,421		173,105
Section 351	796		489		1,815		17,187
Other(1)	84		303		230		914
Total	$	67,689	$	63,074	$	193,466	$	191,206

(1) “Other” represents revenue transactions in the indicated period relating to performance obligations settled prior to October 1, 2019, the date at which the Company changed its pattern of revenue recognition. For all practical purposes, the Company is not able to allocate these revenue transactions to different product groups. This revenue is reflected as part of the Wound & Surgical segment.

Disaggregation of Revenue by Customer

MIMEDX has two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“Direct Customers”), and (2) sales to distributors (“Distributors”).

Below is a summary of net sales by each customer type (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Direct Customers	$	65,898	$	61,087	$	188,231	$	184,706
Distributors	1,791		1,987		5,235		6,500
Net sales	$	67,689	$	63,074	$	193,466	$	191,206

The Company did not have significant foreign operations or a single external customer from which 10% or more of revenues were derived during the three or nine months ended September 30, 2022 or 2021.

- 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
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI https://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Segment Information

9 Months Ended

Sep. 30, 2022

Segment Reporting [Abstract]

Segment Information

Segment InformationThe Company has two reportable segments: Wound & Surgical and Regenerative Medicine.

Wound & Surgical focuses on the Advanced Wound Care and Surgical Recovery markets, the Company’s existing product portfolio, and near-term product development. Its platform technologies include tissue allografts derived from human placental membrane (EPIFIX®, AMNIOFIX®, and AMNIOEFFECT™), tissue allografts derived from human umbilical cord (EPICORD® and AMNIOCORD®), and a particulate extracellular matrix derived from human placental disc (AXIOFILL™). This segment is also responsible for the international sales of the Company’s Section 351 products.

The Regenerative Medicine business focuses solely on Regenerative Medicine technologies, specifically progressing the Company’s placental biologics platform towards registration as a FDA-approved biological drug. Micronized dehydrated human amnion chorion membrane is the lead product candidate in its late-stage pipeline targeted at achieving FDA approval for specific clinical indications, including degenerative musculoskeletal conditions, beginning with KOA.

The Company’s corporate function includes expenses incurred by executive, finance, human resource, information systems, legal, other functions which are generally shared and whose activities are not specifically identifiable solely to either of the other segments. It also includes amortization of intangible assets. The Company has another operating segment related to an expiring dental sales contract. All net sales and cost of sales presented in the Corporate & Other columns below relate to this operating segment.

Wound & Surgical net sales reflects sales of the Company’s Advanced Wound Care products (as discussed in Note 14, Revenue), except for sales of the Company’s dental product. Sales of the Company’s dental product are included in the Corporate & Other columns in the tables below. In addition, Wound & Surgical reflects international sales of the Company’s Section 351 products, which represent all Section 351 sales not reflected in Regenerative Medicine.

The accounting policies of the segments are the same as the Company’s accounting policies. See Note 2, Significant Accounting Policies, included in the 2021 Form 10-K for significant accounting policies.

The Company evaluates the performance of its segments and allocates resources based on segment contribution, defined as net sales less (i) cost of sales, (ii) selling, general and administrative expense, (iii) research and development expense, and (iv) amortization of intangible assets. Prior period results were recast on the basis of new operating segments. The only components which comprise loss before income tax provision that are not included in operating loss are interest expense, net and other expense, net.

Net sales and segment contribution for each reportable segment for the three months ended September 30, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	66,873	$	—	$	816	$	67,689
Cost of sales	11,159		—		1,029		12,188





Selling, general and administrative expense	35,531		—		17,944		53,475
Research and development expense	1,680		4,273		—		5,953
Amortization of intangible assets	—		—		175		175
Segment contribution	$	18,503	$	(4,273)
Investigation, restatement and related expense							3,001

Operating loss							$	(7,103)






Supplemental information
Depreciation expense	$	451	$	36	$	344	$	831
Share-based compensation	$	1,945	$	347	$	80	$	2,372

Net sales and segment contribution by each reportable segment for the three months ended September 30, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	62,138	$	76	$	860	$	63,074
Cost of sales	8,924		16		1,189		10,129





Selling, general and administrative expense	32,104		1,285		12,900		46,289
Research and development expense	1,423		2,945		—		4,368
Amortization of intangible assets	—		—		193		193
Segment contribution	$	19,687	$	(4,170)
Investigation, restatement and related expense							3,170

Operating loss							$	(1,075)






Supplemental information
Depreciation expense	$	511	$	34	$	378	$	923
Share-based compensation	$	1,435	$	322	$	2,054	$	3,811

Net sales and segment contribution by each reportable segment for the nine months ended September 30, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	191,297	$	—	$	2,169	$	193,466
Cost of sales	31,126		—		2,821		33,947





Selling, general and administrative expense	108,256		—		50,582		158,838
Research and development expense	6,068		11,361		—		17,429
Amortization of intangible assets	—		—		519		519
Segment contribution	$	45,847	$	(11,361)
Investigation, restatement and related expense							8,771

Operating loss							$	(26,038)






Supplemental information
Depreciation expense	$	1,364	$	120	$	1,065	$	2,549
Share-based compensation	$	5,609	$	910	$	4,279	$	10,798

Net sales and segment contribution by each reportable segment for the nine months ended September 30, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	172,401	$	16,584	$	2,221	$	191,206
Cost of sales	25,646		3,652		3,232		32,530





Selling, general and administrative expense	87,392		11,127		46,772		145,291
Research and development expense	4,080		8,690		—		12,770
Amortization of intangible assets	—		—		647		647
Segment contribution	$	55,283	$	(6,885)
Investigation, restatement and related expense							8,304

Operating loss							$	(8,336)






Supplemental information
Depreciation expense	$	1,172	$	213	$	2,005	$	3,390
Share-based compensation	$	3,827	$	1,147	$	6,141	$	11,115

The Company does not allocate any assets to the reportable segments. No asset information is reported or disclosed to the chief operating decision maker in the financial information for each segment.

- 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8924-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 34
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8981-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 21
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 26
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8844-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9038-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9054-108599

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 15
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8657-108599

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 21
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-URI https://asc.fasb.org/topic&trid=2134510

+ Details

Significant Accounting Policies (Policies)	9 Months Ended
Significant Accounting Policies (Policies)	Sep. 30, 2022
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three and nine months ended September 30, 2022 and 2021 are not necessarily indicative of the results that may be expected for the full fiscal year. The balance sheet as of December 31, 2021 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2021 Form 10-K.
Use of Estimates	Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, estimates related to the Company’s assessment of goodwill impairment, the measurement of right of use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, estimate for allowance for doubtful accounts, estimates of sales returns and allowances, and valuation of deferred tax assets.
Principles of Consolidation	Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.
Segment Reporting	Segment Reporting The application of GAAP requires the use of the “management approach” model for segment reporting. The management approach model is based on the way a company’s chief operating decision maker (“CODM”) organizes segments within the Company for which separate, discrete financial information is available regarding resource allocation and assessing performance. The Company has concluded that its Chief Executive Officer (“CEO”) is its CODM. Prior to June 30, 2022, the Company assessed that it operated as one operating and reportable segment. The Company reassesses the existence of operating segments when facts and circumstances suggest that there may have been a change in the way that the Company was managed. On September 30, 2022, the Company reassessed its operating segments, concluding that the CODM assesses performance and allocates resources between two, distinct reportable segments: Wound & Surgical and Regenerative Medicine.
Goodwill	Goodwill The Company assesses goodwill for impairment at least annually on October 1 and more frequently whenever events or substantive changes in circumstances indicate that it is more likely than not that goodwill is impaired. In performing the goodwill impairment test, the Company first assesses qualitative factors to determine the existence of impairment. If the qualitative factors indicate that the carrying value of a reporting unit exceeds its fair value, the Company proceeds to a quantitative test to measure the existence and amount, if any, of goodwill impairment. The Company may also choose to bypass the qualitative assessment and proceed directly to the quantitative test. In performing the quantitative test, impairment loss is recorded to the extent that the carrying value of the reporting unit exceeds its assessed fair value. The Company determines the fair value using the income and market approaches. Under the income approach, the fair value of a reporting unit is the present value of its future cash flows as viewed from the lens of a hypothetical market participant in an orderly transaction. These future cash flows are derived from expectations of revenue, expenses, tax deductions and credits, working capital flows, capital expenditures, and other projected sources and uses of cash, as applicable. Value indications are developed by discounting expected cash flows to their present value using a discount rate commensurate with the risks associated with the reporting unit subject to testing. Under the market approach, the Company uses market multiples derived from the various comparable companies based on measures salient to investors in those companies. If the Company concludes that a reporting unit is being managed on the basis of multiple reporting units, the goodwill assigned to the original reporting unit is allocated to the new reporting units based on the relative fair value of the new reporting units. As indicated above, on September 30, 2022, the Company changed its operating segments, determining that it operates as three operating segments. In concert with this re-evaluation, the Company concluded that it has three reporting units. Management performed a goodwill impairment test as of that date on its previous reporting unit, concluding that goodwill was not impaired as of that date. Management subsequently allocated the goodwill assigned to its previous reporting unit to its new reporting units.
Recently Adopted Accounting Standards and Recently Issued Accounting Standards Not Yet Adopted	Recently Adopted Accounting Standards In November 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)”, which provides disclosure requirements regarding government grants and contributions. The ASU requires disclosure of the nature of transactions and related accounting policies used to account for transactions, the effect, including amounts, of government assistance on individual line items on the financial statements, and significant terms and conditions of the transactions, including commitments and contingencies. This ASU is effective for fiscal years beginning after December 15, 2021. The Company adopted the provisions of this ASU effective January 1, 2022. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted All ASUs issued and not yet effective for the three and nine months ended September 30, 2022, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position and results of operations.

Accounts Receivable, Net (Tables)

9 Months Ended

Sep. 30, 2022

Receivables [Abstract]

Schedule of Accounts, Notes, Loans and Financing Receivable

Accounts receivable, net, consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Accounts receivable, gross	$	44,660	$	41,540
Less: allowance for doubtful accounts	(3,830)		(1,187)
Accounts receivable, net	$	40,830	$	40,353

Inventory (Tables)

9 Months Ended

Sep. 30, 2022

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventory consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Raw materials	$	670	$	364
Work in process	7,604		6,112
Finished goods	5,702		4,913


Inventory	$	13,976	$	11,389

Property and Equipment, Net (Tables)

9 Months Ended

Sep. 30, 2022

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment

Property and equipment, net, consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Leasehold improvements	$	9,190	$	9,052
Laboratory and clean room equipment	16,302		16,567
Furniture and equipment	14,997		14,975
Construction in progress	1,383		397
Asset retirement cost	982		863
Finance lease right-of-use asset	189		189
Property and equipment, gross	43,043		42,043
Less: accumulated depreciation and amortization	(35,131)		(32,878)
Property and equipment, net	$	7,912	$	9,165

Schedule of Depreciation Expense

Depreciation expense for the three and nine months ended September 30, 2022 and 2021 is summarized in the table below (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Depreciation expense	$	831	$	923	$	2,549	$	3,390

Goodwill and Intangible Assets, Net (Tables)

9 Months Ended

Sep. 30, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets Activity Summary - Indefinite-lived

Intangible assets, net, are summarized as follows (in thousands):


	September 30, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,810	$	(6,928)	$	2,882	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,102				1,102		1,205				1,205
Total intangible assets	$	11,920			$	4,992	$	11,791			$	5,383

Schedule of Intangible Assets Activity Summary - Finite-lived

Intangible assets, net, are summarized as follows (in thousands):


	September 30, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,810	$	(6,928)	$	2,882	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,102				1,102		1,205				1,205
Total intangible assets	$	11,920			$	4,992	$	11,791			$	5,383

Amortization expense for the three and nine months ended September 30, 2022 and 2021 is summarized in the table below (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Amortization expense	$	175	$	193	$	519	$	647

Schedule of Estimated Future Amortization Expense for Intangible Assets

Expected future amortization of intangible assets as of September 30, 2022, is as follows (in thousands):


Year ending December 31,	Estimated Amortization Expense
2022 (excluding the nine months ended September 30, 2022)	$	174
2023	698
2024	698
2025	303
2026	148
Thereafter	861
Total amortized intangible assets	$	2,882

Accrued Expenses (Tables)

9 Months Ended

Sep. 30, 2022

Payables and Accruals [Abstract]

Schedule of Accrued Liabilities

Accrued expenses consisted of the following (in thousands):


	September 30, 2022		December 31, 2021
Legal and settlement costs	$	4,185	$	2,806

Commissions to sales agents	2,238		2,630
Accrued rebates	878		1,343
Accrued group purchasing organization fees	616		559
Estimated sales returns	999		788
Accrued travel	402		385
Accrued clinical trials	214		694
Other	1,454		607
Accrued expenses	$	10,986	$	9,812

Long Term Debt, Net (Tables)

9 Months Ended

Sep. 30, 2022

Debt Disclosure [Abstract]

Schedule of Debt Issuance Costs

The allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (in thousands):


	July 2, 2020
	Term Loan		DD TL		Total

Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

Schedule of Debt

The balances of the Term Loan as of September 30, 2022 and December 31, 2021 were as follows (in thousands):


	September 30, 2022		December 31, 2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,322)		(1,624)
Original issue discount	(203)		(249)
Long term debt, net	$	48,475	$	48,127

Schedule of Interest Expense

Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Stated interest	$	1,151	$	1,054	$	3,225	3,116
Amortization of deferred financing costs	103		95		302		276
Accretion of original issue discount	16		15		46		42
Interest expense	$	1,270	$	1,164	$	3,573	$	3,434

Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Commitment fee	$	—	$	—	$	—	$	126
Amortization of deferred financing costs	—		—		—		542
Accretion of original issue discount	—		—		—		83
Interest expense	$	—	$	—	$	—	$	751

Schedule of Future Principal Payments for the Term Loan

A summary of principal payments due on the Term Loan, by year, from September 30, 2022 through maturity are as follows (in thousands):


Year ending December 31,	Principal
2022 (excluding the nine months ended September 30, 2022)	$	—
2023	—
2024	—
2025	50,000
2026	—
Thereafter	—
Total long term debt	$	50,000

Net Loss Per Common Share (Tables)

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Basic Net Loss Per Common Share


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net loss	$	(8,426)	$	(2,339)	$	(29,783)	$	(12,500)
Adjustments to reconcile to net loss available to common stockholders
Accumulated dividend on Series B Preferred Stock	1,670		1,574		4,884		3,613
Accretion of increasing-rate dividend feature	—		—		—		926
Total adjustments	1,670		1,574		4,884		4,539
Net loss available to common stockholders	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Weighted average common shares outstanding	113,448,251		110,717,073		112,650,713		110,136,517
Basic net loss per common share	$	(0.09)	$	(0.04)	$	(0.31)	$	(0.15)

Diluted Net Loss Per Common Share

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net loss available to common stockholders	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,670		1,574		4,884		4,539
Less: antidilutive adjustments	(1,670)		(1,574)		(4,884)		(4,539)
Total adjustments	—		—		—		—
Numerator	$	(10,096)	$	(3,913)	$	(34,667)	$	(17,039)
Weighted average shares outstanding	113,448,251		110,717,073		112,650,713		110,136,517
Adjustments
Potential common shares	29,269,481		30,658,193		28,858,049		30,185,813
Less: antidilutive potential common shares (a)	(29,269,481)		(30,658,193)		(28,858,049)		(30,185,813)
Total adjustments	—		—		—		—
Weighted average shares outstanding adjusted for potential common shares	113,448,251		110,717,073		112,650,713		110,136,517
Diluted net loss per common share	$	(0.09)	$	(0.04)	$	(0.31)	$	(0.15)


	Three Months Ended September 30,		Nine Months Ended September 30,
	2022	2021	2022	2021
Series B Convertible Preferred Stock	28,685,739	27,027,252	27,850,916	26,497,570
Restricted stock unit awards	474,355	1,840,483	574,507	1,500,674
Restricted stock awards	22,327	974,687	293,778	1,287,635
Outstanding stock options	22,528	805,437	97,190	875,714
Performance stock unit awards	59,996	10,334	40,141	24,220
Employee Stock Purchase Plan	4,536	—	1,517	—
Potential common shares	29,269,481	30,658,193	28,858,049	30,185,813

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share


	Three Months Ended September 30,		Nine Months Ended September 30,
	2022	2021	2022	2021
Series B Convertible Preferred Stock	28,685,739	27,027,252	27,850,916	26,497,570
Restricted stock unit awards	474,355	1,840,483	574,507	1,500,674
Restricted stock awards	22,327	974,687	293,778	1,287,635
Outstanding stock options	22,528	805,437	97,190	875,714
Performance stock unit awards	59,996	10,334	40,141	24,220
Employee Stock Purchase Plan	4,536	—	1,517	—
Potential common shares	29,269,481	30,658,193	28,858,049	30,185,813

Equity (Tables)

9 Months Ended

Sep. 30, 2022

Equity [Abstract]

Schedule of Series B Preferred Stock

The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2021 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2020	100,000	$	91,568

Deemed dividends	—	926
Balance at September 30, 2021	100,000	$	92,494

Summary of Restricted Stock Awards by Award Type

The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2022 through September 30, 2022. Unvested RSAs noted below are included in issued and outstanding common stock as of September 30, 2022, while unvested RSUs and unvested PSUs are not included in issued or outstanding common stock as of September 30, 2022.


	RSA			RSU			PSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64	—	$	—
Granted	—	—		4,181,885	4.82		441,964	4.62
Vested	(703,405)	3.77		(1,713,078)	8.34		—	—
Forfeited	(5,338)	5.11		(1,274,985)	6.40		(200,893)	4.62
Unvested at September 30, 2022	168,454	$	6.32	5,422,741	$	6.32	241,071	$	4.62

Schedule of Total Shareholder Return Performance Stock Units Assumptions

The assumptions used in determining the fair value of these PSUs were as follows:


	Assumption
Risk-free interest rate	2.68		%
Expected term (years)	2.74
Expected volatility (annualized)	63.7		%
Dividend yield	—		%
Closing stock price on grant date	$	4.62
Grant date fair value	$	2.78

Summary of Stock Options Activity

A summary of stock option activity for the nine months ended September 30, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(285,001)	2.01
Unvested options forfeited	—	—
Vested options expired	(109,500)	4.00
Outstanding at September 30, 2022	1,050,344	6.14		1.07	700
Exercisable at September 30, 2022	1,050,344	$	6.14	1.07	$	700

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities (Tables)

9 Months Ended

Sep. 30, 2022

Supplemental Cash Flow Elements [Abstract]

Schedule of Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Nine Months Ended September 30,
	2022		2021
Cash paid for interest	$	3,233	$	3,269
Income taxes paid	184		157
Non-cash activities:
Purchases of equipment in accounts payable	353		6
Right of use assets arising from operating lease liabilities	(37)		—
Deemed dividends on Series B Preferred Stock	—		926
Fair value of non-cash consideration received for option exercises	—		380
Right of use assets arising from finance lease liabilities	—		189
Note receivable for sale of property and equipment	—		75

Revenue (Tables)

9 Months Ended

Sep. 30, 2022

Revenue from Contract with Customer [Abstract]

Schedule of Disaggregation of Revenue

Below is a summary of net sales by class of product (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Advanced Wound Care
Tissue/Other	$	61,131	$	56,035	$	174,256	$	156,012
Cord	5,678		6,247		17,165		17,093
Total Advanced Wound Care	66,809		62,282		191,421		173,105
Section 351	796		489		1,815		17,187
Other(1)	84		303		230		914
Total	$	67,689	$	63,074	$	193,466	$	191,206

Below is a summary of net sales by each customer type (in thousands):


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Direct Customers	$	65,898	$	61,087	$	188,231	$	184,706
Distributors	1,791		1,987		5,235		6,500
Net sales	$	67,689	$	63,074	$	193,466	$	191,206

Segment Information (Tables)

9 Months Ended

Sep. 30, 2022

Segment Reporting [Abstract]

Schedule of Net Sales and Segment Contribution for Each Reportable Segment

Net sales and segment contribution for each reportable segment for the three months ended September 30, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	66,873	$	—	$	816	$	67,689
Cost of sales	11,159		—		1,029		12,188





Selling, general and administrative expense	35,531		—		17,944		53,475
Research and development expense	1,680		4,273		—		5,953
Amortization of intangible assets	—		—		175		175
Segment contribution	$	18,503	$	(4,273)
Investigation, restatement and related expense							3,001

Operating loss							$	(7,103)






Supplemental information
Depreciation expense	$	451	$	36	$	344	$	831
Share-based compensation	$	1,945	$	347	$	80	$	2,372

Net sales and segment contribution by each reportable segment for the three months ended September 30, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	62,138	$	76	$	860	$	63,074
Cost of sales	8,924		16		1,189		10,129





Selling, general and administrative expense	32,104		1,285		12,900		46,289
Research and development expense	1,423		2,945		—		4,368
Amortization of intangible assets	—		—		193		193
Segment contribution	$	19,687	$	(4,170)
Investigation, restatement and related expense							3,170

Operating loss							$	(1,075)






Supplemental information
Depreciation expense	$	511	$	34	$	378	$	923
Share-based compensation	$	1,435	$	322	$	2,054	$	3,811

Net sales and segment contribution by each reportable segment for the nine months ended September 30, 2022 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	191,297	$	—	$	2,169	$	193,466
Cost of sales	31,126		—		2,821		33,947





Selling, general and administrative expense	108,256		—		50,582		158,838
Research and development expense	6,068		11,361		—		17,429
Amortization of intangible assets	—		—		519		519
Segment contribution	$	45,847	$	(11,361)
Investigation, restatement and related expense							8,771

Operating loss							$	(26,038)






Supplemental information
Depreciation expense	$	1,364	$	120	$	1,065	$	2,549
Share-based compensation	$	5,609	$	910	$	4,279	$	10,798

Net sales and segment contribution by each reportable segment for the nine months ended September 30, 2021 were as follows (in thousands):


	Wound & Surgical		Regenerative Medicine		Corporate & Other		Consolidated
Net sales	$	172,401	$	16,584	$	2,221	$	191,206
Cost of sales	25,646		3,652		3,232		32,530





Selling, general and administrative expense	87,392		11,127		46,772		145,291
Research and development expense	4,080		8,690		—		12,770
Amortization of intangible assets	—		—		647		647
Segment contribution	$	55,283	$	(6,885)
Investigation, restatement and related expense							8,304

Operating loss							$	(8,336)






Supplemental information
Depreciation expense	$	1,172	$	213	$	2,005	$	3,390
Share-based compensation	$	3,827	$	1,147	$	6,141	$	11,115

Nature of Business (Details) $ in Thousands		3 Months Ended		6 Months Ended	9 Months Ended
Nature of Business (Details) $ in Thousands	Sep. 30, 2022 USD ($) segment	Sep. 30, 2022 USD ($) segment	Sep. 30, 2021 USD ($)	Jun. 30, 2022 segment	Sep. 30, 2022 USD ($) segment	Sep. 30, 2021 USD ($)	Dec. 31, 2021 USD ($)
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of reportable segments \| segment	2	2		1	2
Unusual or Infrequent Item, or Both [Line Items]
Net sales		$ 67,689	$ 63,074		$ 193,466	$ 191,206
Inventory	$ 13,976	13,976			13,976		$ 11,389
International Section 351
Unusual or Infrequent Item, or Both [Line Items]
Net sales		800	500		1,800	17,200
Cord
Unusual or Infrequent Item, or Both [Line Items]
Net sales		5,678	$ 6,247		17,165	$ 17,093
Inventory	$ 1,800	$ 1,800			$ 1,800		$ 1,900

- 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
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-SubTopic 10
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
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-Subparagraph (a)
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
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-Paragraph 4
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 280
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 5
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130545-203045

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-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI https://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Significant Accounting Policies - Narrative (Details) - segment		3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2022	Sep. 30, 2022	Jun. 30, 2022	Sep. 30, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Number of operating segment	3	3	1	3	1
Number of reportable segments	2	2	1	2
Number of reporting units	3	3		3	1

Accounts Receivable, Net - Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Receivables [Abstract]
Accounts receivable, gross	$ 44,660	$ 41,540
Less: allowance for doubtful accounts	(3,830)	(1,187)
Accounts receivable, net	$ 40,830	$ 40,353

Accounts Receivable, Net - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Receivables [Abstract]
Bad debt expense	$ 400	$ 0	$ 2,817	$ 0

Inventory (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Inventory (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 670		$ 670		$ 364
Work in process	7,604		7,604		6,112
Finished goods	5,702		5,702		4,913
Inventory	13,976		13,976		$ 11,389
Inventory [Line Items]
Inventory write-down	$ 0	$ 500	$ 0	$ 700
International Section 351
Inventory [Line Items]
Inventory write-down				$ 1,000

Property and Equipment, Net - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Finance lease right-of-use asset	$ 189	$ 189
Property and equipment, gross	43,043	42,043
Less: accumulated depreciation and amortization	(35,131)	(32,878)
Property and equipment, net	7,912	9,165
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	9,190	9,052
Laboratory and clean room equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	16,302	16,567
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	14,997	14,975
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,383	397
Asset retirement cost
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 982	$ 863

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 831	$ 923	$ 2,549	$ 3,390

Goodwill and Intangible Assets, Net - Narrative (Details) $ in Thousands		3 Months Ended	6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2022 USD ($) segment	Sep. 30, 2022 USD ($) segment	Jun. 30, 2022 segment	Sep. 30, 2022 USD ($) segment	Dec. 31, 2021 USD ($) segment
Goodwill [Line Items]
Number of operating segment \| segment	3	3	1	3	1
Number of reportable segments \| segment	2	2	1	2
Number of reporting units \| segment	3	3		3	1
Goodwill \| $	$ 19,976	$ 19,976		$ 19,976	$ 19,976
Wound & Surgical
Goodwill [Line Items]
Goodwill \| $	19,500	19,500		19,500
Regenerative Medicine & Biologics Innovation
Goodwill [Line Items]
Goodwill \| $	$ 500	$ 500		$ 500

- Definition

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

+ References + Details

Goodwill and Intangible Assets, Net - Activity Summary (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Net Carrying Amount	$ 2,882
Indefinite-lived Intangible Assets [Line Items]
Intangible assets, gross carrying amount	11,920	$ 11,791
Intangible assets, net carrying amount	4,992	5,383
Tradenames and trademarks
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Patents in Process
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,102	1,205
Patents and know-how
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	9,810	9,578
Accumulated Amortization	(6,928)	(6,408)
Net Carrying Amount	$ 2,882	$ 3,170

Goodwill and Intangible Assets, Net - Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 175	$ 193	$ 519	$ 647

Goodwill and Intangible Assets, Net - Estimated Future Amortization Expense for Intangible Assets (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Estimated future amortization expense [Abstract]
2022 (excluding the nine months ended September 30, 2022)	$ 174
2023	698
2024	698
2025	303
2026	148
Thereafter	861
Net Carrying Amount	$ 2,882

Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Legal and settlement costs	$ 4,185	$ 2,806
Commissions to sales agents	2,238	2,630
Accrued rebates	878	1,343
Accrued group purchasing organization fees	616	559
Estimated sales returns	999	788
Accrued travel	402	385
Accrued clinical trials	214	694
Other	1,454	607
Accrued expenses	$ 10,986	$ 9,812

Long Term Debt, Net - Term Loan (Details) - Term loan - USD ($)		9 Months Ended
	Feb. 28, 2022	Sep. 30, 2021	Sep. 30, 2022	Jul. 02, 2020
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Principal issued				$ 50,000,000
Effective interest rate (as a percent)			10.40%	8.30%
Hayfin Loan Agreement Term Loan \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, interest rate, floor (percent)	1.50%
Debt instrument, basis spread on variable rate	6.75%
Default interest rate (percent)	3.00%
Credit Facilities
Debt Instrument [Line Items]
Debt covenant, minimum liquidity	$ 20,000,000
Credit Facilities \| Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)	2.00%
Credit Facilities \| Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)	1.00%
Credit Facilities \| Debt Instrument, Redemption, Period Three
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)	0.00%
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Additional commitment fee (percent)		1.00%
BT Term Loan
Debt Instrument [Line Items]
Fair value of the Term Loan			$ 44,700,000
Minimum \| Hayfin Loan Agreement Term Loan \| Prime Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	0.50%
Maximum \| Hayfin Loan Agreement Term Loan \| Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	2.50%

Long Term Debt, Net - Term Loan Debt Issuance Costs (Details) - Term loan - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Jul. 02, 2020
Credit Facilities
Debt Instrument [Line Items]
Original issue discount			$ 500
Deferred financing costs			3,253
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Original issue discount	$ 203	$ 249	333
Deferred financing costs			2,169
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Original issue discount			167
Deferred financing costs			$ 1,084

Long Term Debt, Net - Term Loan Balances (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Jul. 02, 2020
Debt Instrument [Line Items]
Outstanding principal	$ 50,000
Term loan \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Outstanding principal	50,000	$ 50,000
Deferred financing costs	(1,322)	(1,624)
Original issue discount	(203)	(249)	$ (333)
Long term debt, net	$ 48,475	$ 48,127

- Definition

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

+ References + Details

Long Term Debt, Net - Term Loan Interest Expense (Details) - Term loan - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Stated interest	$ 1,151	$ 1,054	$ 3,225	$ 3,116
Amortization of deferred financing costs	103	95	302	276
Accretion of original issue discount	16	15	46	42
Interest expense	1,270	1,164	3,573	3,434
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee	0	0	0	126
Amortization of deferred financing costs	0	0	0	542
Accretion of original issue discount	0	0	0	83
Interest expense	$ 0	$ 0	$ 0	$ 751

Long Term Debt, Net - Term Loan Maturity (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Debt Disclosure [Abstract]
2022 (excluding the nine months ended September 30, 2022)	$ 0
2023	0
2024	0
2025	50,000
2026	0
Thereafter	0
Long term debt, net	$ 50,000

Net Loss Per Common Share - Basic Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share [Abstract]
Net loss	$ (8,426)	$ (2,339)	$ (29,783)	$ (12,500)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,670	1,574	4,884	3,613
Accretion of increasing-rate dividend feature	0	0	0	926
Total adjustments	1,670	1,574	4,884	4,539
Net loss available to common stockholders	$ (10,096)	$ (3,913)	$ (34,667)	$ (17,039)
Weighted average common shares outstanding (in shares)	113,448,251	110,717,073	112,650,713	110,136,517
Basic net loss per common share (in dollars per share)	$ (0.09)	$ (0.04)	$ (0.31)	$ (0.15)

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 815
-SubTopic 40
-Section 65
-Paragraph 1
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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- Definition

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

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- Definition

Amount, after deduction of tax, noncontrolling interests, dividends on preferred stock and participating securities; of income (loss) available to common shareholders.

+ References

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+ Details

Net Loss Per Common Share - Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share [Abstract]
Net loss available to common stockholders	$ (10,096)	$ (3,913)	$ (34,667)	$ (17,039)
Dividends on Series B Convertible Preferred Stock	1,670	1,574	4,884	4,539
Less: antidilutive adjustments	(1,670)	(1,574)	(4,884)	(4,539)
Numerator	$ (10,096)	$ (3,913)	$ (34,667)	$ (17,039)
Weighted average common shares outstanding - basic (in shares)	113,448,251	110,717,073	112,650,713	110,136,517
Potential common shares (in shares)	29,269,481	30,658,193	28,858,049	30,185,813
Less: antidilutive potential common shares (in shares)	(29,269,481)	(30,658,193)	(28,858,049)	(30,185,813)
Weighted average shares outstanding adjusted for potential common shares	113,448,251	110,717,073	112,650,713	110,136,517
Net loss per common share - diluted (in dollars per share)	$ (0.09)	$ (0.04)	$ (0.31)	$ (0.15)

Net Loss Per Common Share - Antidilutive Securities (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	29,269,481	30,658,193	28,858,049	30,185,813
Series B Convertible Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	28,685,739	27,027,252	27,850,916	26,497,570
Restricted stock unit awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	474,355	1,840,483	574,507	1,500,674
Restricted stock awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	22,327	974,687	293,778	1,287,635
Outstanding stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	22,528	805,437	97,190	875,714
Performance stock unit awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	59,996	10,334	40,141	24,220
Employee Stock Purchase Plan
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potential common shares	4,536	0	1,517	0

Equity - Narrative (Details) $ / shares in Units, $ in Thousands			3 Months Ended		9 Months Ended
	Jun. 07, 2022 shares	Jul. 02, 2020 day director $ / shares	Sep. 30, 2022 USD ($) shares	Sep. 30, 2021 USD ($)	Sep. 30, 2022 USD ($) shares	Sep. 30, 2021 USD ($)
Dividends Payable [Line Items]
Series B preferred stock, conversion price (in dollars per share) \| $ / shares		$ 5.25
Restricted Stock, Restricted Stock Units, And Performance Stock Units
Dividends Payable [Line Items]
Total unrecognized stock-based compensation related to time-based, nonvested restricted stock			$ 26,700		$ 26,700
Expenses expected to be recognized over a weighted-average period (in years)					1 year 11 months 4 days
Total Shareholder Return Performance Stock Units \| Executive Officer
Dividends Payable [Line Items]
Vesting percentage (as a percent)					100.00%
Trading days (in days)					30 days
Total Shareholder Return Performance Stock Units \| Executive Officer \| Minimum
Dividends Payable [Line Items]
Performance period (in years)					2 years
Vesting percentage (as a percent)					50.00%
Total Shareholder Return Performance Stock Units \| Executive Officer \| Maximum
Dividends Payable [Line Items]
Performance period (in years)					3 years
Vesting percentage (as a percent)					150.00%
Employee Stock
Dividends Payable [Line Items]
Purchase price of common stock (in percent)	85.00%
Purchase period	6 months
Number of shares available for issuance (in shares) \| shares	3,000,000
Share-based compensation expense			100		$ 100
Accrued ESPP payroll deferrals			200		$ 200
Shares issued during period (in shares) \| shares					0
Preferred Class B Convertible Stock
Dividends Payable [Line Items]
Liquidation preference (USD per share) \| $ / shares		1,000
Series B preferred stock, conversion price (in dollars per share) \| $ / shares		$ 3.85
Series B preferred stock, minimum percentage of conversion stock price to trigger conversion (percent)		770.00%
Number of trading days within consecutive day trading period common stock must exceed trigger conversion price \| day		20
Series B preferred stock, threshold number of consecutive trading days \| day		30
Number of board seats elected by Series B preferred stockholders \| director		2
Series B preferred stock, maximum voting stock percentage on an as-converted basis (percent)		19.90%
Preferred Class B Convertible Stock \| Discounted Dividend Rate prior to Quarterly Dividend Payment ending on June 30,2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)		4.00%
Preferred Class B Convertible Stock \| Perpetual Dividend Rate after Quarterly Dividend Payment ending on June 30, 2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)		6.00%
Series B Convertible Preferred Stock
Dividends Payable [Line Items]
Dividends, preferred stock			0	$ 0	$ 0	$ 926
Dividends accumulated but not paid			$ 12,100		$ 12,100
Convertible shares issuable (in shares) \| shares			29,119,562		29,119,562

Equity - Changes in Series B Preferred Stock (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)			100,000
Series B Preferred Stock, outstanding, beginning			$ 92,494
Series B Preferred Stock, outstanding, ending (in shares)	100,000		100,000
Series B Preferred Stock, outstanding, ending	$ 92,494		$ 92,494
Series B Convertible Preferred Stock
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)				100,000
Series B Preferred Stock, outstanding, beginning				$ 91,568
Deemed dividends	$ 0	$ 0	$ 0	$ 926
Series B Preferred Stock, outstanding, ending (in shares)		100,000		100,000
Series B Preferred Stock, outstanding, ending		$ 92,494		$ 92,494

- Definition

Carrying amount, attributable to parent, of an entity's issued and outstanding stock which is not included within permanent equity. Temporary equity is a security with redemption features that are outside the control of the issuer, is not classified as an asset or liability in conformity with GAAP, and is not mandatorily redeemable. Includes any type of security that is redeemable at a fixed or determinable price or on a fixed or determinable date or dates, is redeemable at the option of the holder, or has conditions for redemption which are not solely within the control of the issuer. Includes stock with a put option held by an ESOP and stock redeemable by a holder only in the event of a change in control of the issuer.

+ References + Details

Equity - Restricted Stock Awards (Details)	9 Months Ended
Equity - Restricted Stock Awards (Details)	Sep. 30, 2022 $ / shares shares
RSA
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	877,197
Granted (in shares) \| shares	0
Vested (in shares) \| shares	(703,405)
Forfeited (in shares) \| shares	(5,338)
Unvested, Ending Balance (in shares) \| shares	168,454
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 4.26
Grant date fair value (in dollars per share) \| $ / shares	0
Vested (in dollars per share) \| $ / shares	3.77
Forfeited (in dollars per share) \| $ / shares	5.11
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 6.32
RSU
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	4,228,919
Granted (in shares) \| shares	4,181,885
Vested (in shares) \| shares	(1,713,078)
Forfeited (in shares) \| shares	(1,274,985)
Unvested, Ending Balance (in shares) \| shares	5,422,741
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 8.64
Grant date fair value (in dollars per share) \| $ / shares	4.82
Vested (in dollars per share) \| $ / shares	8.34
Forfeited (in dollars per share) \| $ / shares	6.40
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 6.32
Performance stock unit awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	0
Granted (in shares) \| shares	441,964
Vested (in shares) \| shares	0
Forfeited (in shares) \| shares	(200,893)
Unvested, Ending Balance (in shares) \| shares	241,071
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 0
Grant date fair value (in dollars per share) \| $ / shares	4.62
Vested (in dollars per share) \| $ / shares	0
Forfeited (in dollars per share) \| $ / shares	4.62
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 4.62

Equity - Fair Value Assumptions (Details) - Total Shareholder Return Performance Stock Units	9 Months Ended
	Sep. 30, 2022 $ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grant date fair value (in dollars per share)	$ 4.62
Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	2.68%
Expected term (years)	2 years 8 months 26 days
Expected volatility (annualized)	63.70%
Dividend yield	0.00%
Closing stock price on grant date (in dollars per share)	$ 4.62
Grant date fair value (in dollars per share)	$ 2.78

Equity - Stock Incentive Plans (Details) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2022
Number of Shares
Outstanding, beginning of period (in shares)	1,444,845
Granted (in shares)	0
Exercised (in shares)	(285,001)
Unvested options forfeited (in shares)	0
Vested options expired (in shares)	(109,500)
Outstanding, end of period (in shares)	1,050,344
Exercisable options, vested and expected to vest (in shares)	1,050,344
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share)	$ 5.18
Granted (in dollars per share)	0
Exercised (in dollars per share)	2.01
Unvested options forfeited (in dollars per share)	0
Vested options expired (in dollars per share)	4.00
Outstanding, end of period (in dollars per share)	6.14
Exercisable (in dollars per share)	$ 6.14
Weighted- Average Remaining Contractual Term (in years)
Outstanding (in years)	1 year 25 days
Aggregate Intrinsic Value
Outstanding	$ 700
Exercisable	$ 700

Income Taxes (Details)	3 Months Ended		9 Months Ended
Income Taxes (Details)	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Effective tax rate	(0.60%)	(14.80%)	(0.60%)	(2.90%)

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Supplemental Cash Flow Elements [Abstract]
Cash paid for interest	$ 3,233	$ 3,269
Income taxes paid	184	157
Non-cash activities:
Purchases of equipment in accounts payable	353	6
Right of use assets arising from operating lease liabilities	(37)	0
Deemed dividends on Series B Preferred Stock	0	926
Fair value of non-cash consideration received for option exercises	0	380
Right of use assets arising from finance lease liabilities	0	189
Note receivable for sale of property and equipment	$ 0	$ 75

Commitments and Contingencies (Details) $ in Thousands		1 Months Ended	3 Months Ended		9 Months Ended
Commitments and Contingencies (Details) $ in Thousands	Jan. 16, 2019 class_action	Jun. 30, 2022 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)	Sep. 15, 2022 USD ($)
Loss Contingencies [Line Items]
Selling, general and administrative			$ 53,475	$ 46,289	$ 158,838	$ 145,291
Payments for legal settlements					700
Number of securities class actions \| class_action	2
Research and Development Arrangement \| Nordic Bioscience Clinical Development A/S
Loss Contingencies [Line Items]
Long-term purchase commitment amount		$ 13,300
Termination period (in days)		30 days
Payments made on long-term purchase commitment			2,000		2,000
Expenses on long-term purchase commitment			600		600
Remaining prepaid expenses on long-term purchase commitment			1,400		1,400
Chief Executive Officer \| Separation Agreement
Loss Contingencies [Line Items]
Other commitment			1,600		1,600		$ 3,100
Selling, general and administrative			$ 3,100		3,100
Insurance Providers
Loss Contingencies [Line Items]
Payments for legal settlements					$ 600

Revenue - Summary of Revenue by Product Type (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenue, Major Customer [Line Items]
Net sales	$ 67,689	$ 63,074	$ 193,466	$ 191,206
Advanced Wound Care
Revenue, Major Customer [Line Items]
Net sales	66,809	62,282	191,421	173,105
Tissue/Other
Revenue, Major Customer [Line Items]
Net sales	61,131	56,035	174,256	156,012
Cord
Revenue, Major Customer [Line Items]
Net sales	5,678	6,247	17,165	17,093
Section 351
Revenue, Major Customer [Line Items]
Net sales	796	489	1,815	17,187
Other
Revenue, Major Customer [Line Items]
Net sales	$ 84	$ 303	$ 230	$ 914

- Definition

+ References

+ Details

Revenue - Narrative (Details)	Sep. 30, 2022 product distribution_channel
Revenue from Contract with Customer [Abstract]
Number of products \| product	2
Number of primary distribution channels \| distribution_channel	2

Revenue - Summary of Revenue by Customer Type (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenue, Major Customer [Line Items]
Net sales	$ 67,689	$ 63,074	$ 193,466	$ 191,206
Direct Customers
Revenue, Major Customer [Line Items]
Net sales	65,898	61,087	188,231	184,706
Distributors
Revenue, Major Customer [Line Items]
Net sales	$ 1,791	$ 1,987	$ 5,235	$ 6,500

- Definition

+ References

+ Details

Segment Information - Narrative (Details) - segment		3 Months Ended	6 Months Ended	9 Months Ended
Segment Information - Narrative (Details) - segment	Sep. 30, 2022	Sep. 30, 2022	Jun. 30, 2022	Sep. 30, 2022
Segment Reporting [Abstract]
Number of reportable segments	2	2	1	2

Segment Information - Net Sales and Operating Income (Loss) by each Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting Information [Line Items]
Net sales	$ 67,689	$ 63,074	$ 193,466	$ 191,206
Cost of sales	12,188	10,129	33,947	32,530
Selling, general and administrative expense	53,475	46,289	158,838	145,291
Research and development expense	5,953	4,368	17,429	12,770
Amortization of intangible assets	175	193	519	647
Investigation, restatement and related expense	3,001	3,170	8,771	8,304
Operating loss	(7,103)	(1,075)	(26,038)	(8,336)
Supplemental information
Depreciation expense	831	923	2,549	3,390
Share-based compensation	2,372	3,811	10,798	11,115
Corporate & Other
Segment Reporting Information [Line Items]
Net sales	816	860	2,169	2,221
Cost of sales	1,029	1,189	2,821	3,232
Selling, general and administrative expense	17,944	12,900	50,582	46,772
Research and development expense	0	0	0	0
Amortization of intangible assets	175	193	519	647
Investigation, restatement and related expense
Operating loss
Supplemental information
Depreciation expense	344	378	1,065	2,005
Share-based compensation	80	2,054	4,279	6,141
Wound & Surgical \| Operating Segments
Segment Reporting Information [Line Items]
Net sales	66,873	62,138	191,297	172,401
Cost of sales	11,159	8,924	31,126	25,646
Selling, general and administrative expense	35,531	32,104	108,256	87,392
Research and development expense	1,680	1,423	6,068	4,080
Amortization of intangible assets		0	0	0
Segment contribution	18,503	19,687	45,847	55,283
Investigation, restatement and related expense
Operating loss
Supplemental information
Depreciation expense	451	511	1,364	1,172
Share-based compensation	1,945	1,435	5,609	3,827
Regenerative Medicine \| Operating Segments
Segment Reporting Information [Line Items]
Net sales	0	76	0	16,584
Cost of sales	0	16	0	3,652
Selling, general and administrative expense	0	1,285	0	11,127
Research and development expense	4,273	2,945	11,361	8,690
Amortization of intangible assets		0	0	0
Segment contribution	(4,273)	(4,170)	(11,361)	(6,885)
Investigation, restatement and related expense
Operating loss
Supplemental information
Depreciation expense	36	34	120	213
Share-based compensation	$ 347	$ 322	$ 910	$ 1,147