RTI Surgical (RTIX) 10-Q 7 Nov 16 2016 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2016	Nov. 01, 2016
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q3
Trading Symbol	RTIX
Entity Registrant Name	RTI SURGICAL, INC.
Entity Central Index Key	1,100,441
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		58,425,397

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Current Assets:
Cash and cash equivalents	$ 11,624	$ 12,614
Accounts receivable - less allowances of $1,721 at September 30, 2016 and $1,454 at December 31, 2015	38,512	47,243
Inventories - net	125,250	118,673
Prepaid and other current assets	7,437	13,184
Total current assets	182,823	191,714
Property, plant and equipment - net	89,070	84,992
Deferred tax assets - net	21,555	22,385
Goodwill	54,887	54,887
Other intangible assets - net	25,682	26,213
Other assets - net	393	471
Total assets	374,410	380,662
Current Liabilities:
Accounts payable	23,287	20,446
Accrued expenses	17,337	28,609
Current portion of deferred revenue	4,816	4,865
Current portion of short and long-term obligations	4,689	5,853
Total current liabilities	50,129	59,773
Long-term obligations - less current portion	78,720	73,384
Other long-term liabilities	395	472
Deferred revenue	7,754	9,354
Total liabilities	136,998	142,983
Preferred stock Series A, $.001 par value: 5,000,000 shares authorized; 50,000 shares issued and outstanding	59,073	56,323
Stockholders' equity:
Common stock, $.001 par value: 150,000,000 shares authorized; 58,417,397 and 57,803,111 shares issued and outstanding, respectively	58	58
Additional paid-in capital	418,166	417,725
Accumulated other comprehensive loss	(6,895)	(7,042)
Accumulated deficit	(232,436)	(228,939)
Less treasury stock, 259,443 and 230,352 shares, respectively, at cost	(554)	(446)
Total stockholders' equity	178,339	181,356
Total liabilities and stockholders' equity	$ 374,410	$ 380,662

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 1,721	$ 1,454
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	50,000	50,000
Preferred stock, shares outstanding	50,000	50,000
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	150,000,000	150,000,000
Common stock, shares issued	58,417,397	58,417,397
Common stock, shares outstanding	57,803,111	57,803,111
Treasury stock, shares	259,443	230,352

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive (Loss) Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Income Statement [Abstract]
Revenues	$ 66,547	$ 66,529	$ 201,518	$ 206,172
Costs of processing and distribution	32,273	31,296	97,270	96,737
Gross profit	34,274	35,233	104,248	109,435
Expenses:
Marketing, general and administrative	28,724	25,464	84,678	80,088
Research and development	3,789	3,793	12,034	11,492
Restructuring charges			1,107
Strategic review costs	650		650
CEO Retirement and transition costs	4,107		4,107
Contested proxy expenses			2,680
Severance costs	328		1,039
Total operating expenses	37,598	29,257	106,295	91,580
Operating (loss) income	(3,324)	5,976	(2,047)	17,855
Other (expense) income:
Interest expense	(308)	(336)	(1,061)	(981)
Interest income	1		8	3
Foreign exchange loss	(67)	(69)	(59)	(8)
Total other expense - net	(374)	(405)	(1,112)	(986)
(Loss) income before income tax provision	(3,698)	5,571	(3,159)	16,869
Income tax benefit (provision)	92	(2,069)	(338)	(6,120)
Net (loss) income	(3,606)	3,502	(3,497)	10,749
Convertible preferred dividend	(883)	(832)	(2,611)	(2,460)
Net (loss) income applicable to common shares	(4,489)	2,670	(6,108)	8,289
Other comprehensive (loss) income:
Unrealized foreign currency translation gain (loss)	241	340	147	(2,212)
Comprehensive (loss) income	$ (4,248)	$ 3,010	$ (5,961)	$ 6,077
Net (loss) income per common share - basic	$ (0.08)	$ 0.05	$ (0.10)	$ 0.14
Net (loss) income per common share - diluted	$ (0.08)	$ 0.05	$ (0.10)	$ 0.14
Weighted average shares outstanding - basic	58,353,110	57,701,810	58,173,580	57,492,606
Weighted average shares outstanding - diluted	58,353,110	58,922,423	58,173,580	58,591,303

Condensed Consolidated Stateme5

Condensed Consolidated Statement of Stockholders' Equity (Unaudited) - 9 months ended Sep. 30, 2016 - USD ($) $ in Thousands	Total	Series A Preferred Stock [Member]	Common Stock [Member]	Additional Paid-In Capital [Member]	Additional Paid-In Capital [Member]Series A Preferred Stock [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Deficit [Member]	Treasury Stock [Member]
Beginning Balance at Dec. 31, 2015	$ 181,356		$ 58	$ 417,725		$ (7,042)	$ (228,939)	$ (446)
Net loss	(3,497)						(3,497)
Foreign currency translation adjustment	147					147
Exercise of common stock options	14			14
Stock-based compensation	3,075			3,075
Purchase of treasury stock	(108)							(108)
Amortization of preferred stock Series A issuance costs		$ (139)			$ (139)
Preferred stock Series A dividend		$ (2,611)			$ (2,611)
Change in tax benefit from stock-based compensation	102			102
Ending Balance at Sep. 30, 2016	$ 178,339		$ 58	$ 418,166		$ (6,895)	$ (232,436)	$ (554)

Condensed Consolidated Stateme6

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Cash flows from operating activities:
Net (loss) income	$ (3,606)	$ 3,502	$ (3,497)	$ 10,749
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities:
Depreciation and amortization expense	4,393	4,111	13,087	12,457
Provision for bad debts and product returns	451	155	946	983
Provision for inventory write-downs	2,052	1,418	4,422	4,473
Amortization of deferred revenue	(1,216)	(1,160)	(3,650)	(5,065)
Deferred income tax provision	485	2,226	366	2,905
Stock-based compensation	1,975	662	3,075	1,915
Other	316	264	580	1,143
Change in assets and liabilities:
Accounts receivable	(1,668)	(3,902)	7,872	(6,509)
Inventories	(6,164)	(2,664)	(10,736)	(10,671)
Accounts payable	(3,400)	(7,910)	1,095	(8,672)
Accrued expenses	(3,042)	(276)	(11,360)	(4,272)
Deferred revenue			2,000	2,000
Other operating assets and liabilities	6,249	(720)	5,834	987
Net cash (used in) provided by operating activities	(3,175)	(4,294)	10,034	2,423
Cash flows from investing activities:
Purchases of property, plant and equipment	(3,371)	(4,392)	(12,774)	(12,969)
Patent and acquired intangible asset costs	(804)	(133)	(2,195)	(249)
Net cash used in investing activities	(4,175)	(4,525)	(14,969)	(13,218)
Cash flows from financing activities:
Proceeds from exercise of common stock options		570	14	2,477
Proceeds from long-term obligations	8,000	6,750	15,000	6,750
Net (payments) proceeds from short-term obligations	(662)	160	(1,511)	508
Payments on long-term obligations	(1,125)	(1,135)	(9,424)	(4,161)
Other financing activities		42	(108)	(169)
Net cash provided by financing activities	6,213	6,387	3,971	5,405
Effect of exchange rate changes on cash and cash equivalents	7	41	(26)	(5)
Net decrease in cash and cash equivalents	(1,130)	(2,391)	(990)	(5,395)
Cash and cash equivalents, beginning of period	12,754	12,699	12,614	15,703
Cash and cash equivalents, end of period	11,624	10,308	11,624	10,308
Supplemental cash flow disclosure:
Cash paid for interest	435	602	1,224	1,071
Cash paid for income taxes, net of refunds	106	1,110	282	2,631
Non-cash acquisition of property, plant and equipment	1,212	1,743	1,445	17
Stock-based compensation related to severance				310
Increase in accrual for dividend payable	$ 883	$ 832	$ 2,611	$ 2,460

Operations and Organization

Operations and Organization	9 Months Ended
	Sep. 30, 2016
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Operations and Organization	1. Operations and Organization The Company is a leader in the use of natural tissues, metals and synthetics to produce orthopedic and other surgical implants that repair and promote the natural healing of human bone and other human tissues and improve surgical outcomes. The Company processes donated human musculoskeletal and other tissue, including bone, cartilage, tendon, ligament, fascia lata, pericardium, sclera and dermal tissue, and bovine and porcine animal tissue in producing allograft and xenograft implants utilizing proprietary BIOCLEANSE ® ® ®

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2016
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	2. Basis of Presentation The accompanying unaudited condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of consolidated financial position, results of operations, comprehensive (loss) income and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). All intercompany balances and transactions have been eliminated in consolidation. The results of operations for any interim period are not necessarily indicative of the results to be expected for the full year. For further information, refer to the consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015. The condensed consolidated financial statements include the accounts of RTI Surgical, Inc. and its wholly owned subsidiaries, Pioneer Surgical Technology, Inc. (“Pioneer”), Tutogen Medical, Inc. (“TMI”), RTI Surgical, Inc. – Cardiovascular (inactive), Biological Recovery Group, Inc. (inactive) and RTI Services, Inc. (inactive). The condensed consolidated financial statements also include the accounts of RTI Donor Services, Inc. (“RTIDS”), which is a controlled entity.

Recently Issued Accounting Stan

Recently Issued Accounting Standards	9 Months Ended
	Sep. 30, 2016
Accounting Changes and Error Corrections [Abstract]
Recently Issued Accounting Standards	3. Recently Issued Accounting Standards Compensation – Stock Compensation “Compensation – Stock Compensation” Revenue from Contracts with Customers “Revenue from Contracts with Customers” “Revenue Recognition” In March and April 2016, the FASB issued two updates to the revenue recognition guidance: ASU 2016-08 “Principal Versus Agent Considerations” “Identifying Performance Obligations and Licensing” In May 2016, the FASB issued ASU Update No. 2016-12 (“ASU 2016-12”) which narrowly amended the revenue recognition guidance regarding collectability, noncash consideration, presentation of sales tax and transition. The Company has not determined the impact ASU 2014-09, ASU 2016-08, ASU 2016-10 and ASU 2016-12 will have on its condensed consolidated financial statements and footnote disclosures. However, an implementation project team has been identified and the Company plans to complete its preliminary assessment, which includes a subset of representative contracts, in 2016. Once the initial evaluation is complete, the Company will expand the scope of its assessment to include all contracts with customers. Simplifying the Presentation of Debt Issuance Costs Interest – Imputation of Interest: Simplifying the Presentation of Debt Issuance Costs”

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	4. Stock-Based Compensation The Company has six stock-based compensation plans (although it may currently issue awards only under one of such plans). The Company’s policy is to grant stock options at an exercise price equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s stock options generally have ten-year contractual terms and vest over a one to five-year period from the date of grant. The Company’s policy is to grant restricted stock awards at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock awards generally vest over one to three-year periods. 2015 Incentive Compensation Plan – 1998 Stock Option Plan, 2004 Equity Incentive Plan, 2010 Equity Incentive Plan, TMI 1996 Stock Option Plan and TMI 2006 Incentive and Non-Statutory Stock Option Plan – Stock Options As of September 30, 2016, there was $2,974 of total unrecognized stock-based compensation related to nonvested stock options. That expense is expected to be recognized over a weighted-average period of 3.12 years. Stock options outstanding, exercisable and available for grant at September 30, 2016 are summarized as follows: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Shares Price Life (Years) Value Outstanding at January 1, 2016 5,661,514 $ 4.49 Granted 619,352 3.31 Exercised (5,000 ) 2.81 Forfeited or expired (419,979 ) 5.67 Outstanding at September 30, 2016 5,855,887 $ 4.28 5.60 $ 249 Vested or expected to vest at September 30, 2016 5,614,949 $ 4.29 5.46 $ 249 Exercisable at September 30, 2016 3,772,138 $ 4.35 4.20 $ 249 Available for grant at September 30, 2016 3,314,686 The aggregate intrinsic value in the tables above represents the total pre-tax intrinsic value of stock options for which the fair market value of the underlying common stock exceeded the respective stock option exercise price. Other information concerning stock options are as follows: For the Nine Months Ended September 30, 2016 2015 Weighted average fair value of stock options granted $ 1.55 $ 2.49 Aggregate intrinsic value of stock options exercised 6 1,572 The aggregate intrinsic value of stock options exercised in a period represents the pre-tax cumulative difference, for the stock options exercised during the period, between the fair market value of the underlying common stock and the stock option exercise prices. Restricted Stock Awards During the first quarter of 2016, the Company granted 223,563 shares of time-based restricted stock and 223,563 shares of performance-based restricted stock. Both sets of awards vest over a three-year period, with a weighted-average grant date fair value of $3.31 per share. During the third quarter of 2016, the Company granted 162,160 shares of restricted stock with a weighted-average grant date fair value of $3.70 per share which vest over a one-year period. As of September 30, 2016, there was $1,735 of total unrecognized stock-based compensation related to time-based and performance-based, nonvested restricted stock. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.78 years. For the three and nine months ended September 30, 2016 and 2015, the Company recognized stock-based compensation as follows: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Stock-based compensation: Costs of processing and distribution $ 33 $ 33 $ 99 $ 99 Marketing, general and administrative 1,927 614 2,931 1,771 Research and development 15 15 45 45 Total $ 1,975 $ 662 $ 3,075 $ 1,915

Net Income Per Common Share

Net Income Per Common Share	9 Months Ended
	Sep. 30, 2016
Earnings Per Share [Abstract]
Net Income Per Common Share	5. Net Income Per Common Share A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Basic shares 58,353,110 57,701,810 58,173,580 57,492,606 Effect of dilutive securities: Stock options — 1,220,613 — 1,098,697 Diluted shares 58,353,110 58,922,423 58,173,580 58,591,303 For the three months ended September 30, 2016 and 2015, approximately 4,854,771 and 1,736,119, respectively, and for the nine months ended September 30, 2016 and 2015, approximately 4,787,572 and 1,767,376, respectively, of issued stock options were not included in the computation of diluted net income per common share because they were anti-dilutive since their exercise price exceeded the market price. For the three and nine months ended September 30, 2016, options to purchase 278,766 and 306,527, respectively, of common stock were not included in the computation of diluted loss per share because dilutive shares are not factored into this calculation when a net loss is reported. For the three and nine months ended September 30, 2016 and 2015, 50,000 shares of convertible preferred stock and accrued but unpaid dividends were anti-dilutive on an as if-converted basis and were not included in the computation of diluted net (loss) income per common share.

Inventories

Inventories	9 Months Ended
	Sep. 30, 2016
Inventory Disclosure [Abstract]
Inventories	6. Inventories Inventories by stage of completion are as follows: September 30, December 31, 2016 2015 Unprocessed tissue, raw materials and supplies $ 28,775 $ 33,028 Tissue and work in process 39,564 36,614 Implantable tissue and finished goods 56,911 49,031 $ 125,250 $ 118,673 For the three months ended September 30, 2016 and 2015, the Company had inventory write-downs of $2,052 and $1,418, respectively, and for the nine months ended September 30, 2016 and 2015, the Company had inventory write-downs of $4,422 and $4,473, respectively, relating primarily to product obsolescence.

Property, Plant and Equipment

Property, Plant and Equipment	9 Months Ended
	Sep. 30, 2016
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment	7. Property, Plant and Equipment Property, plant and equipment are as follows: September 30, December 31, 2016 2015 Land $ 2,353 $ 2,319 Buildings and improvements 63,816 63,699 Processing equipment 47,003 41,831 Surgical instruments 18,168 15,702 Office equipment, furniture and fixtures 2,736 4,657 Computer equipment and software 14,716 11,804 Construction in process 15,914 10,850 Office equipment under capital leases — 152 164,706 151,014 Less accumulated depreciation (75,636 ) (66,022 ) $ 89,070 $ 84,992 For the three months ended September 30, 2016 and 2015, the Company had depreciation expense in connection with property, plant and equipment of $3,459 and $3,011, respectively, and for the nine months ended September 30, 2016 and 2015, the Company had depreciation expense of property, plant and equipment of $10,295 and $9,212, respectively.

Other Intangible Assets

Other Intangible Assets	9 Months Ended
	Sep. 30, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Other Intangible Assets	8. Other Intangible Assets Other intangible assets are as follows: September 30, 2016 December 31, 2015 Gross Gross Carrying Accumulated Carrying Accumulated Amount Amortization Amount Amortization Patents $ 11,783 $ 4,028 $ 11,532 $ 3,448 Acquired licensing rights 12,204 8,149 10,850 7,691 Marketing and procurement intangible assets 22,756 8,884 22,179 7,209 Total $ 46,743 $ 21,061 $ 44,561 $ 18,348 Marketing and procurement intangible assets include the following: procurement contracts, trademarks, selling and marketing relationships, customer lists and non-compete agreements. For the three months ended September 30, 2016 and 2015, the Company had amortization expense of other intangible assets of $934 and $1,100, respectively, and for the nine months ended September 30, 2016 and 2015, the Company had amortization expense of other intangible assets of $2,792 and $3,245, respectively. At September 30, 2016, management’s estimates of future amortization expense for the next five years are as follows: Amortization Expense 2016 $ 875 2017 3,400 2018 3,400 2019 3,400 2020 3,400 2021 3,400 $ 17,875

Accrued Expenses

Accrued Expenses	9 Months Ended
	Sep. 30, 2016
Other Liabilities Disclosure [Abstract]
Accrued Expenses	9. Accrued Expenses Accrued expenses are as follows: September 30, December 31, 2016 2015 Accrued compensation $ 3,032 $ 4,740 Accrued severance charges 639 717 Accrued restructuring charges 150 — Accrued CEO retirement and transition costs 2,572 — Accrued distributor commissions 3,757 3,835 Accrued donor recovery fees 2,584 7,144 Accrued taxes — 514 Accrued indemnification liability — 6,579 Other 4,603 5,080 $ 17,337 $ 28,609 The Company accrues for the estimated donor recovery fees due to third party recovery agencies as tissue is received.

Short and Long-Term Obligations

Short and Long-Term Obligations	9 Months Ended
	Sep. 30, 2016
Debt Disclosure [Abstract]
Short and Long-Term Obligations	10. Short and Long-Term Obligations Short and long-term obligations are as follows: September 30, December 31, 2016 2015 Term loan $ 50,409 $ 53,722 Credit facilities 33,000 25,477 Capital leases — 38 Total 83,409 79,237 Less current portion (4,689 ) (5,853 ) Long-term portion $ 78,720 $ 73,384 On July 16, 2013, the Company obtained from TD Bank and Regions Bank a five-year $80,000 senior secured facility, which includes a $60,000 term loan and a $20,000 revolving credit facility that matures on July 16, 2018, with a variable interest rate between 100 and 175 basis points in excess of the one month LIBOR rate. On October 15, 2014, the Company entered into a Second Amendment to the Second Amended and Restated Loan Agreement with TD Bank, N.A. and Regions Bank, which amended the loan agreement to remove certain financial covenants. On June 29, 2015, the Company entered into a Third Amendment to the Second Amended and Restated Loan Agreement with TD Bank, N.A. and Regions Bank, which increased the maximum revolving credit amount from $20,000 to $30,000. On June 29, 2016, the Company entered into a Fourth Amendment to the Second Amended and Restated Loan Agreement with TD Bank, N.A. and Regions Bank, which increased the maximum revolving credit amount from $30,000 to $45,000. At September 30, 2016, the interest rate for the term loan and revolving credit facility is 2.03%. The facility is secured by substantially all the assets of the Company and its subsidiaries and guaranteed by the Company’s domestic subsidiaries, other than RTIDS. As of September 30, 2016, there was $33,000 outstanding on the revolving credit facility. The term loan facility requires aggregate principal payments of $9,375 from October 1, 2016 through June 30, 2018, with a final balloon principal payment at the end of the loan agreement. The credit agreement limits indebtedness and liens, restricts payment of dividends on common stock, requires the Company to maintain a minimum cash balance on hand of $10,000 and prescribes certain financial covenant ratios. The Company was in compliance with these financial covenants related to its senior secured credit facility as of September 30, 2016. In addition to the credit facility with TD Bank and Regions Bank, the Company had through its German subsidiary, three credit facilities with three German banks. As of September 30, 2016, the three credit facilities with the three German banks were paid off and terminated. The total available credit on the Company’s one revolving credit facility at September 30, 2016 was $12,000. The Company’s ability to access its revolving credit facility is subject to and can be limited by its compliance with its financial and other covenants. The Company was in compliance with the financial covenants related to its revolving credit facility as of September 30, 2016. As of September 30, 2016, the Company paid off all remaining capital leases. On November 7, 2016, as a result of the Company’s uncertainty regarding its ability to comply on a quarterly basis with its leverage to consolidated trailing 12-month earnings before interest, taxes, depreciation, and amortization ratio (the “Leverage to EBITDA Ratio”) covenant in the fourth quarter of 2016, the Company entered into a Fifth Amendment to the Second Amended and Restated Loan Agreement with TD Bank, N.A. and Regions Bank. The amendment increased the Company’s Leverage to EBITDA Ratio from 2.5 to 1.00 to 3.25 to 1.00 through March 31, 2017, and 3.0 to 1.00 after March 31, 2017. As of September 30, 2016, the Company’s leverage ratio was approximately 2.33. The amendment also decreased the Company’s maximum revolving credit amount from $45,000 to $42,500 and placed certain restrictions on the payment of preferred dividends. As of September 30, 2016, contractual maturities of long-term obligations are as follows: Term Loan Credit Facility Total 2016 $ 1,082 $ — $ 1,082 2017 5,070 — 5,070 2018 44,257 33,000 77,257 $ 50,409 $ 33,000 $ 83,409

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2016
Income Tax Disclosure [Abstract]
Income Taxes	11. Income Taxes The Company expects its deferred tax assets of $21,555, net of the valuation allowance at September 30, 2016 of $2,587, to be realized through the generation of future taxable income and the reversal of existing taxable temporary differences. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized. As such, valuation allowances of $2,587 and $1,106 have been established at September 30, 2016 and December 31, 2015, respectively, against a portion of the deferred tax assets relating to certain net operating loss carryforwards. U.S. income taxes have not been provided on the undistributed earnings of the Company’s foreign subsidiaries. It is not practicable to estimate the amount of tax that might be payable. The Company’s intention is to indefinitely reinvest earnings of its foreign subsidiaries outside of the U.S. The Company evaluates the need for deferred tax asset valuation allowances based on a more likely than not standard. The ability to realize deferred tax assets depends on the ability to generate sufficient taxable income within the carryback or carryforward periods provided for in the tax law for each applicable tax jurisdiction. The assessment regarding whether a valuation allowance is required or should be adjusted also considers all available positive and negative evidence. It is difficult to conclude a valuation allowance is not required when there is significant objective and verifiable negative evidence, such as cumulative losses in recent years. The Company utilizes a rolling three years of actual results as the primary measure of cumulative losses in recent years. On a rolling three year basis, the Company’s U.S. operations are in a cumulative income position. The Company considers this objectively verifiable evidence that its current U.S. operations existing on September 30, 2016, have consistently demonstrated the ability to operate at a profit. The Company has a history of utilizing 100 percent of its U.S. deferred taxes assets before they expire and the forecasts of taxable earnings project a complete realization of all U.S. deferred tax assets before they expire, including under stressed scenarios. The Company’s German and French operations are in cumulative loss positions. Since inception, the Company’s French operations have generated losses. As a result, the Company has historically recorded a full valuation allowance on its French subsidiary’s deferred tax assets. During the quarter ended September 30, 2016, the Company’s German operations entered into a cumulative loss position. As a result, the Company recorded a full valuation allowance on its German subsidiary’s deferred tax assets. The Company will continue to regularly assess the realizability of our deferred tax assets. Changes in historical earnings performance and future earnings projections, among other factors, may cause the Company to adjust its valuation allowance, which would impact the Company’s income tax expense in the period the Company determines that these factors have changed. During the quarter ended June 30, 2016, the Company’s German subsidiary completed an examination by the German tax authorities. The examination covered the German subsidiary’s 2010 through 2013 tax years. No material adjustments were recorded as a result of the German examination.

Preferred Stock

Preferred Stock	9 Months Ended
	Sep. 30, 2016
Equity [Abstract]
Preferred Stock	12. Preferred Stock On June 12, 2013, the Company and WSHP Biologics Holdings, LLC, an affiliate of Water Street Healthcare Partners, a leading healthcare-focused private equity firm (“Water Street”), entered into an investment agreement. Pursuant to the terms of the investment agreement, the Company issued $50,000 of convertible preferred equity to Water Street in a private placement which closed on July 16, 2013, with preferred stock issuance costs of $1,290. The preferred stock accrues dividends at a rate of 6% per annum. To the extent dividends are not paid in cash in any quarter, the dividends which have accrued on each outstanding share of preferred stock during such three-month period will accumulate until paid in cash or converted to common stock. Our credit agreement with TD Bank and Regions Bank contains various covenants of financial conditions which, if not met, would restrict the Company from paying dividends. Preferred stock is as follows: Preferred Stock Preferred Stock Net Liquidation Value Issuance Costs Total Balance at December 31, 2015 $ 57,168 $ (845 ) $ 56,323 Accrued dividend payable 2,611 — 2,611 Amortization of preferred stock issuance costs — 139 139 Balance at September 30, 2016 $ 59,779 $ (706 ) $ 59,073

Restructuring Charges

Restructuring Charges	9 Months Ended
	Sep. 30, 2016
Restructuring Charges	13. Restructuring Charges The Company instituted a restructuring plan primarily related to closure of our French distribution and tissue procurement office, which resulted in $1,107 of expenses for the nine months ended September 30, 2016. Accrued restructuring charges at January 1, 2016 $ — French distribution and tissue procurement office closure costs 1,107 Asset abandonments (640 ) Cash payments (317 ) Accrued restructuring charges at September 30, 2016 $ 150
Employee Severance [Member]
Restructuring Charges	17. Severance Charges The Company recorded severance charges related to the termination of former employees as a result of the Company reorganizing its distribution force, which resulted in $995 of expenses for the quarter ended December 31, 2015. The Company recorded additional severance charges to reduce headcount and improve operational efficiencies, which resulted in $1,039 of expenses for the nine months ended September 30, 2016. The total severance charges are expected to be paid in full prior to the fourth quarter of 2018. Severance payments are made to terminated employees over periods ranging from one month to twenty-four months and are not expected to have a material impact on cash flows of the Company in any quarterly period. The following table includes a rollforward of severance charges included in accrued expenses, see Note 9. Accrued severance charges at January 1, 2016 $ 865 Employee separation expenses accrued in 2016 1,039 Subtotal severance charges 1,904 Severance cash payments (1,265 ) Accrued severance charges at September 30, 2016 $ 639

Strategic Review Costs

Strategic Review Costs	9 Months Ended
	Sep. 30, 2016
Text Block [Abstract]
Strategic Review Costs	14. Strategic Review Costs The Company recorded strategic review costs related to the comprehensive strategic review of the Company’s business lines and operations to leverage the Company’s expertise, technology and products and identify opportunities to increase stockholder value, which resulted in $650 of expenses for the nine months ended September 30, 2016.

CEO Retirement and Transition C

CEO Retirement and Transition Costs	9 Months Ended
	Sep. 30, 2016
Postemployment Benefits [Abstract]
CEO Retirement and Transition Costs	15. CEO Retirement and Transition Costs The Company recorded Chief Executive Officer retirement and transition costs related to the retirement of our Chief Executive Officer, Brian K. Hutchison, pursuant to the Executive Transition Agreement dated August 29, 2012, which resulted in $4,107 of expenses for the nine months ended September 30, 2016.

Contested Proxy Expenses

Contested Proxy Expenses	9 Months Ended
	Sep. 30, 2016
Text Block [Abstract]
Contested Proxy Expenses	16. Contested Proxy Expenses The Company recorded contested proxy expenses related to the contested proxy between the Company and Krensavage Partners, LP, which resulted in $2,680 of expenses for the nine months ended September 30, 2016.

Legal Actions

Legal Actions	9 Months Ended
	Sep. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Legal Actions	18. Legal Actions The Company is, from time to time, involved in litigation relating to claims arising out of its operations in the ordinary course of business. The Company believes that none of these claims that were outstanding as of September 30, 2016 will have a material adverse impact on its financial position or results of operations. Coloplast — In addition to claims made directly against the Company, Coloplast, a manufacturer and distributor of TSM’s and a distributor of certain allografts processed and private labeled for them under a contract with the Company, has also been named as a defendant in individual TSM cases in various federal and state courts. Coloplast requested that the Company indemnify or defend Coloplast in those claims which allege injuries caused by the Company’s allograft implants, and on April 24, 2014, Coloplast sued RTI Surgical, Inc. in the Fourth Judicial District of Minnesota for declaratory relief and breach of contract. On December 11, 2014, Coloplast entered into a settlement agreement with RTI Surgical, Inc. and Tutogen Medical, Inc. (the “Company Parties”) resulting in dismissal of the case. Under the terms of the settlement agreement, the Company Parties are responsible for the defense and indemnification of two categories of present and future claims: (1) tissue only (where Coloplast is solely the distributor of Company processed allograft tissue and no Coloplast-manufactured or distributed synthetic mesh is identified), and (2) tissue plus non-Coloplast synthetic mesh (“collectively, the Claims”). There are presently a combined total of 1,126 Claims for which the Company Parties are providing defense and indemnification. The defense and indemnification of these cases are covered under the Company’s insurance policy subject to a reservation of rights by the insurer. Based on the current information available to the Company, it is not possible to evaluate and estimate with reasonable certainty the impact that current or any future TSM litigation may have on the Company. The Company’s accounting policy is to accrue for legal costs as they are incurred.

Regulatory Actions

Regulatory Actions	9 Months Ended
	Sep. 30, 2016
Text Block [Abstract]
Regulatory Actions	19. Regulatory Actions In the quarter ended September 30, 2014, the Company received a letter from the FDA regarding the Company’s map3 ® ® ®

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	20. Commitments and Contingencies Distribution Agreement with Davol

Segment Data

Segment Data	9 Months Ended
	Sep. 30, 2016
Segment Reporting [Abstract]
Segment Data	21. Segment Data The Company distributes human tissue, bovine and porcine animal tissue, metal and synthetic implants through various distribution channels. The Company operates in one reportable segment composed of six lines of business. Effective January 1, 2016, the reporting of the Company’s lines of business is composed primarily of six categories: spine; sports medicine and orthopedics; surgical specialties; cardiothoracic; international; and global commercial. The Company’s previous lines of business were composed of: spine; ortho fixation; sports medicine; bone graft substitutes and general orthopedic; dental; and surgical specialties. The prior year comparable revenue information has been restated to conform to the current year presentation. The Company believes that the change in the reporting of the Company’s lines of business will facilitate a better understanding of our lines of business and align more closely with the end markets in which the Company competes. Discrete financial information is not available for these six lines of business. The following table presents revenues from these six categories and other revenues for the three and nine months ended September 30, 2016 and 2015, respectively: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 (In Thousands) Revenues: Spine $ 17,775 $ 13,674 $ 52,514 $ 42,375 Sports medicine and orthopedics 11,874 11,882 36,956 37,654 Surgical specialties 1,168 670 2,985 2,004 Cardiothoracic 2,893 2,225 8,332 6,403 International 4,352 4,793 15,532 13,938 Subtotal direct 38,062 33,244 116,319 102,374 Global commercial 25,297 30,182 75,396 93,061 Other revenues 3,188 3,103 9,803 10,737 Total revenues $ 66,547 $ 66,529 $ 201,518 $ 206,172 Domestic revenues 60,959 61,046 183,192 189,751 International revenues 5,588 5,483 18,326 16,421 Total revenues $ 66,547 $ 66,529 $ 201,518 $ 206,172 The following table presents percentage of total revenues derived from the Company’s largest distributors and international distribution: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Percent of revenues derived from: Distributor Zimmer Biomet Holdings, Inc. 18 % 24 % 16 % 22 % Medtronic, PLC 8 % 9 % 9 % 9 % International 8 % 8 % 9 % 8 % The following table presents property, plant and equipment - net by significant geographic location: September 30, December 31, 2016 2015 Property, plant and equipment - net: Domestic $ 77,784 $ 72,901 International 12,072 12,091 Total $ 89,856 $ 84,992

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2016
Subsequent Events [Abstract]
Subsequent Events	22. Subsequent Events The Company evaluated subsequent events as of the issuance date of the condensed consolidated financial statements as defined by FASB ASC 855 Subsequent Events

Recently Issued Accounting St28

Recently Issued Accounting Standards (Policies)	9 Months Ended
	Sep. 30, 2016
Accounting Changes and Error Corrections [Abstract]
Compensation - Stock Compensation	Compensation – Stock Compensation “Compensation – Stock Compensation”
Revenue from Contracts with Customers	Revenue from Contracts with Customers “Revenue from Contracts with Customers” “Revenue Recognition” In March and April 2016, the FASB issued two updates to the revenue recognition guidance: ASU 2016-08 “Principal Versus Agent Considerations” “Identifying Performance Obligations and Licensing” In May 2016, the FASB issued ASU Update No. 2016-12 (“ASU 2016-12”) which narrowly amended the revenue recognition guidance regarding collectability, noncash consideration, presentation of sales tax and transition. The Company has not determined the impact ASU 2014-09, ASU 2016-08, ASU 2016-10 and ASU 2016-12 will have on its condensed consolidated financial statements and footnote disclosures. However, an implementation project team has been identified and the Company plans to complete its preliminary assessment, which includes a subset of representative contracts, in 2016. Once the initial evaluation is complete, the Company will expand the scope of its assessment to include all contracts with customers.
Simplifying the Presentation of Debt Issuance Costs	Simplifying the Presentation of Debt Issuance Costs Interest – Imputation of Interest: Simplifying the Presentation of Debt Issuance Costs”

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Options Outstanding, Exercisable and Available for Grant	Stock options outstanding, exercisable and available for grant at September 30, 2016 are summarized as follows: Weighted Weighted Average Average Remaining Aggregate Number of Exercise Contractual Intrinsic Shares Price Life (Years) Value Outstanding at January 1, 2016 5,661,514 $ 4.49 Granted 619,352 3.31 Exercised (5,000 ) 2.81 Forfeited or expired (419,979 ) 5.67 Outstanding at September 30, 2016 5,855,887 $ 4.28 5.60 $ 249 Vested or expected to vest at September 30, 2016 5,614,949 $ 4.29 5.46 $ 249 Exercisable at September 30, 2016 3,772,138 $ 4.35 4.20 $ 249 Available for grant at September 30, 2016 3,314,686
Other Information Concerning Stock Options	Other information concerning stock options are as follows: For the Nine Months Ended September 30, 2016 2015 Weighted average fair value of stock options granted $ 1.55 $ 2.49 Aggregate intrinsic value of stock options exercised 6 1,572
Stock-Based Compensation Recognized	For the three and nine months ended September 30, 2016 and 2015, the Company recognized stock-based compensation as follows: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Stock-based compensation: Costs of processing and distribution $ 33 $ 33 $ 99 $ 99 Marketing, general and administrative 1,927 614 2,931 1,771 Research and development 15 15 45 45 Total $ 1,975 $ 662 $ 3,075 $ 1,915

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2016
Earnings Per Share [Abstract]
Reconciliation of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Basic shares 58,353,110 57,701,810 58,173,580 57,492,606 Effect of dilutive securities: Stock options — 1,220,613 — 1,098,697 Diluted shares 58,353,110 58,922,423 58,173,580 58,591,303

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2016
Inventory Disclosure [Abstract]
Components of Inventories	Inventories by stage of completion are as follows: September 30, December 31, 2016 2015 Unprocessed tissue, raw materials and supplies $ 28,775 $ 33,028 Tissue and work in process 39,564 36,614 Implantable tissue and finished goods 56,911 49,031 $ 125,250 $ 118,673

Property, Plant and Equipment (

Property, Plant and Equipment (Tables)	9 Months Ended
	Sep. 30, 2016
Property, Plant and Equipment [Abstract]
Components of Property, Plant and Equipment	Property, plant and equipment are as follows: September 30, December 31, 2016 2015 Land $ 2,353 $ 2,319 Buildings and improvements 63,816 63,699 Processing equipment 47,003 41,831 Surgical instruments 18,168 15,702 Office equipment, furniture and fixtures 2,736 4,657 Computer equipment and software 14,716 11,804 Construction in process 15,914 10,850 Office equipment under capital leases — 152 164,706 151,014 Less accumulated depreciation (75,636 ) (66,022 ) $ 89,070 $ 84,992

Other Intangible Assets (Tables

Other Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
Components of Other Intangible Assets	Other intangible assets are as follows: September 30, 2016 December 31, 2015 Gross Gross Carrying Accumulated Carrying Accumulated Amount Amortization Amount Amortization Patents $ 11,783 $ 4,028 $ 11,532 $ 3,448 Acquired licensing rights 12,204 8,149 10,850 7,691 Marketing and procurement intangible assets 22,756 8,884 22,179 7,209 Total $ 46,743 $ 21,061 $ 44,561 $ 18,348
Estimates of Future Amortization Expense	At September 30, 2016, management’s estimates of future amortization expense for the next five years are as follows: Amortization Expense 2016 $ 875 2017 3,400 2018 3,400 2019 3,400 2020 3,400 2021 3,400 $ 17,875

Accrued Expenses (Tables)

Accrued Expenses (Tables)	9 Months Ended
	Sep. 30, 2016
Other Liabilities Disclosure [Abstract]
Accrued Expenses	Accrued expenses are as follows: September 30, December 31, 2016 2015 Accrued compensation $ 3,032 $ 4,740 Accrued severance charges 639 717 Accrued restructuring charges 150 — Accrued CEO retirement and transition costs 2,572 — Accrued distributor commissions 3,757 3,835 Accrued donor recovery fees 2,584 7,144 Accrued taxes — 514 Accrued indemnification liability — 6,579 Other 4,603 5,080 $ 17,337 $ 28,609

Short and Long-Term Obligatio35

Short and Long-Term Obligations (Tables)	9 Months Ended
	Sep. 30, 2016
Debt Disclosure [Abstract]
Short and Long-Term Obligations	Short and long-term obligations are as follows: September 30, December 31, 2016 2015 Term loan $ 50,409 $ 53,722 Credit facilities 33,000 25,477 Capital leases — 38 Total 83,409 79,237 Less current portion (4,689 ) (5,853 ) Long-term portion $ 78,720 $ 73,384
Contractual Maturities of Long-Term Obligations	As of September 30, 2016, contractual maturities of long-term obligations are as follows: Term Loan Credit Facility Total 2016 $ 1,082 $ — $ 1,082 2017 5,070 — 5,070 2018 44,257 33,000 77,257 $ 50,409 $ 33,000 $ 83,409

Preferred Stock (Tables)

Preferred Stock (Tables)	9 Months Ended
	Sep. 30, 2016
Equity [Abstract]
Schedule of Preferred Stock	Preferred stock is as follows: Preferred Stock Preferred Stock Net Liquidation Value Issuance Costs Total Balance at December 31, 2015 $ 57,168 $ (845 ) $ 56,323 Accrued dividend payable 2,611 — 2,611 Amortization of preferred stock issuance costs — 139 139 Balance at September 30, 2016 $ 59,779 $ (706 ) $ 59,073

Restructuring Charges (Tables)

Restructuring Charges (Tables)	9 Months Ended
	Sep. 30, 2016
Schedule of Restructuring Charges	The Company instituted a restructuring plan primarily related to closure of our French distribution and tissue procurement office, which resulted in $1,107 of expenses for the nine months ended September 30, 2016. Accrued restructuring charges at January 1, 2016 $ — French distribution and tissue procurement office closure costs 1,107 Asset abandonments (640 ) Cash payments (317 ) Accrued restructuring charges at September 30, 2016 $ 150
Employee Severance [Member]
Schedule of Restructuring Charges	The following table includes a rollforward of severance charges included in accrued expenses, see Note 9. Accrued severance charges at January 1, 2016 $ 865 Employee separation expenses accrued in 2016 1,039 Subtotal severance charges 1,904 Severance cash payments (1,265 ) Accrued severance charges at September 30, 2016 $ 639

Segment Data (Tables)

Segment Data (Tables)	9 Months Ended
	Sep. 30, 2016
Segment Reporting [Abstract]
Revenues from Tissue Distribution and Other Revenues	The following table presents revenues from these six categories and other revenues for the three and nine months ended September 30, 2016 and 2015, respectively: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 (In Thousands) Revenues: Spine $ 17,775 $ 13,674 $ 52,514 $ 42,375 Sports medicine and orthopedics 11,874 11,882 36,956 37,654 Surgical specialties 1,168 670 2,985 2,004 Cardiothoracic 2,893 2,225 8,332 6,403 International 4,352 4,793 15,532 13,938 Subtotal direct 38,062 33,244 116,319 102,374 Global commercial 25,297 30,182 75,396 93,061 Other revenues 3,188 3,103 9,803 10,737 Total revenues $ 66,547 $ 66,529 $ 201,518 $ 206,172 Domestic revenues 60,959 61,046 183,192 189,751 International revenues 5,588 5,483 18,326 16,421 Total revenues $ 66,547 $ 66,529 $ 201,518 $ 206,172
Schedule of Percentage of Total Revenues Derived from Company's Largest Distributors and International Distribution	The following table presents percentage of total revenues derived from the Company’s largest distributors and international distribution: For the Three Months Ended For the Nine Months Ended September 30, September 30, 2016 2015 2016 2015 Percent of revenues derived from: Distributor Zimmer Biomet Holdings, Inc. 18 % 24 % 16 % 22 % Medtronic, PLC 8 % 9 % 9 % 9 % International 8 % 8 % 9 % 8 %
Schedule of Property, Plant and Equipment - Net by Significant Geographic Location	The following table presents property, plant and equipment - net by significant geographic location: September 30, December 31, 2016 2015 Property, plant and equipment - net: Domestic $ 77,784 $ 72,901 International 12,072 12,091 Total $ 89,856 $ 84,992

Operations and Organization - A

Operations and Organization - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2016StateCountryFacility
Operations And Organization [Line Items]
Number of states that receive distribution | State	50
Number of countries that receive distribution | Country	45
Alachua, Florida [Member]
Operations And Organization [Line Items]
Number of operating facilities	2
Neunkirchen, Germany [Member]
Operations And Organization [Line Items]
Number of operating facilities	1

Recently Issued Accounting St40

Recently Issued Accounting Standards - Additional Information (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Accounting Changes and Error Corrections [Abstract]
Debt issuance costs	$ 341	$ 403

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016USD ($)$ / sharesshares	Mar. 31, 2016$ / sharesshares	Sep. 30, 2016USD ($)Plansshares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual term of stock options granted			10 years
Stock-based compensation plans | Plans			6
Percentage of market value of common stock, stock options exercise price			100.00%
Percentage of market value of common stock, restricted stock award granted			100.00%
Total unrecognized stock-based compensation | $	$ 1,735		$ 1,735
Stock-based compensation awards, weighted-average period recognized			1 year 9 months 11 days
Restricted Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period	1 year
Restricted stock granted during period	162,160
Weighted-average grant date fair value of restricted stock granted | $ / shares	$ 3.70
Restricted Stock Awards [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period			1 year
Restricted Stock Awards [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period			3 years
Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized stock-based compensation | $	$ 2,974		$ 2,974
Stock-based compensation awards, weighted-average period recognized			3 years 1 month 13 days
Stock Options [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period			1 year
Stock Options [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period			5 years
2015 Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares of common stock allowed to be issued	4,656,587		4,656,587
Performance Based Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period		3 years
Restricted stock granted during period		223,563
Weighted-average grant date fair value of restricted stock granted | $ / shares		$ 3.31
Time Based Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation award, vesting period		3 years
Restricted stock granted during period		223,563
Weighted-average grant date fair value of restricted stock granted | $ / shares		$ 3.31

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Options Outstanding, Exercisable and Available for Grant (Detail) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2016USD ($)$ / sharesshares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Outstanding, Number of Shares	5,661,514
Granted, Number of Shares	619,352
Exercised, Number of Shares	(5,000)
Forfeited or expired, Number of Shares	(419,979)
Outstanding, Number of Shares	5,855,887
Vested or expected to vest, Number of Shares	5,614,949
Exercisable, Number of Shares	3,772,138
Available for grant, Number of Shares	3,314,686
Outstanding, Weighted Average Exercise Price | $ / shares	$ 4.49
Granted, Weighted Average Exercise Price | $ / shares	3.31
Exercised, Weighted Average Exercise Price | $ / shares	2.81
Forfeited or expired, Weighted Average Exercise Price | $ / shares	5.67
Outstanding, Weighted Average Exercise Price | $ / shares	4.28
Vested or expected to vest, Weighted Average Exercise Price | $ / shares	4.29
Exercisable, Weighted Average Exercise Price | $ / shares	$ 4.35
Outstanding, Weighted Average Remaining Contractual Life (Years)	5 years 7 months 6 days
Vested or expected to vest, Weighted Average Remaining Contractual Life (Years)	5 years 5 months 16 days
Exercisable, Weighted Average Remaining Contractual Life (Years)	4 years 2 months 12 days
Outstanding, Aggregate Intrinsic Value | $	$ 249
Vested or expected to vest, Aggregate Intrinsic Value | $	249
Exercisable, Aggregate Intrinsic Value | $	$ 249

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Information Concerning Stock Options (Detail) - USD ($) $ / shares in Units, $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Weighted average fair value of stock options granted	$ 1.55	$ 2.49
Aggregate intrinsic value of stock options exercised	$ 6	$ 1,572

Stock-Based Compensation - St44

Stock-Based Compensation - Stock-Based Compensation Recognized (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Stock-based compensation	$ 1,975	$ 662	$ 3,075	$ 1,915
Costs of Processing and Distribution [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Stock-based compensation	33	33	99	99
Marketing, General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Stock-based compensation	1,927	614	2,931	1,771
Research and Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Stock-based compensation	$ 15	$ 15	$ 45	$ 45

Net Income Per Common Share - R

Net Income Per Common Share - Reconciliation of Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Earnings Per Share [Abstract]
Basic shares	58,353,110	57,701,810	58,173,580	57,492,606
Effect of dilutive securities: Stock options		1,220,613		1,098,697
Diluted shares	58,353,110	58,922,423	58,173,580	58,591,303

Net Income Per Common Share - A

Net Income Per Common Share - Additional Information (Detail) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Common Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS	278,766		306,527
Convertible Preferred Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS	50,000			50,000
Stock Options [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS	4,854,771	1,736,119	4,787,572	1,767,376

Inventories - Components of Inv

Inventories - Components of Inventories (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Inventory Disclosure [Abstract]
Unprocessed tissue, raw materials and supplies	$ 28,775	$ 33,028
Tissue and work in process	39,564	36,614
Implantable tissue and finished goods	56,911	49,031
Inventory - net	$ 125,250	$ 118,673

Inventories - Additional Inform

Inventories - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Inventory Disclosure [Abstract]
Provision for inventory write-downs	$ 2,052	$ 1,418	$ 4,422	$ 4,473

Property, Plant and Equipment -

Property, Plant and Equipment - Components of Property, Plant and Equipment (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 164,706	$ 151,014
Less accumulated depreciation	(75,636)	(66,022)
Property, plant and equipment, net	89,070	84,992
Land [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	2,353	2,319
Buildings and Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	63,816	63,699
Processing Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	47,003	41,831
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	18,168	15,702
Office Equipment, Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	2,736	4,657
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	14,716	11,804
Construction in Process [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross	$ 15,914	10,850
Office Equipment Under Capital Leases [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, gross		$ 152

Property,Plant and Equipment -

Property,Plant and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Property, Plant and Equipment [Abstract]
Depreciation expense in connection with property, plant and equipment	$ 3,459	$ 3,011	$ 10,295	$ 9,212

Other Intangible Assets - Compo

Other Intangible Assets - Components of Other Intangible Assets (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 46,743	$ 44,561
Accumulated Amortization	21,061	18,348
Patents [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	11,783	11,532
Accumulated Amortization	4,028	3,448
Acquired Licensing Rights [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	12,204	10,850
Accumulated Amortization	8,149	7,691
Marketing and Procurement Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	22,756	22,179
Accumulated Amortization	$ 8,884	$ 7,209

Other Intangible Assets - Addit

Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense of other intangible assets	$ 934	$ 1,100	$ 2,792	$ 3,245

Other Intangible Assets - Estim

Other Intangible Assets - Estimates of Future Amortization Expense (Detail) $ in Thousands	Sep. 30, 2016USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2,016	$ 875
2,017	3,400
2,018	3,400
2,019	3,400
2,020	3,400
2,021	3,400
Total future amortization expense	$ 17,875

Accrued Expenses - Accrued Expe

Accrued Expenses - Accrued Expenses (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Payables and Accruals [Abstract]
Accrued compensation	$ 3,032	$ 4,740
Accrued severance charges	639	717
Accrued restructuring charges	150
Accrued CEO retirement and transition costs	2,572
Accrued distributor commissions	3,757	3,835
Accrued donor recovery fees	2,584	7,144
Accrued taxes		514
Accrued indemnification liability		6,579
Other	4,603	5,080
Total accrued expenses	$ 17,337	$ 28,609

Short and Long-Term Obligatio55

Short and Long-Term Obligations - Short and Long-Term Obligations (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Debt Disclosure [Abstract]
Term loan	$ 50,409	$ 53,722
Credit facilities	33,000	25,477
Capital leases		38
Debt and capital lease obligation, total	83,409	79,237
Debt and capital lease obligation, total	83,409	79,237
Less current portion	(4,689)	(5,853)
Long-term portion	$ 78,720	$ 73,384

Short and Long-Term Obligatio56

Short and Long-Term Obligations - Additional Information (Detail)	Mar. 31, 2017	Nov. 04, 2016USD ($)	Sep. 30, 2016USD ($)Debt_Instruments	Jul. 16, 2013USD ($)	Sep. 30, 2016USD ($)Debt_Instruments	Nov. 03, 2016USD ($)	Jun. 29, 2016USD ($)	Dec. 31, 2015USD ($)	Jun. 29, 2015USD ($)
Line of Credit Facility [Line Items]
Credit outstanding			$ 33,000,000		$ 33,000,000			$ 25,477,000
Leverage to EBITDA Ratio			233.00%
Subsequent Event [Member]
Line of Credit Facility [Line Items]
Credit facility, borrowing capacity		$ 42,500,000				$ 45,000,000
Minimum [Member] | Subsequent Event [Member]
Line of Credit Facility [Line Items]
Leverage to EBITDA Ratio		250.00%
Maximum [Member] | Subsequent Event [Member]
Line of Credit Facility [Line Items]
Leverage to EBITDA Ratio		325.00%
Scenario, Forecast [Member]
Line of Credit Facility [Line Items]
Leverage to EBITDA Ratio	300.00%
Credit Facility [Member]
Line of Credit Facility [Line Items]
Credit outstanding			$ 33,000,000		$ 33,000,000
Long-term obligations outstanding, number | Debt_Instruments					1
Current borrowing capacity			$ 12,000,000		$ 12,000,000
TD Bank and Regions Bank Senior Secured Facility [Member]
Line of Credit Facility [Line Items]
Term of senior secured credit facility				5 years
Amount of senior secured facility obtained				$ 80,000,000
Maturity date of senior secured credit facility				Jul. 16, 2018
Description of variable interest rate basis					One month LIBOR rate
Revolving credit facility, variable interest rate			2.03%		2.03%
Aggregate principal payment on term loan					$ 9,375,000
Minimum cash balance required for covenant compliance					$ 10,000,000
Covenant Terms of Credit Facility					The credit agreement limits indebtedness and liens, restricts payment of dividends on common stock, requires the Company to maintain a minimum cash balance on hand of $10,000 and prescribes certain financial covenant ratios.
TD Bank and Regions Bank Senior Secured Facility [Member] | Minimum [Member]
Line of Credit Facility [Line Items]
Variable interest rate range				1.00%
TD Bank and Regions Bank Senior Secured Facility [Member] | Maximum [Member]
Line of Credit Facility [Line Items]
Variable interest rate range				1.75%
TD Bank and Regions Bank Senior Secured Facility [Member] | Revolving Credit Facility [Member]
Line of Credit Facility [Line Items]
Credit facility, borrowing capacity				$ 20,000,000			$ 45,000,000		$ 30,000,000
TD Bank and Regions Bank Senior Secured Facility [Member] | Term Loan [Member]
Line of Credit Facility [Line Items]
Amount of senior secured facility obtained				$ 60,000,000
German Bank Credit Facilities [Member]
Line of Credit Facility [Line Items]
Long-term obligations outstanding, number | Debt_Instruments					3
Number of credit facilities paid off and cancelled | Debt_Instruments			3		3

Short and Long-Term Obligatio57

Short and Long-Term Obligations - Contractual Maturities of Long-Term Obligations (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Debt Instrument [Line Items]
2,016	$ 1,082
2,017	5,070
2,018	77,257
Debt and capital lease obligation, total	83,409	$ 79,237
Term Loan [Member]
Debt Instrument [Line Items]
2,016	1,082
2,017	5,070
2,018	44,257
Debt and capital lease obligation, total	50,409
Credit Facility [Member]
Debt Instrument [Line Items]
2,018	33,000
Debt and capital lease obligation, total	$ 33,000

Income Taxes - Additional Infor

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Jun. 30, 2016	Sep. 30, 2016	Dec. 31, 2015
Operating Loss Carryforwards [Line Items]
Deferred tax assets		$ 21,555
Deferred tax assets, valuation allowances		$ 2,587
Primary measure of cumulative losses, number of rolling years		3 years
Utilized percentage of deferred tax assets before expiration		100.00%
Domestic Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Deferred tax assets, valuation allowances		$ 2,587	$ 1,106
Earliest Tax Year [Member] | Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Income tax examination year	2,010
Latest Tax Year [Member] | Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Income tax examination year	2,013

Preferred Stock - Additional In

Preferred Stock - Additional Information (Detail) - USD ($) $ in Thousands	Jul. 16, 2013	Jun. 12, 2013	Sep. 30, 2016	Dec. 31, 2015
Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Preferred stock issuance cost			$ 706	$ 845
Private Placement with WSHP [Member] | Convertible Preferred Stock [Member]
Temporary Equity [Line Items]
Convertible preferred stock issued		$ 50,000
Preferred stock issuance cost		$ 1,290
Private Placement with WSHP [Member] | Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Preferred stock dividend rate	6.00%

Preferred Stock - Schedule of P

Preferred Stock - Schedule of Preferred Stock (Detail) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Dec. 31, 2015
Temporary Equity [Line Items]
Amortization of preferred stock issuance costs	$ 139
Net Total	59,073	$ 56,323
Accrued dividend payable	2,611
Series A Preferred Stock [Member]
Temporary Equity [Line Items]
Amortization of preferred stock issuance costs	139
Preferred Stock Liquidation Value	59,779	57,168
Preferred Stock Issuance Costs	(706)	$ (845)
Accrued dividend payable	$ 2,611

Restructuring Charges - Additio

Restructuring Charges - Additional Information (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2016USD ($)
Restructuring and Related Activities [Abstract]
French distribution and tissue procurement office closure costs	$ 1,107

Restructuring Charges - Schedul

Restructuring Charges - Schedule of Restructuring Charges (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2016USD ($)
Restructuring and Related Activities [Abstract]
French distribution and tissue procurement office closure costs	$ 1,107
Asset abandonments	(640)
Cash payments	(317)
Accrued restructuring charges, ending balance	$ 150

Strategic Review Costs - Additi

Strategic Review Costs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2016
Research and Development [Abstract]
Strategic review costs	$ 650	$ 650

CEO Retirement and Transition64

CEO Retirement and Transition Costs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2016
Postemployment Benefits Disclosure [Line Items]
Retirement and transition costs	$ 4,107	$ 4,107
Brian K. Hutchison [Member]
Postemployment Benefits Disclosure [Line Items]
Retirement and transition costs		$ 4,107

Contested Proxy Expenses - Addi

Contested Proxy Expenses - Additional Information (Detail) $ in Thousands	9 Months Ended
	Sep. 30, 2016USD ($)
Other Income and Expenses [Abstract]
Contested proxy expenses	$ 2,680

Severance Charges - Additional

Severance Charges - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Dec. 31, 2015	Sep. 30, 2016
Restructuring and Related Activities [Abstract]
Severance charges related to the termination of former employees	$ 328	$ 995	$ 1,039

Severance Charges - Schedule of

Severance Charges - Schedule of Restructuring Charges (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Dec. 31, 2015	Sep. 30, 2016
Restructuring Cost and Reserve [Line Items]
Employee separation expenses accrued in 2016	$ 328	$ 995	$ 1,039
Subtotal severance charges			1,107
Severance cash payments			(317)
Accrued restructuring charges, ending balance	150		150
Employee Severance [Member]
Restructuring Cost and Reserve [Line Items]
Accrued restructuring charges, beginning balance			865
Employee separation expenses accrued in 2016			1,039
Subtotal severance charges			1,904
Severance cash payments			(1,265)
Accrued restructuring charges, ending balance	$ 639	$ 865	$ 639

Legal Actions - Additional Info

Legal Actions - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2016LitigationClaims
Commitments and Contingencies Disclosure [Abstract]
Outstanding claims | Litigation	0
Claims for which the Company Parties are providing defense and indemnification | Claims	1,126

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Thousands	Jul. 13, 2009	Mar. 31, 2015	Dec. 31, 2010	Sep. 30, 2016	Sep. 30, 2015
Commitment And Contingencies [Line Items]
Exclusivity payments				$ 3,500
Deferred revenue recognition				2,000	$ 2,000
Davol, Inc. [Member]
Commitment And Contingencies [Line Items]
Non-refundable license fee	$ 8,000
Revenue milestone payment			$ 3,500
Exclusivity payments				$ 8,000
Initial agreement term				10 years
Exclusive worldwide distribution agreement, extended expiration date				Jul. 13, 2019
Deferred revenue recognition		$ 1,500

Segment Data - Additional Infor

Segment Data - Additional Information (Detail)	9 Months Ended
	Sep. 30, 2016Segment
Segment Reporting [Abstract]
Number of reportable segments	1
Lines of business	6

Segment Data - Revenues from Ti

Segment Data - Revenues from Tissue Distribution and Other Revenues (Detail) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Segment Reporting Information [Line Items]
Other revenues	$ 3,188	$ 3,103	$ 9,803	$ 10,737
Revenues	66,547	66,529	201,518	206,172
Domestic [Member]
Segment Reporting Information [Line Items]
Revenues	60,959	61,046	183,192	189,751
International [Member]
Segment Reporting Information [Line Items]
Revenues	5,588	5,483	18,326	16,421
Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	38,062	33,244	116,319	102,374
Spine [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	17,775	13,674	52,514	42,375
Sports Medicine and Orthopedics [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	11,874	11,882	36,956	37,654
Surgical Specialties [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	1,168	670	2,985	2,004
Cardiothoracic [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	2,893	2,225	8,332	6,403
International [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	4,352	4,793	15,532	13,938
Global Commercial [Member] | Tissue Distribution [Member]
Segment Reporting Information [Line Items]
Tissue distribution	$ 25,297	$ 30,182	$ 75,396	$ 93,061

Segment Data - Schedule of Perc

Segment Data - Schedule of Percentage of Total Revenues Derived from Company's Largest Distributors and International Distribution (Detail) - Distributors Concentration Risk [Member] - Sales Revenue, Net [Member]	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Zimmer Biomet Holdings, Inc. [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	18.00%	24.00%	16.00%	22.00%
Medtronic, PLC [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	8.00%	9.00%	9.00%	9.00%
International Customers [Member]
Concentration Risk [Line Items]
Percentage of sales revenue	8.00%	8.00%	9.00%	8.00%

Segment Data - Schedule of Prop

Segment Data - Schedule of Property, Plant and Equipment - Net by Significant Geographic Location (Detail) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Property, Plant and Equipment [Line Items]
Property, plant and equipment - net	$ 89,070	$ 84,992
Domestic [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment - net	77,784	72,901
International [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment - net	$ 12,072	$ 12,091