Integra LifeSciences (IART) 10-Q 29 Jul 21 2021 Q2 Quarterly report Financial data

DOCUMENT AND ENTITY INFORMATION

DOCUMENT AND ENTITY INFORMATION - shares	6 Months Ended
	Jun. 30, 2021	Jul. 27, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2021
Document Transition Report	false
Entity File Number	0-26224
Entity Registrant Name	INTEGRA LIFESCIENCES HOLDINGS CORP
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	51-0317849
Entity Address	1100 Campus Road
Entity City	Princeton
Entity State	NJ
Entity Postal Zip Code	08540
City Area Code	609
Local Phone Number	275-0500
Title of 12(b) Security	Common Stock, Par Value $.01 Per Share
Trading Symbol	IART
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Bankruptcy Proceedings, Reporting Current	false
Entity Common Stock, Shares Outstanding (in shares)		84,579,542
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q2
Entity Central Index Key	0000917520
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME / (LOSS) (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement [Abstract]
Total revenue, net	$ 389,992	$ 258,665	$ 750,063	$ 612,989
Costs and expenses:
Cost of goods sold	151,267	105,478	297,090	238,954
Research and development	20,121	14,926	42,495	35,742
Selling, general and administrative	162,552	116,108	319,185	282,060
Intangible asset amortization	4,198	8,073	8,725	15,050
Total costs and expenses	338,138	244,585	667,495	571,806
Operating income	51,854	14,080	82,568	41,183
Interest income	1,764	2,281	3,512	4,851
Interest expense	(13,149)	(15,682)	(26,078)	(33,434)
Gain (loss) from the sale of business	(679)	0	42,197	0
Other income, net	5,034	972	9,903	493
Income before income taxes	44,824	1,651	112,102	13,093
Provision for income taxes	9,756	2,020	31,640	4,282
Net income (loss)	$ 35,068	$ (369)	$ 80,462	$ 8,811
Net income per share
Basic (in dollars per share)	$ 0.41	$ 0	$ 0.95	$ 0.10
Diluted (in dollars per share)	$ 0.41	$ 0	$ 0.94	$ 0.10
Weighted average common shares outstanding (See Note 13):
Basic (in shares)	84,687	84,706	84,593	84,955
Diluted (in shares)	85,340	84,706	85,324	85,548
Comprehensive income (loss) (See Note 14)	$ 28,731	$ 1,095	$ 104,558	$ (17,912)

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 397,414	$ 470,166
Trade accounts receivable, net of allowances of $6,687 and $6,439	229,823	225,532
Inventories, net	323,618	310,117
Prepaid expenses and other current assets	81,527	69,282
Assets held for sale	0	162,105
Total current assets	1,032,382	1,237,202
Property, plant and equipment, net	295,759	287,529
Right of use asset - operating leases	89,174	83,635
Intangible assets, net	1,178,884	989,436
Goodwill	1,015,638	932,367
Deferred tax assets, net	80,086	73,690
Other assets	20,864	11,277
Total assets	3,712,787	3,615,136
Current liabilities:
Current portion of borrowings under senior credit facility	45,000	33,750
Current portion of borrowings under securitization facility	0	112,500
Current portion of lease liability - operating leases	13,987	12,818
Accounts payable, trade	65,512	54,608
Income taxes payable	17,112	0
Contract liabilities	5,890	5,275
Accrued compensation	72,047	76,117
Accrued expenses and other current liabilities	99,208	94,194
Liabilities held for sale	0	11,751
Total current liabilities	318,756	401,013
Long-term borrowings under senior credit facility	823,208	933,387
Long-term borrowings under securitization facility	112,500	0
Long-term convertible securities	562,968	474,834
Lease liability - operating leases	95,196	88,118
Deferred tax liabilities	63,447	16,190
Other liabilities	161,731	186,727
Total liabilities	2,137,806	2,100,269
Stockholders’ equity:
Preferred stock; no par value; 15,000 authorized shares; none outstanding	0	0
Common stock; $0.01 par value; 240,000 authorized shares; 89,474 and 89,251 issued at June 30, 2021 and December 31, 2020, respectively	895	893
Additional paid-in capital	1,248,555	1,290,909
Treasury stock, at cost; 4,899 shares and 4,914 shares at June 30, 2021 and December 31, 2020, respectively	(234,461)	(235,141)
Accumulated other comprehensive loss	(49,963)	(74,059)
Retained earnings	609,955	532,265
Total stockholders’ equity	1,574,981	1,514,867
Total liabilities and stockholders’ equity	$ 3,712,787	$ 3,615,136

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 6,687	$ 6,439
Preferred stock, par value (in dollars per share)	$ 0	$ 0
Preferred stock, authorized shares (in shares)	15,000	15,000
Preferred stock, outstanding shares (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, authorized shares (in shares)	240,000,000	240,000,000
Common stock, issued shares (in shares)	89,474,000	89,251,000
Treasury stock, shares (in shares)	4,899,000	4,914,000

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended		12 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
OPERATING ACTIVITIES:
Net income	$ 35,068	$ 45,394	$ (369)	$ 9,180	$ 80,462	$ 8,811
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization					58,968	58,826
Non-cash impairment charges					2,754	0
Deferred income tax (benefit) provision					(4,907)	(401)
Share-based compensation					22,033	8,922
Amortization of debt issuance costs and expenses associated with debt refinancing					3,569	5,551
Non-cash lease expense					2,528	1,760
Accretion of bond issuance discount					0	6,780
Loss on disposal of property and equipment					86	517
Gain from the sale of business	679		0		(42,197)	0
Change in fair value of contingent consideration and others					(385)	(708)
Changes in assets and liabilities:
Accounts receivable					10,802	95,293
Inventories					2,893	(47,041)
Prepaid expenses and other current assets					(8,061)	2,191
Other non-current assets					4,067	6,149
Accounts payable, accrued expenses and other current liabilities					27,277	(88,671)
Other non-current liabilities					482	(4,048)
Net cash provided by operating activities					160,371	53,931
INVESTING ACTIVITIES:
Purchases of property and equipment					(13,309)	(23,736)
Proceeds from sale of Extremity Orthopedics business					191,736	0
Proceeds from sale of property and equipment					0	3,302
Cash (paid) provided for business acquisitions, net of cash acquired					(303,910)	0
Acquired in-process research and development					0	(5,000)
Net cash used in investing activities					(125,483)	(25,434)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness					2,200	127,700
Payments on debt					(102,200)	(388,500)
Purchase of option hedge on convertible notes					0	(104,248)
Proceeds from convertible notes issuance					0	575,000
Proceeds from sale of stock purchase warrants					0	44,563
Payment of debt issuance costs					(249)	(20,264)
Purchases of treasury stock					0	(100,000)
Proceeds from exercised stock options					3,603	3,598
Cash taxes paid in net equity settlement					(3,844)	(4,397)
Net cash (used) provided by financing activities					(100,490)	133,452
Effect of exchange rate changes on cash and cash equivalents					(7,150)	121
Net increase in cash and cash equivalents					(72,752)	162,070
Cash and cash equivalents at beginning of period		$ 470,166		$ 198,911	470,166	198,911	$ 198,911
Cash and cash equivalents at end of period	$ 397,414		$ 360,981		$ 397,414	$ 360,981	$ 470,166

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDER'S EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Treasury Stock	Additional Paid-In Capital	Additional Paid-In CapitalCumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Loss	Retained Earnings	Retained EarningsCumulative Effect, Period of Adoption, Adjustment
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	$ 1,416,736	$ (200)	$ 887	$ (119,943)	$ 1,213,620		$ (76,401)	$ 398,573	$ (200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	9,180							9,180
Other comprehensive income (loss), net of tax	(28,187)						(28,187)
Issuance of common stock through employee stock purchase plan (in shares)			13,000
Issuance of common stock through employee stock purchase plan	694				694
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			357,000	10,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(2,739)		$ 2	$ 476	(3,217)
Share-based compensation	3,781				3,781
Share repurchase and equity component of the convertible note issuance, net (in shares)				(135,000)
Share repurchase and equity component of the convertible note issuance, net	34,906			$ (7,632)	42,538
Accelerated shares repurchased (in shares)				(1,304,000)
Accelerated shares repurchased	(92,368)			$ (75,407)	(16,961)
Balance End of Period, Shares (in shares) at Mar. 31, 2020			89,105,000
Balance, End of Period at Mar. 31, 2020	1,341,803		$ 889	$ (202,506)	1,240,455		(104,588)	407,553
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2020				(4,294,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	1,416,736	(200)	$ 887	$ (119,943)	1,213,620		(76,401)	398,573	(200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	8,811
Balance End of Period, Shares (in shares) at Jun. 30, 2020			89,189,000
Balance, End of Period at Jun. 30, 2020	1,349,096		$ 892	$ (235,226)	1,279,370		(103,124)	407,184
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2020				(4,915,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2019			88,735,000
Balance, Beginning of Period at Dec. 31, 2019	$ 1,416,736	(200)	$ 887	$ (119,943)	1,213,620		(76,401)	398,573	(200)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2019				(2,865,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accelerated shares repurchased (in shares)	(2,100,000)
Balance End of Period, Shares (in shares) at Dec. 31, 2020			89,251,000
Balance, End of Period at Dec. 31, 2020	$ 1,514,867	(66,046)	$ 893	$ (235,141)	1,290,909	$ (63,274)	(74,059)	532,265	(2,772)
Balance, End of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2020	(4,914,000)			(4,914,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2020			89,105,000
Balance, Beginning of Period at Mar. 31, 2020	$ 1,341,803		$ 889	$ (202,506)	1,240,455		(104,588)	407,553
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2020				(4,294,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	(369)							(369)
Other comprehensive income (loss), net of tax	1,464						1,464
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			84,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	1,250		$ 3	$ (35)	1,282
Share-based compensation	4,948				4,948
Accelerated shares repurchased (in shares)				(621,000)
Accelerated shares repurchased	0			$ (32,685)	32,685
Balance End of Period, Shares (in shares) at Jun. 30, 2020			89,189,000
Balance, End of Period at Jun. 30, 2020	1,349,096		$ 892	$ (235,226)	1,279,370		(103,124)	407,184
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2020				(4,915,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2020			89,251,000
Balance, Beginning of Period at Dec. 31, 2020	$ 1,514,867	(66,046)	$ 893	$ (235,141)	1,290,909	(63,274)	(74,059)	532,265	(2,772)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2020	(4,914,000)			(4,914,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 45,394							45,394
Other comprehensive income (loss), net of tax	30,432						30,432
Issuance of common stock through employee stock purchase plan (in shares)			18,000
Issuance of common stock through employee stock purchase plan	1,127				1,127
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			137,000	15,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(2,541)		$ 1	$ 680	(3,222)
Share-based compensation	6,098				6,098
Balance End of Period, Shares (in shares) at Mar. 31, 2021			89,406,000
Balance, End of Period at Mar. 31, 2021	1,529,331		$ 894	$ (234,461)	1,231,638		(43,627)	574,887
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2021				(4,899,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2020			89,251,000
Balance, Beginning of Period at Dec. 31, 2020	$ 1,514,867	$ (66,046)	$ 893	$ (235,141)	1,290,909	$ (63,274)	(74,059)	532,265	$ (2,772)
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2020	(4,914,000)			(4,914,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 80,462
Other comprehensive income (loss), net of tax	24,096
Balance End of Period, Shares (in shares) at Jun. 30, 2021			89,474,000
Balance, End of Period at Jun. 30, 2021	$ 1,574,981		$ 895	$ (234,461)	1,248,555		(49,963)	609,955
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2021	(4,899,000)			(4,899,000)
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2021			89,406,000
Balance, Beginning of Period at Mar. 31, 2021	$ 1,529,331		$ 894	$ (234,461)	1,231,638		(43,627)	574,887
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2021				(4,899,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	35,068							35,068
Other comprehensive income (loss), net of tax	(6,336)						(6,336)
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			68,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	1,176		$ 1	$ 0	1,175
Share-based compensation	15,742				15,742
Balance End of Period, Shares (in shares) at Jun. 30, 2021			89,474,000
Balance, End of Period at Jun. 30, 2021	$ 1,574,981		$ 895	$ (234,461)	$ 1,248,555		$ (49,963)	$ 609,955
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2021	(4,899,000)			(4,899,000)

BASIS OF PRESENTATION

BASIS OF PRESENTATION	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BASIS OF PRESENTATION	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the June 30, 2021 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, statement of changes in shareholder's equity, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 2020 included in the Company’s Annual Report on Form 10-K. The December 31, 2020 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three and six month period ended June 30, 2021 are not necessarily indicative of the results to be expected for the entire year. The preparation of consolidated financial statements is in conformity with generally accepted accounting principles in the United States ("GAAP") which requires management to make estimates and assumptions that affect the reported amount of assets and liabilities, the disclosure of contingent liabilities, and the reported amounts of revenues and expenses. Significant estimates affecting amounts reported or disclosed in the consolidated financial statements include allowances for doubtful accounts receivable and sales returns and allowances, net realizable value of inventories, valuation of intangible assets including amortization periods for acquired intangible assets, discount rates and estimated projected cash flows used to value and test impairments of long-lived assets and goodwill, estimates of projected cash flows and depreciation and amortization periods for long-lived assets, computation of taxes, valuation allowances recorded against deferred tax assets, the valuation of stock-based compensation, valuation of derivative instruments, valuation of contingent liabilities, the fair value of debt instruments and loss contingencies. These estimates are based on historical experience and on various other assumptions that are believed to be reasonable under the current circumstances. Actual results could differ from these estimates. Risks and Uncertainties The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic. During the beginning of 2020, the Company's customers diverted resources to treat COVID-19 patients and deferred or canceled elective or non-emergent surgical procedures, all of which impacted hospitals' abilities to meet their obligations, including to the Company. Towards the end of 2020 and during the first half of 2021, procedural volumes relevant to the Company’s products steadily increased and, in some geographic areas, began to approach normalized levels. However, on-going uncertainty persists about the continuing sustainability of those procedural volumes as virus outbreaks constrain healthcare networks. Furthermore, capital markets and economies worldwide have also been negatively impacted by the COVID-19 pandemic, and it is possible that it could cause a local and/or global economic recession. Such economic disruption has had an adverse effect on the Company's business as customers curtailed and reduced capital and overall spending. Policymakers around the globe have responded with fiscal policy actions to support the healthcare industry and the economy as a whole. The magnitude and overall effectiveness of these actions remains uncertain. The severity of the impact of the COVID-19 pandemic on the Company's business will depend on a number of factors, including, but not limited to, duration of the pandemic, including resurgences, new variants or strains, impact of government regulations, the speed and effectiveness of vaccine distribution, vaccine adoption rates and the direct and indirect economic effects of the pandemic and containment measures. The Company's future results of operations and liquidity could be adversely impacted by delays in payments of outstanding receivable amounts beyond normal payment terms, supply chain disruptions and uncertain demand, and the impact of any initiatives or programs that the Company may undertake to address financial and operations challenges faced by its customers. During the first half of 2021, the Company's revenues were still impacted due to COVID-19 resurgences and lower surgical procedural volumes, though not to the levels seen in early 2020. As a result, the Company has continued to manage its operating costs in this environment. Even after the COVID-19 pandemic and government responses thereto have subsided, residual economic and other effects may have an impact on the demand for post-pandemic surgery levels that are difficult to predict. Recent Accounting Pronouncements In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326) : Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The ASU became effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020 is not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the COVID-19 pandemic, and other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact due to customer and governmental responses to the COVID-19 pandemic. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans . This guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans. The ASU is effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption was permitted. The Company adopted this guidance during the year ended December 31, 2020. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures. In August 2018, the FASB issued ASU 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under this guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a prospective transition method. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes: Simplifying the Accounting for Income Taxes, intended to simplify the accounting for income taxes by eliminating certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplifies aspects of the accounting for franchise taxes and enacted changes in tax laws or rates and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The standard is effective for annual periods beginning after December 15, 2020 and interim periods within, with early adoption permitted. The Company adopted ASU No. 2019-12 as of January 1, 2021. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The adoption of this guidance did not have a material impact on the Company's results or financial position. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform , which provides optional guidance for a limited period of time to ease the potential burden in accounting for (or recognizing the effects of) reference rate reform on financial reporting. This amendment applies to all entities, subject to meeting certain criteria, that have contracts, hedging relationships, and other transactions that reference London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued because of reference rate reform. This ASU is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into or evaluated on or before December 31, 2022. In January 2021, the FASB also issued ASU 2021-01, Reference Rate Reform- Scope which clarified certain optional expedients and exceptions to entities that are affected because of the reference rate reform. The amendments in this ASU affect the guidance in ASU 2020-04 and are effective in the same timeframe as ASU 2020-04. The Company is currently assessing the impact that this ASU will have on its consolidated financial statements and related disclosures. In August 2020, the FASB issued ASU 2020-06, Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting for Convertible Instruments and Contracts in an Entity's Own Equity . The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will be effective for annual and interim periods beginning after December 15, 2021, and early adoption is permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years using either the modified retrospective or full retrospective method. As detailed in Note 6 – Debt , on February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes are subject to the guidance included in ASU 2020-06. The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts: ADJUSTMENT CONSOLIDATED BALANCE SHEET CLASSIFICATION AMOUNT Deferred tax impact of cumulative-effect adjustment Deferred tax liabilities $ (20.6) Debt discount reclassification Long-term convertible securities 89.1 Equity issuance costs reclassification Long-term convertible securities (2.5) Debt discount amortization and equity costs reclassification, net of tax Retained Earnings (2.8) Net impact of cumulative-effect adjustment Additional paid-in capital (63.3) Upon adoption of this ASU 2020-06, the Company’s Convertible Senior Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its convertible senior notes to be settled in cash and any excess in shares. Following the irrevocable notice, only the amounts settled in excess of the principal will be considered in diluted earnings per share under the “if-converted” method. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount, therefore the interest expense for the 2025 Notes, which is included in the interest expense on the consolidated statements of operations and comprehensive loss, is lower as compared to the fiscal year of 2020. In October 2020, the FASB issued ASU 2020-10, Codification Improvements , which updates various codification topics by clarifying or improving disclosure requirements to align with the SEC’s regulations. The ASU will be effective for the Company for annual and interim periods beginning after January 1, 2021. The Company adopted this standard on the January 1, 2021. The adoption of this guidance did not have a material impact on the Company's results, financial position or disclosures. In May 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options which provides guidance to clarify and reduce diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options (for example, warrants) that remain equity classified after modification or exchange. The amendments in this ASU No. 2021-04 are effective for all entities for fiscal years beginning after December 15, 2021, and interim periods within those fiscal years, with early adoption permitted, including interim periods within those fiscal years. The amendment currently has no impact to the Company as the effect will largely depend on the terms of written call options or financings issued or modified in the future. There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.

ACQUISITIONS AND DIVESTITURES

ACQUISITIONS AND DIVESTITURES	6 Months Ended
	Jun. 30, 2021
Mergers, Acquisitions and Dispositions [Abstract]
ACQUISITIONS AND DIVESTITURES	ACQUISITIONS AND DIVESTITURES Sale of Extremity Orthopedics Business On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business to Smith & Nephew USD Limited ("Smith & Nephew"). The transaction included the sale of the Company's upper and lower Extremity Orthopedics product portfolio, including ankle and shoulder arthroplasty and hand and wrist product lines. The Company received an aggregate purchase price of $240.0 million from Smith and Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO") effectively terminating the licensing agreement between Integra and CFO relating to the development of shoulder arthroplasty products. Assets and liabilities divested consisted of the following as of December 31, 2020 (dollar amounts in thousands): Prepaid expenses and other current assets $ 713 Right of use asset-operating leases and Other assets 3,186 Deferred tax assets 6,589 Intangible assets, net 13,332 Property, plant and equipment, net 37,893 Goodwill 47,546 Inventories 52,845 Total assets held for sale $ 162,104 Other liabilities 336 Current portion of lease liability - operating leases 539 Accrued compensation 1,767 Deferred tax liabilities 3,440 Lease liability - operating leases 5,669 Total liabilities held for sale $ 11,751 The Divestiture does not represent a strategic shift that will have a major effect on the Company's operations and financial statements. Goodwill was allocated to the assets and liabilities divested using the relative fair value method of the Extremity Orthopedics business to the Company's Tissue Technologies reporting unit. In connection with the sale, the Company recognized a loss of $0.7 million associated with certain working capital adjustments and gain of $42.2 million that is presented in Gain from the sale of business in the consolidated statement of operations for the three and six months ended June 30, 2021. The net proceeds are subject to adjustments based on changes in the actual closing net working capital. The purchase price is preliminary pending finalization of potential working capital adjustments. The Company also entered into a transition services agreement ("TSA") with Smith & Nephew which requires the Company to provide certain services on behalf of Smith & Nephew for the duration of the period subsequent to the sale of the business as defined in the agreement. The Com pany recognized a payable due to Smith & Nephew of $10.9 million as of June 30, 2021, included in the consolidated balance sheet within accrued expenses and other current liabilities respectively. ACell Inc. Acquisition On January 20, 2021, the Company acquired ACell Inc. (the "ACell Acquisition") for an acquisition purchase price of $306.9 million plus contingent consideration of up to $100 million, that may be payable upon achieving certain revenue-based performance milestones in 2022, 2023 and 2025. The final working capital adjustments of $1.3 million was finalized and paid as of June 30, 2021; however certain amounts relating to tax related matters have not been finalized. The finalization of these matters may result in changes to goodwill. ACell was a privately-held company that offered a portfolio of regenerative products for complex wound management, including developing and commercializing products based on MatriStem Urinary Bladder Matrix ("UBM"), a technology platform derived from porcine urinary bladder extracellular matrix. Assets Acquired and Liabilities Assumed at Fair Value The ACell Acquisition has been accounted for using the acquisition method of accounting. This method requires that assets acquired and liabilities assumed in a business combination are recognized at their fair values as of the acquisition date. The following table summarizes the preliminary fair values of the assets acquired and liabilities assumed at the acquisition date: Dollars in thousands Preliminary Valuation as of June 30, 2021 Weighted Average Life Current assets: Cash $ 2,726 Trade accounts receivable, net 16,469 Inventories, net 18,299 Prepaids expenses and other current assets 1,498 Total current assets 38,992 Property, plant and equipment, net 13,769 Intangible assets 245,000 13-14 years Goodwill 94,298 Right of use asset - operating leases 9,259 Deferred tax assets 9,768 Other assets 148 Total assets acquired 411,234 Current liabilities: Accounts payable $ 718 Accrued expenses 5,966 Current portion of lease liability - operating leases 1,673 Total current liabilities 8,357 Other long-term liability 276 Lease liability - operating leases 7,585 Deferred tax liability 64,178 Contingent consideration 23,900 Total liabilities assumed 104,296 Net assets acquired $ 306,938 Intangible Assets The estimated fair value of the developed technology acquired was determined using the multi-period excess earnings method of the income approach, which estimates value based on the present value of future economic benefits. Some of the more significant assumptions inherent in the development of those asset valuations include the estimated net cash flows for each year for each product including net revenues, cost of sales, R&D costs, selling and marketing costs, the appropriate discount rate to select in order to measure the risk inherent in each future cash flow stream, the assessment of each asset’s life cycle, and competitive trends impacting the asset and each cash flow stream. The Company used a discount rate of 8.5% to arrive at the present value for the acquired intangible assets to reflect the rate of return a market participant would expect to earn and incremental commercial uncertainty in the cash flow projections. No assurances can be given that the underlying assumptions used to prepare the discounted cash flow analysis will not change. For these and other reasons, actual results may vary significantly from estimated results. Goodwill The Company allocated goodwill related to the ACell Acquisition to the Tissue Technologies segment. Goodwill is the excess of the consideration transferred over the net assets recognized and represents the expected synergies of the combined company and assembled workforce. Goodwill recognized as a result of this acquisition is non-deductible for income tax purposes. Contingent Consideration As part of the acquisition, the Company is required to pay the former shareholders of ACell up to $100 million based on the achievement of certain revenue-based performance milestones in 2022, 2023, and 2025. T he Company used iterations of the Monte Carlo simulation to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specific milestone. The Company estimated the fair value of the contingent consideration to be $23.9 million at the acquisition date. The estimated fair value as of June 30, 2021 was $23.5 million. This amount is included in other liabilities at June 30, 2021 in the consolidated balance sheets of the Company. The Company determines the acquisition date fair value of contingent consideration obligations using a Monte Carlo simulation, as well as significant unobservable inputs, reflecting the Company’s assessment of the assumptions market participants would use to value these liabilities. The fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined using the fair value concepts in ASC 820. The resultant most likely payouts are discounted using an appropriate effective annual interest rate. At each reporting date, the contingent consideration obligation will be revalued to estimated fair value and changes in fair value will be reflected as income or expense in our consolidated statement of operations. Changes in the fair value of the contingent considerations may result from changes in discount periods and rates and changes in the timing and amount of revenue estimates. Deferred Tax Liabilities Deferred tax liabilities result from identifiable intangible assets’ fair value adjustments. These adjustments create excess book basis over tax basis which is tax-effected by the statutory tax rates of applicable jurisdictions. Pro Forma Results (unaudited) Pro forma revenues for the three months ended June 30, 2021 and 2020 were $390.0 million and $269.6 million, re

REVENUES FROM CONTRACTS WITH CU

REVENUES FROM CONTRACTS WITH CUSTOMERS	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
REVENUES FROM CONTRACTS WITH CUSTOMERS	REVENUES FROM CONTRACTS WITH CUSTOMERS Summary of Accounting Policies on Revenue Recognition Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services. Performance Obligations The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers. Significant Judgments Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company and the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant. The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract. The Company's return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days. The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the goods or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers. Contract Asset and Liability Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet. Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability. The following table summarizes the changes in the contract asset and liability balances for the six months ended June 30, 2021: Contract Asset Contract asset, January 1, 2021 $ 7,430 Transferred to trade receivable of contract asset included in beginning of the year contract asset (7,430) Contract asset, net of transferred to trade receivables on contracts during the period 7,952 Contract asset, June 30, 2021 $ 7,952 Contract Liability Contract liability, January 1, 2021 $ 11,961 Recognition of revenue included in beginning of year contract liability (2,838) Contract liability, net of revenue recognized on contracts during the period 3,102 Foreign currency translation (125) Contract liability, June 30, 2021 $ 12,100 At June 30, 2021, the short-term portion of the contract liability of $5.9 million and the long-term portion of $6.2 million were included in accrued expenses and other current liabilities and other liabilities, respectively, in the consolidated balance sheet. As of June 30, 2021, the Company is expected to recognize approximately 49% of unsatisfied (or partially unsatisfied) performance obligations as revenue within twelve months, with the remaining balance to be recognized thereafter. Shipping and Handling Fees The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in the cost of goods sold. Product Warranties Certain of the Company's medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet. Taxes Collected from Customers The Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer. Disaggregated Revenue The following table presents revenues disaggregated by the major sources of revenues for the three and six months ended June 30, 2021 and 2020 (dollar amounts in thousands): Three Months Ended June 30, 2021 Three Months Ended June 30, 2020 Six Months Ended June 30, 2021 Six Months Ended June 30, 2020 Neurosurgery $ 202,600 $ 141,430 $ 391,854 $ 326,373 Instruments 54,237 28,348 106,224 74,845 Total Codman Specialty Surgical 256,837 169,778 498,078 401,218 Wound Reconstruction and Care (2) 102,616 56,291 191,314 128,558 Extremity Orthopedics (1) — 11,162 — 32,634 Private Label 30,539 21,434 60,671 50,579 Total Tissue Technologies 133,155 88,887 251,985 211,771 Total revenue $ 389,992 $ 258,665 $ 750,063 $ 612,989 (1) On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business. In conjunction with the sale of this business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021. See Note 2. Acquisitions and Divestitures, for details. (2) See Note 2. Acquisitions and Divestitures, for details around the ACell Inc. Acquisition. See Note 15, Segment and Geographical Information , for details of revenues based on the location of the customer.

INVENTORIES

INVENTORIES	6 Months Ended
	Jun. 30, 2021
Inventory Disclosure [Abstract]
INVENTORIES	INVENTORIES Inventories, net consisted of the following: Dollars in thousands June 30, 2021 December 31, 2020 Finished goods $ 180,835 $ 180,301 Work in process 61,987 53,336 Raw materials 80,796 76,480 Total inventories, net $ 323,618 $ 310,117

GOODWILL AND OTHER INTANGIBLE A

GOODWILL AND OTHER INTANGIBLE ASSETS	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL AND OTHER INTANGIBLE ASSETS	GOODWILL AND OTHER INTANGIBLE ASSETS Goodwill Changes in the carrying amount of goodwill for the six-month period ended June 30, 2021 were as follows: Dollars in thousands Codman Specialty Tissue Technologies Total Goodwill at December 31, 2020 $ 671,975 $ 260,392 $ 932,367 ACell Acquisition — 94,298 94,298 Foreign currency translation (7,218) (3,809) (11,027) Goodwill at June 30, 2021 $ 664,757 $ 350,881 $ 1,015,638 The components of the Company’s identifiable intangible assets were as follows: June 30, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,125,279 $ (274,287) $ 850,992 Customer relationships 12 years $ 212,572 $ (137,897) $ 74,675 Trademarks/brand names 28 years $ 99,319 $ (29,866) $ 69,453 Codman tradename Indefinite $ 166,651 $ — $ 166,651 Supplier relationships 30 years $ 30,211 $ (15,691) $ 14,520 All other 11 years $ 6,473 $ (3,880) $ 2,593 $ 1,640,505 $ (461,621) $ 1,178,884 December 31, 2020 Dollars in thousands Weighted Cost Accumulated Net Completed technology 19 years $ 896,478 $ (248,088) $ 648,390 Customer relationships 12 years 213,270 (132,838) 80,432 Trademarks/brand names 28 years 104,209 (31,767) 72,442 Codman tradename Indefinite 170,226 — 170,226 Supplier relationships 27 years 30,211 (15,203) 15,008 All other (1) 4 years 6,693 (3,755) 2,938 $ 1,421,087 $ (431,651) $ 989,436 (1) Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation. The increase in the Company's identifiable intangible assets at June 30, 2021 as compared to the year ended December 31, 2020, was primarily driven from intangible assets acquired in conjunction with the ACell Inc. acquisition. See Note 2, Acquisitions and Divestitures , for details. Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of product revenues) is expected to be approximately $40.6 million for the remainder of 2021, $79.1 million in 2022, $78.4 million in 2023, $77.7 million in 2024, $77.7 million in 2025, $77.5 million in 2026 and $585.7 million thereafter.

DEBT

DEBT	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
DEBT	DEBT Amendment to the Sixth Amended and Restated Senior Credit Agreement On February 3, 2020, the Company entered into the sixth amendment and restatement (the "February 2020 Amendment") of its Senior Credit Facility (the "Senior Credit Facility") with a syndicate of lending banks with Bank of America, N.A., as Administrative Agent. The February 2020 Amendment extended the maturity date to February 3, 2025. The Company continues to have the aggregate principal amount of up to approximately $2.2 billion available to it through the following facilities: (i) a $877.5 million Term Loan facility, and (ii) a $1.3 billion revolving credit facility, which includes a $60 million sublimit for the issuance of standby letters of credit and a $60 million sublimit for swingline loans. On July 14, 2020, the Company entered into an amendment (the "July 2020 Amendment") to the February 2020 Amendment of the Senior Credit Facility to increase financial flexibility in light of the unprecedented impact and uncertainty of the COVID-19 pandemic on the global economy. The July 2020 amendment does not increase the Company’s total indebtedness. In connection with the July 2020 amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) was modified to the following: Fiscal Quarter Maximum Consolidated Total Leverage Ratio Execution of July 2020 Amendment through June 30, 2021 5.50 to 1.00 September 30, 2021 through June 30, 2022 5.00 to 1.00 September 30, 2022 through June 30, 2023 4.50 to 1.00 September 30, 2023 and the last day of each fiscal quarter thereafter 4.00 to 1.00 Borrowings under the Senior Credit Facility bear interest, at the Company’s option, at a rate equal to the following: i. the Eurodollar Rate (as defined in the amendment and restatement) in effect from time to time plus the applicable rate (ranging from 1.00% to 2.25%), or ii. the highest of: 1. the weighted average overnight Federal funds rate, as published by the Federal Reserve Bank of New York, plus 0.50% 2. the prime lending rate of Bank of America, N.A. or 3. the one-month Eurodollar Rate plus 1.00% The applicable rates are based on the Company’s consolidated total leverage ratio (defined as the ratio of (a) consolidated funded indebtedness as of such date less cash that is not subject to any restriction on the use or investment thereof to (b) consolidated EBITDA as defined by the July 2020 amendment, for the period of four consecutive fiscal quarters ending on such date). The Company will pay an annual commitment fee (ranging from 0.15% to 0.30%), based on the Company's consolidated total leverage ratio, on the amount available for borrowing under the revolving credit facility. The Senior Credit Facility is collateralized by substantially all of the assets of the Company’s U.S. subsidiaries, excluding intangible assets. The Senior Credit Facility is subject to various financial and negative covenants and at June 30, 2021, the Company was in compliance with all such covenants. In connection with the February 2020 Amendment, the Company capitalized $4.6 million of financing costs in connection with modification of the Senior Credit Facility and wrote off $1.2 million of previously capitalized financing costs during the first quarter of 2020. In connection with the July 2020 amendment, the Company expensed $3.3 million of incremental financing costs in connection with the modification of the Senior Credit Facility during the third quarter of 2020. At June 30, 2021 and December 31, 2020, there wa s $8.8 million an d $97.5 million, respectively, ou tstanding under the revolving credit component of the Senior Credit Facility at weighted average interest rates of 1.5%. At June 30, 2021 and December 31, 2020, there was $866.3 million and $877.5 million, respectively, outstanding under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 1.5%. At June 30, 2021, $45.0 million of the Term Loan component of the Senior Credit Facility is classified as current on the consolidated balance sheet. The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at June 30, 2021 wer e $8.6 million and $850.4 million, re sp ectively. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly, and are other than active market observable i nputs that reflect unadjusted quoted prices for identical assets or liabilities. Letters of credit outstanding as of June 30, 2021 and December 31, 2020 to taled $1.6 million. There were no amounts drawn as of June 30, 2021. Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows: Quarter Ended June 30, 2021 Principal Repayment Dollars in thousands Remainder of 2021 $ 22,500 2022 $ 45,000 2023 $ 61,875 2024 $ 67,500 2025 $ 669,375 $ 866,250 The outstanding balance of the revolving credit component of the Senior Credit Facility is due on February 3, 2025. Convertible Senior Notes On February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes will mature on August 15, 2025 and bear interest at a rate of 0.5% per annum payable semi-annually in arrears, unless earlier converted, repurchased or redeemed in accordance with the terms of the Notes. The portion of debt proceeds that was classified as equity at the time of the offering was $104.5 million. The effective interest rate implicit in the liability component was 4.2%. In connection with this offering, the Company capitalized $13.2 million of financing fees. The 2025 Notes are senior, unsecured obligations of the Company, and are convertible into cash and shares of its common stock based on initial conversion rate, subject to adjustment of 13.5739 shares per $1,000 principal amounts of the 2025 Notes (which represents an initial conversion price of $73.67 per share). The 2025 Notes convert only in the following circumstances: (1) if the closing price of the Company's common stock has been at least 130% of the conversion price during the period; (2) if the average trading price per $1,000 principal amount of the 2025 Notes is less than or equal to 98% of the average conversion value of the 2025 Notes during a period as defined in the indenture; (3) at any time on or after February 20, 2023; or (4) if specified corporate transactions occur. As of June 30, 2021, none of these conditions existed with respect to the 2025 Notes and as a result the 2025 Notes are classified as long term. On December 9, 2020, the Company entered into the First Supplemental Indenture to the original agreement dated as of February 4, 2020 between the Company and Citibank, N.A., as trustee, governing the Company’s outstanding 2025 Notes. The Company irrevocably elected (1) to eliminate the Company’s option to choose physical settlement on any conversion of the 2025 Notes that occurs on or after the date of the First Supplemental Indenture and (2) with respect to any Combination Settlement for a conversion of the 2025 Notes, the Specified Dollar Amount that will be settled in cash per $1,000 principal amount of the 2025 Notes shall be no lower than $1,000. Holders of the Notes will have the right to require the Company to repurchase for cash all or a portion of their Notes at 100% of their principal amount, plus any accrued and unpaid interest, upon the occurrence of a fundamental change (as defined in the indenture relating to the Notes). The Company will also be required to increase the conversion rate for holders who convert their Notes in connection with certain fundamental changes occurring prior to the maturity date or following delivery by the Company of a notice of redemption. In connection with the issuance of the 2025 Notes, the Company entered into call transactions and warrant transactions, primarily with affiliates of the initial purchasers of the 2025 Notes (the “hedge participants”). The cost of the call transactions was $104.2 million for the 2025 Notes. The Company received $44.5 million of proceeds from the warrant transactions for the 2025 Notes. The call transactions involved purchasing call options from the hedge participants, and the warrant transactions involved selling call options to the hedge participants with a higher strike price than the purchased call options. The initial strike price of the call transactions was $73.67, subject to anti-dilution adjustments substantially similar to those in the 2025 Notes. The initial strike price of the warrant transactions was $113.34 for the 2025 Notes, subject to customary anti-dilution adjustments. At December 31, 2020, the carrying amount of the liability component was $485.9 million , the remaining unamortized discount wa s $89.1 million , and the principal amount outstanding was $575.0 million . On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. At June 30, 2021 , in conjunction with the adoption of the ASU, the carrying amount of the liability w as $575.0 million. The fair value of the 2025 Notes at June 30, 2021 was $630.7 million. Factors that the Company considered when estimating the fair value of the 2025 Notes included recent quoted market prices or dealer quote. The level of the 2025 Notes is considered as Level 1. On January 1, 2021, the Company adopted ASU 2020-06 using the modified retrospective method. See Note 1, Basis of Presentation, for further details. As a result of the adoption of the ASU, the Company recognized only cash interest related to the contractual interest coupon of $1.4 million on the 2025 Notes for the six months ended June 30, 2021. Prior to the adoption, during the six months ended June 30, 2020, the Company recognized cash interest of $1.2 million and amortization of the discount on the liability component of $6.8 million for a total interest charge of $8.0 million on the 2020 Notes. Securitization Facility During the fourth quarter of 2018, the Company entered into an accounts receivable securitization facility (the "Securitization Facility") under which accounts receivable of certain domestic subsidiaries are sold on a non-recourse basis to a special purpose entity (“SPE”), which is a bankruptcy-remote, consolidated subsidiary of the Company. Accordingly, the assets of the SPE are not available to satisfy the obligations of the Company or any of its subsidiaries. From time to time, the SPE may finance such accounts receivable with a revolving loan facility secured by a pledge of such accounts receivable. The amount of outstanding borrowings on the Securitization Facility at any one time is limited to $150.0 million. The Securitization Facility Agreement ("Securitization Agreement") governing the Securitization Facility contains certain covenants and termination events. An occurrence of an event of default or a termination event under this Securitization Agreement may give rise to the right of its counterparty to terminate this facility. As of June 30, 2021, the Company was in compliance with the covenants and none of the termination events had occurred. On May 28, 2021, the Company entered into an amendment (the "May 2021 Amendment") of the Securitization Facility which extended the maturity date from December 21, 2021 to May 28, 2024. The May 2021 amendment does not increase the Company’s total indebtedness. At June 30, 2021 and December 31, 2020, the Company had $112.5 million, respectively, of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 1.2% and 1.3%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at June 30, 2021 was $110.3 million. These fair values were determined by using a discounted cash flow model based on current market interest rates available to the Company. These inputs are corroborated by observable market data for similar liabilities and therefore classified within Level 2 of the fair value hierarchy. Level 2 inputs represent inputs that are observable for the asset or liability, either directly or indirectly, and are other than active market observable i nputs that reflect unadjusted quoted prices for identical assets or liabilities.

DERIVATIVE INSTRUMENTS

DERIVATIVE INSTRUMENTS	6 Months Ended
	Jun. 30, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
DERIVATIVE INSTRUMENTS	DERIVATIVE INSTRUMENTS Interest Rate Hedging The Company’s interest rate risk relates to U.S. dollar denominated variable interest rate borrowings. The Company uses interest rate swap derivative instruments to manage earnings and cash flow exposure resulting from changes in interest rates. These interest rate swaps apply a fixed interest rate on a portion of the Company's expected LIBOR-indexed floating-rate borrowings. The Company held the following interest rate swaps as of June 30, 2021 and December 31, 2020 (dollar amounts in thousands): June 30, 2021 December 31, 2020 June 30, 2021 December 31, 2020 Hedged Item Notional Amount Designation Date Effective Date Termination Date Fixed Interest Rate Estimated Fair Value Asset (Liability) 1-month USD LIBOR Loan $ — $ 100,000 March 27, 2017 December 31, 2017 June 30, 2021 1.971 % $ — $ (929) 1-month USD LIBOR Loan 300,000 300,000 December 13, 2017 January 1, 2018 December 31, 2022 2.201 % (9,122) (12,557) 1-month USD LIBOR Loan 150,000 150,000 December 13, 2017 July 1, 2019 June 30, 2024 2.423 % (8,692) (11,502) 1-month USD LIBOR Loan 200,000 200,000 December 13, 2017 January 1, 2018 December 31, 2024 2.313 % (11,856) (16,243) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.220 % (7,595) (9,836) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.199 % (7,553) (9,826) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.209 % (7,541) (9,783) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.885 % (7,703) (10,407) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.867 % (7,592) (10,431) 1-month USD LIBOR Loan 575,000 575,000 December 15, 2020 July 31, 2025 December 31, 2027 1.415 % 3,931 (1,907) 1-month USD LIBOR Loan 125,000 125,000 December 15, 2020 July 1, 2025 December 31, 2027 1.404 % 987 (348) $ 1,775,000 $ 1,875,000 $ (62,736) $ (93,769) The Company has designated these derivative instruments as cash flow hedges. The Company assesses the effectiveness of these derivative instruments and has recorded the changes in the fair value of the derivative instrument designated as a cash flow hedge as unrealized gains or losses in accumulated other comprehensive loss (“AOCL”), net of tax, until the hedged item affected earnings, at which point any gain or loss was reclassified to earnings. If the hedged cash flow does not occur, or if it becomes probable that it will not occur, the Company will reclassify the remaining amount of any gain or loss on the related cash flow hedge recorded in AOCL to interest expense at that time. Foreign Currency Hedging From time to time, the Company enters into foreign currency hedge contracts intended to protect the U.S. dollar value of certain forecasted foreign currency denominated transactions. The Company assesses the effectiveness of the contracts that are designated as hedging instruments. The changes in fair value of foreign currency cash flow hedges are recorded in AOCL, net of tax. Those amounts are subsequently reclassified to earnings from AOCL as impacted by the hedged item when the hedged item affects earnings. If the hedged forecasted transaction does not occur or if it becomes probable that it will not occur, the Company will reclassify the amount of any gain or loss on the related cash flow hedge to earnings at that time. For contracts not designated as hedging instruments, the changes in fair value of the contracts are recognized in other income, net in the consolidated statements of operation, along with the offsetting foreign currency gain or loss on the underlying assets or liabilities. During the fourth quarter of 2020, the Company entered into foreign currency forward contracts, with a notional amount of $9.7 million to mitigate the foreign exchange risk related to certain intercompany loans denominated in Canadian Dollar ("CAD") and intercompany receivables denominated in Japanese Yen ("JPY"). The contracts are not designated as hedging instruments. The Company recognized a $0.3 million loss from the change in fair value of the contracts, which was included in other income, net in the consolidated statement of operations as of June 30, 2021. The Company subsequently settled its foreign currency forward contracts associated with the intercompany receivables denominated in JPY during the first quarter of 2021. The fair value of the foreign currency forward contracts denominated in CAD was $0.3 million as of June 30, 2021. During the second quarter of 2021, the Company entered into a foreign currency swap, with a notional of $7.3 million to mitigate the risk from fluctuations in foreign currency exchange rates associated with certain intercompany loan denominated in Japanese Yen ("JPY"). In a foreign currency swap transaction, the Company agrees with another party to exchange, at specified intervals, the difference between one currency and another currency at a fixed exchange rate, generally set at inception, calculated by reference to an agreed upon notional amount. The notional amount of each currency is exchanged at the inception and termination of the currency swap by each party. The change in fair value of the foreign currency swap was not material for the period. The success of the Company’s hedging program depends, in part, on forecasts of certain activity denominated in foreign currency. The Company may experience unanticipated currency exchange gains or losses to the extent that there are differences between forecasted and actual activities during periods of currency volatility. In addition, changes in currency exchange rates related to any unhedged transactions may affect earnings and cash flows. Cross-Currency Rate Swaps On October 2, 2017, the Company entered into cross-currency swap agreements to convert a notional amount of $300.0 million equivalent to 291.2 million of Swiss Francs ("CHF") denominated intercompany loans into U.S. dollars. The CHF-denominated intercompany loans were the result of the purchase of intellectual property by a subsidiary in Switzerland as part of an acquisition. On December 21, 2020, the Company entered into cross-currency swap agreements to convert a notional amount of $471.6 million equivalent to 420.1 million of a CHF-denominated intercompany loan into U.S. dollars. The CHF-denominated intercompany loan was the result of an intra-entity transfer of certain intellectual property rights to a subsidiary in Switzerland completed during the fourth quarter of 2020. The intercompany loan requires quarterly payments of CHF 5.8 million plus accrued interest. As a result, the aggregate notional amount of the related cross-currency swaps will decrease by a corresponding amount. The objective of these cross-currency swaps is to reduce volatility of earnings and cash flows associated with changes in the foreign currency exchange rate. Under the terms of these contracts, which have been designated as cash flow hedges, the Company will make interest payments in Swiss Francs and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in Swiss Francs and receive U.S. dollars from the counterparties. The Company held the following cross-currency rate swaps as of June 30, 2021 and December 31, 2020 (dollar amounts in thousands): June 30, 2021 December 31, 2020 June 30, 2021 December 31, 2020 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay CHF October 2, 2017 October 2, 2021 1.85% CHF 48,533 48,533 (2,228) (4,335) Receive U.S.$ 4.46% $ 50,000 50,000 Pay CHF October 2, 2017 October 2, 2022 1.95% CHF 145,598 145,598 (4,641) (11,262) Receive U.S.$ 4.52% $ 150,000 150,000 Pay CHF December 21, 2020 December 20, 2025 3.00% CHF 408,637 420,137 10,124 (7,843) Receive U.S.$ 3.98% $ 458,730 471,640 Total $ 3,255 $ (23,441) The cross-currency swaps are carried on the consolidated balance sheet at fair value, and changes in the fair values are recorded as unrealized gains or losses in AOCL. For the three and six months ended June 30, 2021, the Company recorded a loss of $12.9 million and a gain of $30.0 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gains or losses recognized on the intercompany loans. For the three and six months ended June 30, 2020, the Company recorded losses of $3.4 million and $5.1 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the gains recognized on the intercompany loans. For the three and six months ended June 30, 2021, the Company recorded a loss of $11.0 million and a gain of $29.2 million in AOCL, respectively, related to change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded a loss of $2.3 million and a gain of $3.6 million in AOCL, respectively, related to change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2021, the Company recorded gains of $1.3 million and $2.5 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded gains of $1.5 million and $3.0 million, respectively, in other income, net included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. The estimated gain that is expected to be reclassified to other income (expense), net from AOCL as of June 30, 2021 within the next twelve months is $7.0 million. As of June 30, 2021, the Company does not expect any gains or losses will be reclassified into earnings as a result of the discontinuance of these cash flow hedges because the original forecasted transaction will not occur. Net Investment Hedges The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk from its international operations through foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business. On October 1, 2018 and December 16, 2020, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries. The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 2021 and December 31, 2020, respectively (dollar amounts in thousands): June 30, 2021 December 31, 2020 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay EUR October 3, 2018 September 30, 2021 —% EUR 44,859 $ (864) $ (1,884) Receive U.S.$ 3.01% $ 52,000 Pay EUR October 3, 2018 September 30, 2023 —% EUR 51,760 901 (450) Receive U.S.$ 2.57% $ 60,000 Pay EUR October 3, 2018 September 30, 2025 —% EUR 38,820 849 92 Receive U.S.$ 2.19% $ 45,000 Pay CHF December 16, 2020 December 16, 2027 —% CHF 222,300 3,292 (3,794) Receive U.S.$ 1.10% $ 250,000 Total $ 4,178 $ (6,036) The cross-currency swaps were carried on the consolidated balance sheet at fair value and changes in the fair values were recorded as unrealized gains or losses in AOCL. For the three and six months ended June 30, 2021, the Company recorded gains of $0.1 million and $13.7 million, respectively, in AOCL related to the change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded a loss of $2.5 million and a gain of $16.4 million, respectively, in AOCL related to the change in fair value of the cross-currency swaps. For the three and six months ended June 30, 2021, the Company recorded gains of $1.7 million and $3.4 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. For the three and six months ended June 30, 2020, the Company recorded gains of $2.2 million and $4.4 million in interest income included in the consolidated statements of operations related to the interest rate differential of the cross-currency swaps. The estimated gain that is expected to be reclassified to interest income from AOCL as of June 30, 2021 within the next twelve months is $4.5 million. Counterparty Credit Risk The Company manages its concentration of counterparty credit risk on its derivative instruments by limiting acceptable counterparties to a group of major financial institutions with investment grade credit ratings, and by actively monitoring their credit ratings and outstanding positions on an ongoing basis. Therefore, the Company considers the credit risk of the counterparties to be low. Furthermore, none of the Company’s derivative transactions are subject to collateral or other security arrangements, and none contain provisions that depend upon the Company’s credit ratings from any credit rating agency. Fair Value of Derivative Instruments The Company has classified all of its derivative instruments within Level 2 of the fair value hierarchy because observable inputs are available for substantially the full term of the derivative instruments. The fair values of the interest rate swaps and cross-currency swaps were developed using a market approach based on publicly available market yield curves and the terms of the swap. The Company performs ongoing assessments of counterparty credit risk. The following table summarizes the fair value for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of June 30, 2021 and December 31, 2020: Fair Value as of Location on Balance Sheet (1) : June 30, 2021 December 31, 2020 Dollars in thousands Derivatives designated as hedges — Assets: Prepaid expenses and other current assets Cash Flow Hedges Cross-currency swap $ 9,206 $ 7,623 Net Investment Hedges Cross-currency swap 5,345 5,297 Other assets Cash Flow Hedges Interest rate swap (2) 4,918 — Cross-currency swap 4,605 — Net Investment Hedges Cross-currency swap 505 — Total derivatives designated as hedges — Assets $ 24,579 $ 12,920 Derivatives designated as hedges — Liabilities: Accrued expenses and other current liabilities Cash Flow Hedges Interest rate swap (2) $ 21,003 $ 22,033 Cross-currency swap 2,228 4,335 Net Investment Hedges Cross-currency swap 864 1,884 Other liabilities Cash Flow Hedges Interest rate swap (2) 46,651 71,736 Cross-currency swap 8,328 26,728 Net Investment Hedges Cross-currency swap 808 9,449 Total derivatives designated as hedges — Liabilities $ 79,882 $ 136,165 (1) The Company classifies derivative assets and liabilities as current based on the cash flows expected to be incurred within the following 12 months. (2) At June 30, 2021 and December 31, 2020, the total notional amounts related to the Company’s interest rate swaps were $1.8 billion and $1.9 billion, respectively. The following presents the effect of derivative instruments designated as cash flow hedges on the accompanying condensed consolidated statement of operations during the three and six months ended June 30, 2021 and 2020: Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Three Months Ended June 30, 2021 Cash Flow Hedges Interest rate swap $ (53,546) $ (15,013) $ (5,823) $ (62,736) Interest expense Cross-currency swap (5,029) (10,969) (11,635) (4,363) Other income (expense),net Net Investment Hedges Cross-currency swap (429) 88 1,737 (2,078) Interest income $ (59,004) $ (25,894) $ (15,721) $ (69,177) Three Months Ended June 30, 2020 Cash Flow Hedges Interest rate swap $ (95,753) $ (9,988) $ (3,614) $ (102,127) Interest expense Cross-currency swap 6,266 (2,322) (1,899) 5,843 Other income (expense),net Net Investment Hedges Cross-currency swap 26,946 (2,543) 2,179 22,224 Interest income $ (62,541) $ (14,853) $ (3,334) $ (74,060) Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Six Months Ended June 30, 2021 Cash Flow Hedges Interest rate swap $ (93,769) $ 19,505 $ (11,528) $ (62,736) Interest expense Cross-currency swap (1,073) 29,225 32,515 (4,363) Other income (expense),net Net Investment Hedges Cross-currency swap (12,291) 13,661 3,448 (2,078) Interest income $ (107,133) $ 62,391 $ 24,435 $ (69,177) Six Months Ended June 30, 2020 Cash Flow Hedges Interest rate swap $ (45,146) $ (61,637) $ (4,656) $ (102,127) Interest expense Cross-currency swap 177 3,585 (2,081) 5,843 Other income (expense), net Net Investment Hedges Cross-currency swap 10,229 16,357 4,362 22,224 Interest income $ (34,740) $ (41,695) $ (2,375) $ (74,060)

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	6 Months Ended
	Jun. 30, 2021
Share-based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of June 30, 2021, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under the 2003 Equity Incentive Plan (the “2003 Plan”). The 2000 and 2001 Equity Incentive Plans were terminated as of February 19, 2021, and no further awards may be issued under the plans. Stock options issued under the 2003 Plan become exercisable over specified periods, generally within four years from the date of grant for officers and employees, within one year from date of grant for directors which generally expire eight years from the grant date for employees, and from six Stock Options As of June 30, 2021, there were approximately $4.6 million of total unrecognized compensation costs related to unvested stock options. These costs are expected to be recognized over a weighted-average period of approximately three years. There were 149,558 stock options granted during the six months ended June 30, 2021. For the six months ended June 30, 2021, the weighted average grant date fair value for stock options was $22.59 per option. Awards of Restricted Stock and Performance Stock Performance stock and restricted stock awards generally have requisite service periods of three years, except in certain instances that result in accelerated vesting due to death, disability, retirement age provision or change in-control provisions in their grant agreements. Performance stock units are subject to graded vesting conditions based on revenue goals of the Company. The Company expenses the fair value of restricted stock awards on a straight-line basis over the requisite service period. As of June 30, 2021, there was approximately $32.9 million of total unrecognized compensation costs related to these unvested awards. The Company expects to recognize these costs over a weighted-average period of approximately two years. The Company granted 242,464 restricted stock awards and 176,147 performance stock awards during the six months ended June 30, 2021. For the six months ended June 30, 2021, the weighted average grant date fair value for restricted stock awards and performance stock units was $68.21 and $68.10 per award, respectively.

RETIREMENT PLANS

RETIREMENT PLANS	6 Months Ended
	Jun. 30, 2021
Retirement Benefits [Abstract]
RETIREMENT PLANS	RETIREMENT PLANS The Company maintains defined benefit pension plans that cover certain employees in France, Japan, Germany and Switzerland. Net periodic benefit costs for the Company’s defined benefit pension plans for three and the six months ended June 30, 2021 were $0.6 million and $1.2 million. The components of the net periodic benefit costs other than the service cost component of $0.8 million and $1.7 million for the three and six months ended June 30, 2021, are included in other income (expense), net in the consolidated statements of operations. Net periodic benefit costs for the Company’s defined benefit pension plans for the three and six months ended June 30, 2020 were $1.0 million and $1.9 million, respectively. The components of the net periodic benefit costs other than the service cost component of $0.9 million and $1.9 million for the three and six months ended June 30, 2020, respectively, are included in other income (expense), net in the consolidated statements of operations. The estimated fair values of plan assets were $33.8 million and $37.8 million as of June 30, 2021 and December 31, 2020, respectively. The net plan assets of the pension plans are invested in common trusts as of June 30, 2021 and December 31, 2020. Common trusts are classified as Level 2 in the fair value hierarchy. The fair value of common trusts is valued at the net asset value based on the fair values of the underlying investments of the trusts as determined by the sponsor of the trusts. The investment strategy of the Company's defined benefit plans is both to meet the liabilities of the plans as they fall due and to maximize the return on invested assets within an appropriate risk profile. Deferred Compensation Plan The Company maintains a Deferred Compensation Plan in which certain employees of the Company may defer the payment and taxation of up to 75% of their base salary and up to 100% of bonus amounts and other eligible cash compensation. During the first quarter of 2020, employees participating in the Company's deferred compensation plan began to defer their compensation. This deferred compensation is invested in funds offered under this plan and is valued based on Level 1 measurements in the fair value hierarchy. Assets of the Company's deferred compensation plan are included in other current assets and recorded at fair value based on their quoted market prices. The fair value of these assets were $3.2 million and $2.0 million as of June 30, 2021 and December 31, 2020, respectively. Offsetting liabilities relating to the deferred compensation plan are included in Other liabilities.

LEASES AND RELATED PARTY LEASES

LEASES AND RELATED PARTY LEASES	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
LEASES AND RELATED PARTY LEASES	LEASES AND RELATED PARTY LEASESThe Company leases administrative, manufacturing, research and distribution facilities and vehicles through operating lease agreements. The Company has no finance leases as of June 30, 2021. Many of the Company's leases include both lease (e.g., fixed payments including rent) and non-lease components (e.g., common-area or other maintenance costs). For vehicles, the Company has elected the practical expedient to group lease and non-lease components. Most facility leases include one or more options to renew. The exercise of lease renewal options is typically at the Company's sole discretion, therefore, the majority of renewals to extend the lease terms are not included in the Right of Use ("ROU") assets and lease liabilities as they are not reasonably certain of exercise. The Company regularly evaluates renewal options and when they are reasonably certain of exercise, the renewal period is included in the lease term. As most of the Company's leases do not provide an implicit rate, the Company uses a collateralized incremental borrowing rate based on the information available at the lease commencement date in determining the present value of the lease payments. Total operating lease expense for the six months ended June 30, 2021 and June 30, 2020 was $10.6 million and $9.7 million respectively, which includes $0.1 million, in related party operating lease expense. Supplemental balance sheet information related to operating leases were as follows: Dollars in thousands, except lease term and discount rate June 30, 2021 December 31, 2020 ROU assets $ 89,174 $ 83,635 Current lease liabilities 13,987 12,818 Non-current lease liabilities 95,196 88,118 Total lease liabilities $ 109,183 $ 100,936 Weighted average remaining lease term (in years): Leased facilities 11.3 years 11.6 years Leased vehicles 2.3 years 2.3 years Weighted average discount rate: Leased facilities 5.0 % 4.6 % Leased vehicles 2.7 % 2.3 % Supplemental cash flow information related to leases for the six months ended June 30, 2021 and 2020 were as follows: Dollars in thousands June 30, 2021 June 30, 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 7,019 $ 6,728 ROU assets obtained in exchange for lease liabilities: Operating leases $ 10,528 $ 6,007 Future minimum lease payments under operating leases at June 30, 2021 were as follows: Dollars in thousands Related Parties Third Parties Total 2021 $ 148 $ 7,973 $ 8,121 2022 296 16,833 17,129 2023 296 13,945 14,241 2024 296 11,461 11,757 2025 296 10,835 11,131 2026 296 9,553 9,849 Thereafter 837 72,887 73,724 Total minimum lease payments $ 2,465 $ 143,487 $ 145,952 Less: Imputed interest 36,769 Total lease liabilities 109,183 Less: Current lease liabilities 13,987 Long-term lease liabilities 95,196 Related Party Leases The Company leases its manufacturing facility in Plainsboro, New Jersey, from a general partnership that is 50% owned by a corporation whose shareholders are trusts, whose beneficiaries include family members of the Company’s principal stockholder and former director. The term of the current lease agreement is through October 31, 2029 at an annual rate of approximately $0.3 million per year. The current lease agreement also provides (i) a 5-year renewal option for the Company to extend the lease from November 1, 2029 through October 31, 2034 at the fair market rental rate of the premises, and (ii) another 5-year renewal option to extend the lease from November 1, 2034 through October 31, 2039 at the fair market rental rate of the premises.

TREASURY STOCK

TREASURY STOCK	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK As of June 30, 2021 and December 31, 2020, there were 4.9 million shares of treasury stock outstanding with a cost of $234.5 million and $235.1 million, respectively, at a weighted average cost per share of $47.86. On December 7, 2020, the Board of Directors of the Company authorized the Company to repurchase up to $225.0 million of the Company’s common stock. The program allows the Company to repurchase its shares opportunistically from time to time. The repurchase authorization expires in December 2022. The Company has $225.0 million remaining under the share repurchase of its Common Stock. The price and timing of any future purchases under the share repurchase program will depend on factors such as levels of cash generation from operations, the volume of stock option exercises by employees, cash requirements for acquisitions, dividends, economic and market conditions and stock price.

INCOME TAXES

INCOME TAXES	6 Months Ended
	Jun. 30, 2021
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The following table provides a summary of the Company's effective tax rate: Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Reported tax rate 21.8 % 122.4 % 28.2 % 32.7 % The Company’s effective income tax rates for the three months ended June 30, 2021 and 2020 w ere 21.8% and 122.4%, respectively. For the three months ended June 30, 2021, the primary driver of the lower tax rate is due to mix of income impacted by the COVID-19 pandemic. For the three months ended June 30, 2020, the primary drivers of the higher tax rate was lower income impacted by the COVID-19 pandemic and a $3.4 million valuation allowance on certain foreign deferred tax assets. The Company's effective income tax rates for the six months ended June 30, 2021 and 2020 were 28.2% and 32.7%, respectively. For the six months ended June 30, 2021, the primary drivers of the lower tax rate were mix of income in lower-taxes jurisdictions, offset by the tax impact of the gain on the sale of the Extremity and Orthopedics business which was completed during the first quarter of 2021. For the six months ended June 30, 2020, the primary drivers of the higher tax rate were lower book income in low er-taxed jurisdictions and a $3.4 million valuation allowance on certain foreign deferred tax assets as the Company determined that it was no longer more likely than not that these foreign deferred tax assets would be realized due to the adverse impact of the COVID-19 pandemic in certain jurisdictions. As of June 30, 2021, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed indefinitely reinvested. Such taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. As such, the Company has determined the tax impact of repatriating these earnings would not be material as of June 30, 2021. The Company does not anticipate the need to repatriate earnings from foreign subsidiaries as a result of the impact of the COVID-19 pandemic.

NET INCOME PER SHARE

NET INCOME PER SHARE	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
NET INCOME PER SHARE	NET INCOME PER SHARE Basic and diluted net income per share was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands, except per share amounts 2021 2020 2021 2020 Basic net income per share: Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Weighted average common shares outstanding 84,687 84,706 84,593 84,955 Basic net income per common share $ 0.41 $ (0.00) $ 0.95 $ 0.10 Diluted net income per share: Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Weighted average common shares outstanding — Basic 84,687 84,706 84,593 84,955 Effect of dilutive securities: Stock options and restricted stock 653 — 731 593 Weighted average common shares for diluted earnings per share 85,340 84,706 85,324 85,548 Diluted net income per common share $ 0.41 $ 0.00 $ 0.94 $ 0.10 Common stock of approximately 0.1 million and 0.5 million shares at June 30, 2021, and 2020, respectively that are issuable through exercise of dilutive securities were not included in the computation of diluted net income per share because their effect would have been anti-dilutive. Performance Shares and Restricted Units that entitle the holders to approximately 0.5 million shares of common stock are included in the basic and diluted weighted average shares outstanding calculation from their date of issuance because no further consideration is due related to the issuance of the underlying common shares. Based on the adoption of ASU 2020-06, as the principal amount of the 2025 Notes will be paid in cash and only the conversion spread is settled in shares, the Company will be utilizing the if-converted method and only includes the net number of incremental shares that would be issued upon conversion.

ACCUMULATED OTHER COMPREHENSIVE

ACCUMULATED OTHER COMPREHENSIVE LOSS	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
ACCUMULATED OTHER COMPREHENSIVE LOSS	ACCUMULATED OTHER COMPREHENSIVE LOSS Comprehensive income (loss) for the six months ended June 30, 2021 and 2020 was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Foreign currency translation adjustment 1,558 10,433 (5,243) 3,620 Change in unrealized loss on derivatives, net of tax (7,804) (8,830) 29,111 (30,136) Pension liability adjustment, net of tax (91) (139) 228 (207) Comprehensive income (loss), net $ 28,731 $ 1,095 $ 104,558 $ (17,912) Changes in accumulated other comprehensive loss by component between December 31, 2020 and June 30, 2021 are presented in the table below, net of tax: Dollars in thousands Gains and Losses on Derivatives Defined Benefit Pension Items Foreign Currency Items Total Balance at January 1, 2021 $ (82,249) $ (5,105) $ 13,295 $ (74,059) Other comprehensive income (loss) 47,885 228 (5,243) 42,870 Less: Amounts reclassified from accumulated other comprehensive loss 18,774 — — 18,774 Net current-period other comprehensive income (loss) 29,111 228 (5,243) 24,096 Balance at June 30, 2021 $ (53,138) $ (4,877) $ 8,052 $ (49,963)

SEGMENT AND GEOGRAPHIC INFORMAT

SEGMENT AND GEOGRAPHIC INFORMATION	6 Months Ended
	Jun. 30, 2021
Segment Reporting [Abstract]
SEGMENT AND GEOGRAPHIC INFORMATION	SEGMENT AND GEOGRAPHIC INFORMATION The Company internally manages two global reportable segments and reports the results of its businesses to its chief operating decision maker. The two reportable segments and their activities are described below. • The Codman Specialty Surgical segment includes (i) the Neurosurgery business, which sells a full line of products for neurosurgery and neuro critical care such as tissue ablation equipment, dural repair products, cerebral spinal fluid management devices, intracranial monitoring equipment, and cranial stabilization equipment and (ii) the instruments business, which sells more than 40,000 instrument patterns and surgical and lighting products to hospitals, surgery centers, dental, podiatry, and veterinary offices. • The Tissue Technologies segment includes such offerings as skin and wound repair, bone grafts, and nerve and tendon repair products. In conjunction with the sale of the Extremity Orthopedics business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021. The Corporate and other category includes (i) various executive, finance, human resource, information systems and legal functions, (ii) brand management, and (iii) share-based compensation costs. The operating results of the various reportable segments as presented are not comparable to one another because (i) certain operating segments are more dependent than others on corporate functions for unallocated general and administrative and/or operational manufacturing functions and (ii) the Company does not allocate certain manufacturing costs and general and administrative costs to the operating segment results. Net sales and profit by each reportable segment for the three and six months ended June 30, 2021 and 2020 are as follows : Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 Segment Net Sales Codman Specialty Surgical $ 256,837 $ 169,778 $ 498,078 $ 401,218 Tissue Technologies 133,155 88,887 251,985 211,771 Total revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989 Segment Profit Codman Specialty Surgical $ 113,996 $ 65,256 $ 220,774 $ 152,491 Tissue Technologies 64,413 28,688 114,424 59,958 Segment profit 178,409 93,944 335,198 212,449 Amortization (4,198) (8,073) (8,725) (15,050) Corporate and other (122,357) (71,791) (243,905) (156,216) Operating income $ 51,854 $ 14,080 $ 82,568 $ 41,183 The Company does not allocate any assets to the reportable segments. No asset information is reported to the chief operating decision maker and disclosed in the financial information for each segment. The Company attributes revenues to geographic areas based on the location of the customer. Total revenue by major geographic area consisted of the following: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 United States $ 278,186 $ 181,850 $ 525,979 $ 428,702 Europe 48,437 32,026 94,256 77,922 Asia Pacific 44,306 33,501 91,601 73,461 Rest of World 19,063 11,288 38,227 32,904 Total Revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES In consideration for certain technology, manufacturing, distribution, selling rights and licenses granted to the Company, the Company has agreed to pay royalties on sales of certain products that it sells. The royalty payments that the Company made under these agreements were not significant for any of the periods presented. The Company is subject to various claims, lawsuits and proceedings in the ordinary course of the Company's business, including claims by current or former employees, distributors and competitors and with respect to its products and product liability claims, lawsuits and proceedings, some of which have been settled by the Company. In the opinion of management, such claims are either adequately covered by insurance or otherwise indemnified, or are not expected, individually or in the aggregate, to result in a material, adverse effect on the Company's financial condition. However, it is possible that the Company's results of operations, financial position and cash flows in a particular period could be materially affected by these contingencies. The Company accrues for loss contingencies when it is deemed probable that a loss has been incurred and that loss is estimable. The amounts accrued are based on the full amount of the estimated loss before considering insurance proceeds and do not include an estimate for legal fees expected to be incurred in connection with the loss contingency. The Company consistently accrues legal fees expected to be incurred in connection with loss contingencies as those fees are incurred by outside counsel as a period cost. Contingent Consideration The Company determined the fair value of contingent consideration during the six month period ended June 30, 2021 and June 30, 2020 to reflect the change in estimates, additions, payments, transfers and the time value of money during the period. A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the six months ended June 30, 2021 and June 30, 2020 is as follows (in thousands): Six Months Ended June 30, 2021 Contingent Consideration Liability Related to Acquisition of: Arkis Location in Financial Statements Derma Sciences ACell Inc. Location in Financial Statements Short-term Long-term Long-term Long-term Balance as of January 1, 2021 $ 3,415 $ 11,746 $ 230 $ — Additions from acquisition of ACell — — — 23,900 Transfers (3,432) 3,432 — — Gain (loss) from change in fair value of contingent consideration liabilities 17 $ (402) Research and development — (400) Selling, general and administrative Balance as of June 30, 2021 $ — $ 14,776 $ 230 $ 23,500 Six Months Ended June 30, 2020 Contingent Consideration Liability Related to Acquisition of: Arkis Derma Sciences Location in Financial Statements Long-term Long-term Balance as of January 1, 2020 $ 14,210 $ 230 Loss from change in fair value of contingent consideration liabilities (708) — Research and development Balance as of June 30, 2020 $ 13,502 $ 230 Arkis BioSciences Inc. On July 29, 2019, the Company acquired Arkis BioSciences Inc. ("Arkis") for an acquisition purchase price of $30.6 million (the "Arkis Acquisition") plus contingent consideration of up to $25.5 million, that may be payable based on the successful completion of certain development and commercial milestones. Arkis was a privately-held company that marketed the CerebroFlo® external ventricular drainage (EVD) catheter with Endexo® technology, a permanent additive designed to reduce the potential for catheter obstruction due to thrombus formation. As part of the acquisition, the Company is required to pay the former shareholders of Arkis up to $25.5 million based on the timing of certain development milestones of $10.0 million and commercial sales milestones of $15.5 million, respectively. The Company used a probability weighted income approach to calculate the fair value of the contingent consideration that considered the possible outcomes of scenarios related to each specified milestone. The Company estimated the fair value of the contingent consideration to be $13.1 million at the acquisition date. The estimated fair value as of June 30, 2021 and June 30, 2020 was $14.8 million and $13.5 million, respectively. The Company recorded $14.8 million and $13.5 million in other liabilities at June 30, 2021 and June 30, 2020, respectively, in the consolidated balance sheet of the Company. Derma Sciences

BASIS OF PRESENTATION (Policies

BASIS OF PRESENTATION (Policies)	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis Of Presentation	BASIS OF PRESENTATION General The terms “we,” “our,” “us,” “Company” and “Integra” refer to Integra LifeSciences Holdings Corporation, a Delaware corporation, and its subsidiaries unless the context suggests otherwise. In the opinion of management, the June 30, 2021 unaudited condensed consolidated financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary for a fair statement of the financial position, statement of changes in shareholder's equity, results of operations and cash flows of the Company. Certain information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles have been condensed or omitted in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements for the year ended December 31, 2020 included in the Company’s Annual Report on Form 10-K. The December 31, 2020 consolidated balance sheet was derived from audited financial statements, but does not include all disclosures required by accounting principles generally accepted in the United States. Operating results for the three and six month period ended June 30, 2021 are not necessarily indicative of the results to be expected for the entire year.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326) : Measurement of Credit Losses on Financial Instruments. The ASU is intended to improve financial reporting by requiring timelier recording of credit losses on loans and other financial instruments held by financial institutions and other organizations. The ASU requires the measurement of all expected credit losses for financial assets including trade receivables held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. Financial institutions and other organizations will now use forward-looking information to better inform their credit loss estimates. The ASU became effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a modified retrospective transition method which requires a cumulative-effect adjustment to the opening balance of retained earnings to be recognized on the date of adoption with no change to financial results reported in prior periods. The cumulative-effect adjustment recorded on January 1, 2020 is not material. The adoption of this ASU did not have a significant impact on the Company's consolidated financial statements and related disclosures. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage, and reimbursement, economic pressures or uncertainty associated with local or global economic recessions, disruption associated with the COVID-19 pandemic, and other customer-specific factors. Although the Company has historically not experienced significant credit losses, it is possible that there could be an adverse impact due to customer and governmental responses to the COVID-19 pandemic. In August 2018, the FASB issued ASU 2018-14, Compensation-Retirement Benefits-Defined Benefit Plans-General (Subtopic 715-20): Disclosure Framework-Changes to the Disclosure Requirements for Defined Benefit Plans . This guidance modifies the disclosure requirements for employers that sponsor defined benefit pension or other postretirement plans. The ASU is effective for fiscal years beginning after December 15, 2020, including interim periods within those fiscal years. Early adoption was permitted. The Company adopted this guidance during the year ended December 31, 2020. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures. In August 2018, the FASB issued ASU 2018-15, Intangibles - Goodwill and Other - Internal-Use Software (Subtopic 350-40), relating to a customer's accounting for implementation, set-up, and other upfront costs incurred in a cloud computing arrangement that is hosted by a vendor (e.g., a service contract). Under this guidance, a customer will apply the same criteria for capitalizing implementation costs as it would for an arrangement that has a software license. The new guidance also prescribes the balance sheet, income statement, and cash flow classification of the capitalized implementation costs and related amortization expense, and requires additional quantitative and qualitative disclosures. The ASU is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019. The Company adopted this guidance on January 1, 2020 using a prospective transition method. The adoption of this guidance did not have a significant impact on the Company's consolidated financial statements and related disclosures. In December 2019, the FASB issued ASU 2019-12, Income Taxes: Simplifying the Accounting for Income Taxes, intended to simplify the accounting for income taxes by eliminating certain exceptions related to the approach for intra-period tax allocation, the methodology for calculating income taxes in an interim period and the recognition of deferred tax liabilities for outside basis differences. This guidance also simplifies aspects of the accounting for franchise taxes and enacted changes in tax laws or rates and clarifies the accounting for transactions that result in a step-up in the tax basis of goodwill. The standard is effective for annual periods beginning after December 15, 2020 and interim periods within, with early adoption permitted. The Company adopted ASU No. 2019-12 as of January 1, 2021. Adoption of the standard requires certain changes to be made prospectively, with some changes to be made retrospectively. The adoption of this guidance did not have a material impact on the Company's results or financial position. In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform , which provides optional guidance for a limited period of time to ease the potential burden in accounting for (or recognizing the effects of) reference rate reform on financial reporting. This amendment applies to all entities, subject to meeting certain criteria, that have contracts, hedging relationships, and other transactions that reference London Inter-Bank Offered Rate ("LIBOR") or another reference rate expected to be discontinued because of reference rate reform. This ASU is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into or evaluated on or before December 31, 2022. In January 2021, the FASB also issued ASU 2021-01, Reference Rate Reform- Scope which clarified certain optional expedients and exceptions to entities that are affected because of the reference rate reform. The amendments in this ASU affect the guidance in ASU 2020-04 and are effective in the same timeframe as ASU 2020-04. The Company is currently assessing the impact that this ASU will have on its consolidated financial statements and related disclosures. In August 2020, the FASB issued ASU 2020-06, Debt- Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging Contracts in Entity's Own Equity (Subtopic 815-40)-Accounting for Convertible Instruments and Contracts in an Entity's Own Equity . The guidance simplifies accounting for convertible instruments by removing major separation models required under current GAAP. Consequently, more convertible debt instruments will be reported as a single liability instrument with no separate accounting for embedded conversion features. The ASU removes certain settlement conditions that are required for equity contracts to qualify for the derivative scope exception, which will permit more equity contracts to qualify. The guidance also simplifies the diluted net income per share calculation in certain areas. The ASU will be effective for annual and interim periods beginning after December 15, 2021, and early adoption is permitted for fiscal years beginning after December 15, 2020, and interim periods within those fiscal years using either the modified retrospective or full retrospective method. As detailed in Note 6 – Debt , on February 4, 2020, the Company issued $575.0 million aggregate principal amount of its 0.5% Convertible Senior Notes due 2025 (the "2025 Notes"). The 2025 Notes are subject to the guidance included in ASU 2020-06. The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts: ADJUSTMENT CONSOLIDATED BALANCE SHEET CLASSIFICATION AMOUNT Deferred tax impact of cumulative-effect adjustment Deferred tax liabilities $ (20.6) Debt discount reclassification Long-term convertible securities 89.1 Equity issuance costs reclassification Long-term convertible securities (2.5) Debt discount amortization and equity costs reclassification, net of tax Retained Earnings (2.8) Net impact of cumulative-effect adjustment Additional paid-in capital (63.3) Upon adoption of this ASU 2020-06, the Company’s Convertible Senior Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its convertible senior notes to be settled in cash and any excess in shares. Following the irrevocable notice, only the amounts settled in excess of the principal will be considered in diluted earnings per share under the “if-converted” method. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount, therefore the interest expense for the 2025 Notes, which is included in the interest expense on the consolidated statements of operations and comprehensive loss, is lower as compared to the fiscal year of 2020. In October 2020, the FASB issued ASU 2020-10, Codification Improvements , which updates various codification topics by clarifying or improving disclosure requirements to align with the SEC’s regulations. The ASU will be effective for the Company for annual and interim periods beginning after January 1, 2021. The Company adopted this standard on the January 1, 2021. The adoption of this guidance did not have a material impact on the Company's results, financial position or disclosures. In May 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options which provides guidance to clarify and reduce diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options (for example, warrants) that remain equity classified after modification or exchange. The amendments in this ASU No. 2021-04 are effective for all entities for fiscal years beginning after December 15, 2021, and interim periods within those fiscal years, with early adoption permitted, including interim periods within those fiscal years. The amendment currently has no impact to the Company as the effect will largely depend on the terms of written call options or financings issued or modified in the future. There are no other recently issued accounting pronouncements that are expected to have any significant effect on the Company's financial position, results of operations or cash flows.
Summary of Accounting Policies on Revenue Recognition and Shipping and Handling Fees	Summary of Accounting Policies on Revenue Recognition Revenue is recognized upon the transfer of control of promised products or services to the customers in an amount that reflects the consideration the Company expects to receive in exchange for those products and services. Performance Obligations The Company's performance obligations consist mainly of transferring control of goods and services identified in the contracts, purchase orders, or invoices. The Company has no significant multi-element contracts with customers. Significant Judgments Usage-based royalties and licenses are estimated based on the provisions of contracts with customers and recognized in the same period that the royalty-based products are sold by the Company and the Company's strategic partners. The Company estimates and recognizes royalty revenue based upon communication with licensees, historical information, and expected sales trends. Differences between actual reported licensee sales and those that were estimated are adjusted in the period in which they become known, which is typically the following quarter. Historically, such adjustments have not been significant. The Company estimates returns, price concessions, and discount allowances using the expected value method based on historical trends and other known factors. Rebate allowances are estimated using the most likely method based on each customer contract. The Company's return policy, as set forth in its product catalogs and sales invoices, requires review and authorization in advance prior to the return of product. Upon the authorization, a credit will be issued for the goods returned within a set amount of days from the shipment, which is generally ninety days. The Company disregards the effects of a financing component if the Company expects, at contract inception, that the period between the transfer and customer payment for the goods or services will be one year or less. The Company has no significant revenues recognized on payments expected to be received more than one year after the transfer of control of products or services to customers. Contract Asset and Liability Revenues recognized from the Company's private label business that are not invoiced to the customers as a result of recognizing revenue over time are recorded as a contract asset included in the prepaid expenses and other current assets account in the consolidated balance sheet. Other operating revenues may include fees received under service agreements. Non-refundable fees received under multiple-period service agreements are recognized as revenue as the Company satisfies the performance obligations to the other party. A portion of the transaction price allocated to the performance obligations to be satisfied in the future periods is recognized as contract liability.
Product Warranties	Product Warranties Certain of the Company's medical devices, including monitoring systems and neurosurgical systems, are designed to operate over long periods of time. These products are sold with warranties which may extend for up to two years from the date of purchase. The warranties are not considered a separate performance obligation. The Company estimates its product warranties using the expected value method based on historical trends and other known factors. The Company includes them in accrued expenses and other current liabilities in the consolidated balance sheet.
Taxes Collected from Customers	Taxes Collected from CustomersThe Company elected to exclude from the measurement of the transaction price all taxes assessed by a governmental authority that are both imposed on and concurrent with a specific revenue-producing transaction and collected by the entity from a customer.

BASIS OF PRESENTATION (Tables)

BASIS OF PRESENTATION (Tables)	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Accounting Standards Update	The Company adopted this guidance on January 1, 2021 using the modified retrospective approach which resulted in a cumulative-effect adjustment that increased (decreased) the following consolidated balance sheet accounts: ADJUSTMENT CONSOLIDATED BALANCE SHEET CLASSIFICATION AMOUNT Deferred tax impact of cumulative-effect adjustment Deferred tax liabilities $ (20.6) Debt discount reclassification Long-term convertible securities 89.1 Equity issuance costs reclassification Long-term convertible securities (2.5) Debt discount amortization and equity costs reclassification, net of tax Retained Earnings (2.8) Net impact of cumulative-effect adjustment Additional paid-in capital (63.3)

ACQUISITIONS AND DIVESTITURES (

ACQUISITIONS AND DIVESTITURES (Tables)	6 Months Ended
	Jun. 30, 2021
Mergers, Acquisitions and Dispositions [Abstract]
Disposal Groups, Including Discontinued Operations	Assets and liabilities divested consisted of the following as of December 31, 2020 (dollar amounts in thousands): Prepaid expenses and other current assets $ 713 Right of use asset-operating leases and Other assets 3,186 Deferred tax assets 6,589 Intangible assets, net 13,332 Property, plant and equipment, net 37,893 Goodwill 47,546 Inventories 52,845 Total assets held for sale $ 162,104 Other liabilities 336 Current portion of lease liability - operating leases 539 Accrued compensation 1,767 Deferred tax liabilities 3,440 Lease liability - operating leases 5,669 Total liabilities held for sale $ 11,751
Schedule of Assets Acquired and Liabilities Assumed	The following table summarizes the preliminary fair values of the assets acquired and liabilities assumed at the acquisition date: Dollars in thousands Preliminary Valuation as of June 30, 2021 Weighted Average Life Current assets: Cash $ 2,726 Trade accounts receivable, net 16,469 Inventories, net 18,299 Prepaids expenses and other current assets 1,498 Total current assets 38,992 Property, plant and equipment, net 13,769 Intangible assets 245,000 13-14 years Goodwill 94,298 Right of use asset - operating leases 9,259 Deferred tax assets 9,768 Other assets 148 Total assets acquired 411,234 Current liabilities: Accounts payable $ 718 Accrued expenses 5,966 Current portion of lease liability - operating leases 1,673 Total current liabilities 8,357 Other long-term liability 276 Lease liability - operating leases 7,585 Deferred tax liability 64,178 Contingent consideration 23,900 Total liabilities assumed 104,296 Net assets acquired $ 306,938

REVENUES FROM CONTRACTS WITH _2

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
Schedule of Changes in Contract Assets and Contract Liabilities	The following table summarizes the changes in the contract asset and liability balances for the six months ended June 30, 2021: Contract Asset Contract asset, January 1, 2021 $ 7,430 Transferred to trade receivable of contract asset included in beginning of the year contract asset (7,430) Contract asset, net of transferred to trade receivables on contracts during the period 7,952 Contract asset, June 30, 2021 $ 7,952 Contract Liability Contract liability, January 1, 2021 $ 11,961 Recognition of revenue included in beginning of year contract liability (2,838) Contract liability, net of revenue recognized on contracts during the period 3,102 Foreign currency translation (125) Contract liability, June 30, 2021 $ 12,100
Schedule of Disaggregation of Revenue	The following table presents revenues disaggregated by the major sources of revenues for the three and six months ended June 30, 2021 and 2020 (dollar amounts in thousands): Three Months Ended June 30, 2021 Three Months Ended June 30, 2020 Six Months Ended June 30, 2021 Six Months Ended June 30, 2020 Neurosurgery $ 202,600 $ 141,430 $ 391,854 $ 326,373 Instruments 54,237 28,348 106,224 74,845 Total Codman Specialty Surgical 256,837 169,778 498,078 401,218 Wound Reconstruction and Care (2) 102,616 56,291 191,314 128,558 Extremity Orthopedics (1) — 11,162 — 32,634 Private Label 30,539 21,434 60,671 50,579 Total Tissue Technologies 133,155 88,887 251,985 211,771 Total revenue $ 389,992 $ 258,665 $ 750,063 $ 612,989 (1) On January 4, 2021, the Company completed its previously announced sale of its Extremity Orthopedics business. In conjunction with the sale of this business, the Company rebranded the Orthopedics and Tissue Technologies segment as Tissue Technologies in the first quarter of 2021. See Note 2. Acquisitions and Divestitures, for details. (2) See Note 2. Acquisitions and Divestitures, for details around the ACell Inc. Acquisition.

INVENTORIES (Tables)

INVENTORIES (Tables)	6 Months Ended
	Jun. 30, 2021
Inventory Disclosure [Abstract]
Schedule of Inventories, Net	Inventories, net consisted of the following: Dollars in thousands June 30, 2021 December 31, 2020 Finished goods $ 180,835 $ 180,301 Work in process 61,987 53,336 Raw materials 80,796 76,480 Total inventories, net $ 323,618 $ 310,117

GOODWILL AND OTHER INTANGIBLE_2

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Amount of Goodwill	Changes in the carrying amount of goodwill for the six-month period ended June 30, 2021 were as follows: Dollars in thousands Codman Specialty Tissue Technologies Total Goodwill at December 31, 2020 $ 671,975 $ 260,392 $ 932,367 ACell Acquisition — 94,298 94,298 Foreign currency translation (7,218) (3,809) (11,027) Goodwill at June 30, 2021 $ 664,757 $ 350,881 $ 1,015,638
Schedule of Finite-Lived Intangible Assets	The components of the Company’s identifiable intangible assets were as follows: June 30, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,125,279 $ (274,287) $ 850,992 Customer relationships 12 years $ 212,572 $ (137,897) $ 74,675 Trademarks/brand names 28 years $ 99,319 $ (29,866) $ 69,453 Codman tradename Indefinite $ 166,651 $ — $ 166,651 Supplier relationships 30 years $ 30,211 $ (15,691) $ 14,520 All other 11 years $ 6,473 $ (3,880) $ 2,593 $ 1,640,505 $ (461,621) $ 1,178,884 December 31, 2020 Dollars in thousands Weighted Cost Accumulated Net Completed technology 19 years $ 896,478 $ (248,088) $ 648,390 Customer relationships 12 years 213,270 (132,838) 80,432 Trademarks/brand names 28 years 104,209 (31,767) 72,442 Codman tradename Indefinite 170,226 — 170,226 Supplier relationships 27 years 30,211 (15,203) 15,008 All other (1) 4 years 6,693 (3,755) 2,938 $ 1,421,087 $ (431,651) $ 989,436 (1) Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.
Schedule of Indefinite-Lived Intangible Assets	The components of the Company’s identifiable intangible assets were as follows: June 30, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,125,279 $ (274,287) $ 850,992 Customer relationships 12 years $ 212,572 $ (137,897) $ 74,675 Trademarks/brand names 28 years $ 99,319 $ (29,866) $ 69,453 Codman tradename Indefinite $ 166,651 $ — $ 166,651 Supplier relationships 30 years $ 30,211 $ (15,691) $ 14,520 All other 11 years $ 6,473 $ (3,880) $ 2,593 $ 1,640,505 $ (461,621) $ 1,178,884 December 31, 2020 Dollars in thousands Weighted Cost Accumulated Net Completed technology 19 years $ 896,478 $ (248,088) $ 648,390 Customer relationships 12 years 213,270 (132,838) 80,432 Trademarks/brand names 28 years 104,209 (31,767) 72,442 Codman tradename Indefinite 170,226 — 170,226 Supplier relationships 27 years 30,211 (15,203) 15,008 All other (1) 4 years 6,693 (3,755) 2,938 $ 1,421,087 $ (431,651) $ 989,436 (1) Prior period amounts were reclassified as it relates to All other within this table to conform to the current period presentation.

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Schedule of Long-term Debt Maximum Leverage Ratios	In connection with the July 2020 amendment, the Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) was modified to the following: Fiscal Quarter Maximum Consolidated Total Leverage Ratio Execution of July 2020 Amendment through June 30, 2021 5.50 to 1.00 September 30, 2021 through June 30, 2022 5.00 to 1.00 September 30, 2022 through June 30, 2023 4.50 to 1.00 September 30, 2023 and the last day of each fiscal quarter thereafter 4.00 to 1.00
Schedule of Contractual Repayments of Long-Term Debt	Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows: Quarter Ended June 30, 2021 Principal Repayment Dollars in thousands Remainder of 2021 $ 22,500 2022 $ 45,000 2023 $ 61,875 2024 $ 67,500 2025 $ 669,375 $ 866,250

DERIVATIVE INSTRUMENTS (Tables)

DERIVATIVE INSTRUMENTS (Tables)	6 Months Ended
	Jun. 30, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Instruments	The Company held the following interest rate swaps as of June 30, 2021 and December 31, 2020 (dollar amounts in thousands): June 30, 2021 December 31, 2020 June 30, 2021 December 31, 2020 Hedged Item Notional Amount Designation Date Effective Date Termination Date Fixed Interest Rate Estimated Fair Value Asset (Liability) 1-month USD LIBOR Loan $ — $ 100,000 March 27, 2017 December 31, 2017 June 30, 2021 1.971 % $ — $ (929) 1-month USD LIBOR Loan 300,000 300,000 December 13, 2017 January 1, 2018 December 31, 2022 2.201 % (9,122) (12,557) 1-month USD LIBOR Loan 150,000 150,000 December 13, 2017 July 1, 2019 June 30, 2024 2.423 % (8,692) (11,502) 1-month USD LIBOR Loan 200,000 200,000 December 13, 2017 January 1, 2018 December 31, 2024 2.313 % (11,856) (16,243) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.220 % (7,595) (9,836) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.199 % (7,553) (9,826) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.209 % (7,541) (9,783) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.885 % (7,703) (10,407) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.867 % (7,592) (10,431) 1-month USD LIBOR Loan 575,000 575,000 December 15, 2020 July 31, 2025 December 31, 2027 1.415 % 3,931 (1,907) 1-month USD LIBOR Loan 125,000 125,000 December 15, 2020 July 1, 2025 December 31, 2027 1.404 % 987 (348) $ 1,775,000 $ 1,875,000 $ (62,736) $ (93,769) The Company held the following cross-currency rate swaps as of June 30, 2021 and December 31, 2020 (dollar amounts in thousands): June 30, 2021 December 31, 2020 June 30, 2021 December 31, 2020 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay CHF October 2, 2017 October 2, 2021 1.85% CHF 48,533 48,533 (2,228) (4,335) Receive U.S.$ 4.46% $ 50,000 50,000 Pay CHF October 2, 2017 October 2, 2022 1.95% CHF 145,598 145,598 (4,641) (11,262) Receive U.S.$ 4.52% $ 150,000 150,000 Pay CHF December 21, 2020 December 20, 2025 3.00% CHF 408,637 420,137 10,124 (7,843) Receive U.S.$ 3.98% $ 458,730 471,640 Total $ 3,255 $ (23,441) The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 2021 and December 31, 2020, respectively (dollar amounts in thousands): June 30, 2021 December 31, 2020 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay EUR October 3, 2018 September 30, 2021 —% EUR 44,859 $ (864) $ (1,884) Receive U.S.$ 3.01% $ 52,000 Pay EUR October 3, 2018 September 30, 2023 —% EUR 51,760 901 (450) Receive U.S.$ 2.57% $ 60,000 Pay EUR October 3, 2018 September 30, 2025 —% EUR 38,820 849 92 Receive U.S.$ 2.19% $ 45,000 Pay CHF December 16, 2020 December 16, 2027 —% CHF 222,300 3,292 (3,794) Receive U.S.$ 1.10% $ 250,000 Total $ 4,178 $ (6,036)
Schedule of Fair Value and Presentation of Derivatives	The following table summarizes the fair value for derivatives designated as hedging instruments in the condensed consolidated balance sheets as of June 30, 2021 and December 31, 2020: Fair Value as of Location on Balance Sheet (1) : June 30, 2021 December 31, 2020 Dollars in thousands Derivatives designated as hedges — Assets: Prepaid expenses and other current assets Cash Flow Hedges Cross-currency swap $ 9,206 $ 7,623 Net Investment Hedges Cross-currency swap 5,345 5,297 Other assets Cash Flow Hedges Interest rate swap (2) 4,918 — Cross-currency swap 4,605 — Net Investment Hedges Cross-currency swap 505 — Total derivatives designated as hedges — Assets $ 24,579 $ 12,920 Derivatives designated as hedges — Liabilities: Accrued expenses and other current liabilities Cash Flow Hedges Interest rate swap (2) $ 21,003 $ 22,033 Cross-currency swap 2,228 4,335 Net Investment Hedges Cross-currency swap 864 1,884 Other liabilities Cash Flow Hedges Interest rate swap (2) 46,651 71,736 Cross-currency swap 8,328 26,728 Net Investment Hedges Cross-currency swap 808 9,449 Total derivatives designated as hedges — Liabilities $ 79,882 $ 136,165 (1) The Company classifies derivative assets and liabilities as current based on the cash flows expected to be incurred within the following 12 months. (2) At June 30, 2021 and December 31, 2020, the total notional amounts related to the Company’s interest rate swaps were $1.8 billion and $1.9 billion, respectively.
Effect of Derivative Instruments Designated as Cash Flow Hedges on Statements of Operations	The following presents the effect of derivative instruments designated as cash flow hedges on the accompanying condensed consolidated statement of operations during the three and six months ended June 30, 2021 and 2020: Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Three Months Ended June 30, 2021 Cash Flow Hedges Interest rate swap $ (53,546) $ (15,013) $ (5,823) $ (62,736) Interest expense Cross-currency swap (5,029) (10,969) (11,635) (4,363) Other income (expense),net Net Investment Hedges Cross-currency swap (429) 88 1,737 (2,078) Interest income $ (59,004) $ (25,894) $ (15,721) $ (69,177) Three Months Ended June 30, 2020 Cash Flow Hedges Interest rate swap $ (95,753) $ (9,988) $ (3,614) $ (102,127) Interest expense Cross-currency swap 6,266 (2,322) (1,899) 5,843 Other income (expense),net Net Investment Hedges Cross-currency swap 26,946 (2,543) 2,179 22,224 Interest income $ (62,541) $ (14,853) $ (3,334) $ (74,060) Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Six Months Ended June 30, 2021 Cash Flow Hedges Interest rate swap $ (93,769) $ 19,505 $ (11,528) $ (62,736) Interest expense Cross-currency swap (1,073) 29,225 32,515 (4,363) Other income (expense),net Net Investment Hedges Cross-currency swap (12,291) 13,661 3,448 (2,078) Interest income $ (107,133) $ 62,391 $ 24,435 $ (69,177) Six Months Ended June 30, 2020 Cash Flow Hedges Interest rate swap $ (45,146) $ (61,637) $ (4,656) $ (102,127) Interest expense Cross-currency swap 177 3,585 (2,081) 5,843 Other income (expense), net Net Investment Hedges Cross-currency swap 10,229 16,357 4,362 22,224 Interest income $ (34,740) $ (41,695) $ (2,375) $ (74,060)

LEASES AND RELATED PARTY LEAS_2

LEASES AND RELATED PARTY LEASES (Tables)	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
Supplemental Balance Sheet Information	Supplemental balance sheet information related to operating leases were as follows: Dollars in thousands, except lease term and discount rate June 30, 2021 December 31, 2020 ROU assets $ 89,174 $ 83,635 Current lease liabilities 13,987 12,818 Non-current lease liabilities 95,196 88,118 Total lease liabilities $ 109,183 $ 100,936 Weighted average remaining lease term (in years): Leased facilities 11.3 years 11.6 years Leased vehicles 2.3 years 2.3 years Weighted average discount rate: Leased facilities 5.0 % 4.6 % Leased vehicles 2.7 % 2.3 %
Supplemental Cash Flow Information	Supplemental cash flow information related to leases for the six months ended June 30, 2021 and 2020 were as follows: Dollars in thousands June 30, 2021 June 30, 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 7,019 $ 6,728 ROU assets obtained in exchange for lease liabilities: Operating leases $ 10,528 $ 6,007
Schedule of Operating Lease Maturities	Future minimum lease payments under operating leases at June 30, 2021 were as follows: Dollars in thousands Related Parties Third Parties Total 2021 $ 148 $ 7,973 $ 8,121 2022 296 16,833 17,129 2023 296 13,945 14,241 2024 296 11,461 11,757 2025 296 10,835 11,131 2026 296 9,553 9,849 Thereafter 837 72,887 73,724 Total minimum lease payments $ 2,465 $ 143,487 $ 145,952 Less: Imputed interest 36,769 Total lease liabilities 109,183 Less: Current lease liabilities 13,987 Long-term lease liabilities 95,196

INCOME TAXES (Tables)

INCOME TAXES (Tables)	6 Months Ended
	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Schedule of Effective Income Tax Rate	The following table provides a summary of the Company's effective tax rate: Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Reported tax rate 21.8 % 122.4 % 28.2 % 32.7 %

NET INCOME PER SHARE (Tables)

NET INCOME PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Basic and Diluted Net Income (Loss) Per Share	Basic and diluted net income per share was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands, except per share amounts 2021 2020 2021 2020 Basic net income per share: Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Weighted average common shares outstanding 84,687 84,706 84,593 84,955 Basic net income per common share $ 0.41 $ (0.00) $ 0.95 $ 0.10 Diluted net income per share: Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Weighted average common shares outstanding — Basic 84,687 84,706 84,593 84,955 Effect of dilutive securities: Stock options and restricted stock 653 — 731 593 Weighted average common shares for diluted earnings per share 85,340 84,706 85,324 85,548 Diluted net income per common share $ 0.41 $ 0.00 $ 0.94 $ 0.10

ACCUMULATED OTHER COMPREHENSI_2

ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)	6 Months Ended
	Jun. 30, 2021
Equity [Abstract]
Schedule of Comprehensive Income (Loss)	Comprehensive income (loss) for the six months ended June 30, 2021 and 2020 was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 Net income (loss) $ 35,068 $ (369) $ 80,462 $ 8,811 Foreign currency translation adjustment 1,558 10,433 (5,243) 3,620 Change in unrealized loss on derivatives, net of tax (7,804) (8,830) 29,111 (30,136) Pension liability adjustment, net of tax (91) (139) 228 (207) Comprehensive income (loss), net $ 28,731 $ 1,095 $ 104,558 $ (17,912)
Schedule of Changes in Accumulated Other Comprehensive Loss by Component	Changes in accumulated other comprehensive loss by component between December 31, 2020 and June 30, 2021 are presented in the table below, net of tax: Dollars in thousands Gains and Losses on Derivatives Defined Benefit Pension Items Foreign Currency Items Total Balance at January 1, 2021 $ (82,249) $ (5,105) $ 13,295 $ (74,059) Other comprehensive income (loss) 47,885 228 (5,243) 42,870 Less: Amounts reclassified from accumulated other comprehensive loss 18,774 — — 18,774 Net current-period other comprehensive income (loss) 29,111 228 (5,243) 24,096 Balance at June 30, 2021 $ (53,138) $ (4,877) $ 8,052 $ (49,963)

SEGMENT AND GEOGRAPHIC INFORM_2

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)	6 Months Ended
	Jun. 30, 2021
Segment Reporting [Abstract]
Schedule of Net Sales and Profit by Segments	Net sales and profit by each reportable segment for the three and six months ended June 30, 2021 and 2020 are as follows : Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 Segment Net Sales Codman Specialty Surgical $ 256,837 $ 169,778 $ 498,078 $ 401,218 Tissue Technologies 133,155 88,887 251,985 211,771 Total revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989 Segment Profit Codman Specialty Surgical $ 113,996 $ 65,256 $ 220,774 $ 152,491 Tissue Technologies 64,413 28,688 114,424 59,958 Segment profit 178,409 93,944 335,198 212,449 Amortization (4,198) (8,073) (8,725) (15,050) Corporate and other (122,357) (71,791) (243,905) (156,216) Operating income $ 51,854 $ 14,080 $ 82,568 $ 41,183 Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 United States $ 278,186 $ 181,850 $ 525,979 $ 428,702 Europe 48,437 32,026 94,256 77,922 Asia Pacific 44,306 33,501 91,601 73,461 Rest of World 19,063 11,288 38,227 32,904 Total Revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989
Schedule of Geographic Revenue by Area	Net sales and profit by each reportable segment for the three and six months ended June 30, 2021 and 2020 are as follows : Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 Segment Net Sales Codman Specialty Surgical $ 256,837 $ 169,778 $ 498,078 $ 401,218 Tissue Technologies 133,155 88,887 251,985 211,771 Total revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989 Segment Profit Codman Specialty Surgical $ 113,996 $ 65,256 $ 220,774 $ 152,491 Tissue Technologies 64,413 28,688 114,424 59,958 Segment profit 178,409 93,944 335,198 212,449 Amortization (4,198) (8,073) (8,725) (15,050) Corporate and other (122,357) (71,791) (243,905) (156,216) Operating income $ 51,854 $ 14,080 $ 82,568 $ 41,183 Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2021 2020 2021 2020 United States $ 278,186 $ 181,850 $ 525,979 $ 428,702 Europe 48,437 32,026 94,256 77,922 Asia Pacific 44,306 33,501 91,601 73,461 Rest of World 19,063 11,288 38,227 32,904 Total Revenues $ 389,992 $ 258,665 $ 750,063 $ 612,989

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Tables)	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Schedule of Contingent Consideration	A reconciliation of the opening balances to the closing balances of these Level 3 measurements for the six months ended June 30, 2021 and June 30, 2020 is as follows (in thousands): Six Months Ended June 30, 2021 Contingent Consideration Liability Related to Acquisition of: Arkis Location in Financial Statements Derma Sciences ACell Inc. Location in Financial Statements Short-term Long-term Long-term Long-term Balance as of January 1, 2021 $ 3,415 $ 11,746 $ 230 $ — Additions from acquisition of ACell — — — 23,900 Transfers (3,432) 3,432 — — Gain (loss) from change in fair value of contingent consideration liabilities 17 $ (402) Research and development — (400) Selling, general and administrative Balance as of June 30, 2021 $ — $ 14,776 $ 230 $ 23,500 Six Months Ended June 30, 2020 Contingent Consideration Liability Related to Acquisition of: Arkis Derma Sciences Location in Financial Statements Long-term Long-term Balance as of January 1, 2020 $ 14,210 $ 230 Loss from change in fair value of contingent consideration liabilities (708) — Research and development Balance as of June 30, 2020 $ 13,502 $ 230

BASIS OF PRESENTATION - Narrati

BASIS OF PRESENTATION - Narrative (Details) - 2025 Notes $ in Thousands	Feb. 04, 2020USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Convertible debt	$ 575,000
Convertible Debt
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Convertible notes, interest rate	0.50%

BASIS OF PRESENTATION - Adoptio

BASIS OF PRESENTATION - Adoption of 2020-06 (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Deferred tax liabilities	$ 63,447	$ 16,190
Long-term convertible securities	562,968	474,834
Retained earnings	$ 609,955	532,265
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Deferred tax liabilities		(20,600)
Retained earnings		(2,800)
Additional paid-in capital		(63,300)
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Reclassification
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Long-term convertible securities		89,100
Cumulative Effect, Period of Adoption, Adjustment, Debt Discount Amortization and Equity Costs Reclassification
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Long-term convertible securities		$ (2,500)

ACQUISITIONS AND DIVESTITURES -

ACQUISITIONS AND DIVESTITURES - Divestitures, Narrative (Details) - USD ($) $ in Thousands	Jan. 04, 2021	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain (loss) from the sale of business		$ (679)	$ 0	$ 42,197	$ 0
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Extremity Orthopedics
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of business, disposition price	$ 240,000
Gain (loss) from the sale of business		(700)		42,200
Transitional supply agreement, payable		$ 10,900		$ 10,900
Consortium of Focused Orthopedists, LLC | Disposal Group, Disposed of by Sale, Not Discontinued Operations | Extremity Orthopedics
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Payment related to contract termination	$ 41,500

ACQUISITIONS AND DIVESTITURES_2

ACQUISITIONS AND DIVESTITURES - Assets and Liabilities Divested (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - Extremity Orthopedics $ in Thousands	Dec. 31, 2020USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Prepaid expenses and other current assets	$ 713
Right of use asset-operating leases and Other assets	3,186
Deferred tax assets	6,589
Intangible assets, net	13,332
Property, plant and equipment, net	37,893
Goodwill	47,546
Inventories	52,845
Total assets held for sale	162,104
Other liabilities	336
Current portion of lease liability - operating leases	539
Accrued compensation	1,767
Deferred tax liabilities	3,440
Lease liability - operating leases	5,669
Total liabilities held for sale	$ 11,751

ACQUISITIONS AND DIVESTITURES-

ACQUISITIONS AND DIVESTITURES- Business Combination, Narrative (Details) - ACell, Inc. - USD ($)	Jan. 20, 2021	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Business Acquisition [Line Items]
Payments to acquire businesses, gross	$ 306,900,000
Contingent consideration, maximum undiscounted payment amount	$ 100,000,000	$ 100,000,000		$ 100,000,000
Intangible asset acquired, discount rate (percent)	8.50%
Contingent consideration, estimated fair value	$ 23,900,000	23,500,000		23,500,000
Business acquisition, pro forma revenue		390,000,000	$ 269,600,000	754,700,000	$ 646,900,000
Business Combination, Working Capital Adjustment		$ 1,300,000		$ 1,300,000

ACQUISITIONS AND DIVESTITURES_3

ACQUISITIONS AND DIVESTITURES - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Current assets:
Goodwill	$ 1,015,638	$ 932,367
ACell, Inc.
Current assets:
Cash	2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaids expenses and other current assets	1,498
Total current assets	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000
Goodwill	94,298
Right of use asset - operating leases	9,259
Deferred tax assets	9,768
Other assets	148
Total assets acquired	411,234
Current liabilities:
Accounts payable	718
Accrued expenses	5,966
Current portion of lease liability - operating leases	1,673
Total current liabilities	8,357
Other long-term liability	276
Lease liability - operating leases	7,585
Deferred tax liability	64,178
Contingent consideration	23,900
Total liabilities assumed	104,296
Net assets acquired	$ 306,938
ACell, Inc. | Minimum
Current liabilities:
Weighted Average Life	13 years
ACell, Inc. | Maximum
Current liabilities:
Weighted Average Life	14 years

REVENUES FROM CONTRACTS WITH _3

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Number of days from shipment to issue a credit	90 days
Short-term portion of contract liability	$ 5,890	$ 5,275
Long-term portion of contract liability	$ 6,200
Product warranty period (up to)	2 years

REVENUES FROM CONTRACTS WITH _4

REVENUES FROM CONTRACTS WITH CUSTOMERS - Narrative, Revenue Remaining Performance Obligation (Details) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-07-01	Jun. 30, 2021
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation through 2021, percentage	49.00%
Performance obligations expected to be satisfied, expected timing	12 months

REVENUES FROM CONTRACTS WITH _5

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Changes in Contract Assets and Liabilities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)
Contract Asset
Contract asset, Beginning of period	$ 7,430
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(7,430)
Contract asset, net of transferred to trade receivables on contracts during the period	7,952
Contract asset, End of Period	7,952
Contract Liability
Contract liability, Beginning of Period	11,961
Recognition of revenue included in beginning of year contract liability	(2,838)
Contract liability, net of revenue recognized on contracts during the period	3,102
Foreign currency translation	(125)
Contract liability, End of Period	$ 12,100

REVENUES FROM CONTRACTS WITH _6

REVENUES FROM CONTRACTS WITH CUSTOMERS - Schedule of Revenues Disaggregated by Major Source (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Disaggregation of Revenue [Line Items]
Total Revenues	$ 389,992	$ 258,665	$ 750,063	$ 612,989
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	256,837	169,778	498,078	401,218
Codman Specialty Surgical | Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	202,600	141,430	391,854	326,373
Codman Specialty Surgical | Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	54,237	28,348	106,224	74,845
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	133,155	88,887	251,985	211,771
Tissue Technologies | Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	102,616	56,291	191,314	128,558
Tissue Technologies | Extremity Orthopedics
Disaggregation of Revenue [Line Items]
Total Revenues	0	11,162	0	32,634
Tissue Technologies | Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 30,539	$ 21,434	$ 60,671	$ 50,579

INVENTORIES - Schedule of Net I

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Finished goods	$ 180,835	$ 180,301
Work in process	61,987	53,336
Raw materials	80,796	76,480
Inventories, net	$ 323,618	$ 310,117

INVENTORIES - Narrative (Detail

INVENTORIES - Narrative (Details) $ in Thousands	Dec. 31, 2020USD ($)
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Extremity Orthopedics
Inventory [Line Items]
Inventories	$ 52,845

GOODWILL AND OTHER INTANGIBLE_3

GOODWILL AND OTHER INTANGIBLE ASSETS - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)
Goodwill [Roll Forward]
Beginning of Period	$ 932,367
ACell Acquisition	94,298
Foreign currency translation	(11,027)
End of Period	1,015,638
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of Period	671,975
ACell Acquisition	0
Foreign currency translation	(7,218)
End of Period	664,757
Tissue Technologies
Goodwill [Roll Forward]
Beginning of Period	260,392
ACell Acquisition	94,298
Foreign currency translation	(3,809)
End of Period	$ 350,881

GOODWILL AND OTHER INTANGIBLE_4

GOODWILL AND OTHER INTANGIBLE ASSETS - Components of Company's Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,640,505	$ 1,421,087
Accumulated Amortization	(461,621)	(431,651)
Net	1,178,884	989,436
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	166,651	170,226
Net	$ 166,651	$ 170,226
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	18 years	19 years
Cost	$ 1,125,279	$ 896,478
Accumulated Amortization	(274,287)	(248,088)
Net	$ 850,992	$ 648,390
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 212,572	$ 213,270
Accumulated Amortization	(137,897)	(132,838)
Net	$ 74,675	$ 80,432
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 99,319	$ 104,209
Accumulated Amortization	(29,866)	(31,767)
Net	$ 69,453	$ 72,442
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	27 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(15,691)	(15,203)
Net	$ 14,520	$ 15,008
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	11 years	4 years
Cost	$ 6,473	$ 6,693
Accumulated Amortization	(3,880)	(3,755)
Net	$ 2,593	$ 2,938

GOODWILL AND OTHER INTANGIBLE_5

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) $ in Millions	Jun. 30, 2021USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Expected annual amortization expense, remainder of 2021	$ 40.6
Expected annual amortization expense, in 2022	79.1
Expected annual amortization expense, in 2023	78.4
Expected annual amortization expense, in 2024	77.7
Expected annual amortization expense, in 2025	77.7
Expected annual amortization expense, in 2026	77.5
Expected annual amortization expense, thereafter	$ 585.7

DEBT - Narrative (Details)

DEBT - Narrative (Details)	Feb. 04, 2020USD ($)$ / shares	Sep. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Feb. 03, 2020USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility				$ 45,000,000		$ 33,750,000
Cost of call transactions				0	$ 104,248,000
Proceeds from warrant transactions				0	44,563,000
Carrying amount, liability component				562,968,000		474,834,000
Securitization program outstanding borrowings, maximum limit				150,000,000
Long-term borrowings under securitization facility				$ 112,500,000		$ 112,500,000
Weighted average interest rate, accounts receivable securitization revolving loan facility				1.20%		1.30%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value				$ 110,300,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 1,300,000,000
Line of credit facility outstanding				$ 8,800,000		$ 97,500,000
Weighted average interest rate on debt				1.50%		1.50%
Revolving Credit Facility | Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				$ 8,600,000
Standby Letters of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000
Swingline Loans
Debt Instrument [Line Items]
Maximum borrowing capacity							60,000,000
Senior Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity							2,200,000,000
Incremental financing costs capitalized							4,600,000
Previously capitalized financing costs, written-off			$ 1,200,000
Incremental financing cost expense		$ 3,300,000
Senior Credit Facility | Overnight Federal Funds
Debt Instrument [Line Items]
Interest rates available				0.50%
Senior Credit Facility | One Month Eurodollar Rate
Debt Instrument [Line Items]
Interest rates available				1.00%
Senior Credit Facility | Minimum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage				0.15%
Senior Credit Facility | Minimum | Eurodollar
Debt Instrument [Line Items]
Interest rates available				1.00%
Senior Credit Facility | Maximum
Debt Instrument [Line Items]
Line of credit, commitment fee percentage				0.30%
Senior Credit Facility | Maximum | Eurodollar
Debt Instrument [Line Items]
Interest rates available				2.25%
Senior Credit Facility | Standby Letters of Credit
Debt Instrument [Line Items]
Line of credit facility outstanding				$ 0
Letters of credit outstanding				1,600,000		$ 1,600,000
Term Loan Facility | Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity							$ 877,500,000
Line of credit facility outstanding				$ 866,300,000		$ 877,500,000
Weighted average interest rate on debt				1.50%		1.50%
Term loan component of senior credit facility				$ 45,000,000
Term Loan Facility | Secured Debt | Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding				850,400,000
2025 Notes | Convertible Debt
Debt Instrument [Line Items]
Incremental financing costs capitalized	$ 13,200,000
Convertible notes, maximum borrowing capacity	$ 575,000,000			575,000,000		$ 575,000,000
Convertible notes, interest rate	0.50%
Debt proceeds, classified as equity at time of offering	$ 104,500,000
Effective interest rate	4.20%
Initial conversion rate	13.5739
Initial conversion price (in dollars per share) | $ / shares	$ 73.67
Maximum selling price of the company's common stock of the conversion price	130.00%
Maximum average conversion value of notes	98.00%
Redemption price, percentage	100.00%
Warrant strike price (in dollars per share) | $ / shares	$ 113.34
Carrying amount, liability component						485,900,000
Unamortized discount						$ 89,100,000
Fair value				630,700,000
Cash interest				$ 1,400,000
2025 Notes | Convertible Debt | Call Option
Debt Instrument [Line Items]
Cost of call transactions	$ 104,200,000
Proceeds from warrant transactions	$ 44,500,000
Initial strike price (in dollars per share) | $ / shares	$ 73.67
2020 Notes
Debt Instrument [Line Items]
Incremental financing cost expense					6,800,000
Cash interest					1,200,000
Interest expense					$ 8,000,000

DEBT - Maximum Total Leverage R

DEBT - Maximum Total Leverage Ratio Table (Details) - Senior Credit Facility	Jul. 14, 2020
Execution of July 2020 Amendment through June 30, 2021
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5.50
September 30, 2021 through June 30, 2022
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	5
September 30, 2022 through June 30, 2023
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4.50
September 30, 2023 and the last day of each fiscal quarter thereafter
Debt Instrument [Line Items]
Maximum Consolidated Total Leverage Ratio	4

DEBT - Contractual Maturity Tab

DEBT - Contractual Maturity Table (Details) $ in Thousands	Jun. 30, 2021USD ($)
Debt Disclosure [Abstract]
Remainder of 2021	$ 22,500
2022	45,000
2023	61,875
2024	67,500
2025	669,375
Principal Repayment	$ 866,250

DERIVATIVE INSTRUMENTS - Schedu

DERIVATIVE INSTRUMENTS - Schedule of Derivatives (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($)	Jun. 30, 2021	Dec. 31, 2020
Derivative [Line Items]
Estimated Fair Value, Asset (Liability)	$ (62,736,000)	$ (93,769,000)
1-Month USD LIBOR
Derivative [Line Items]
Notional amount	1,775,000,000	1,875,000,000
1-Month USD LIBOR | Interest Rate Swap Designated March 27, 2017
Derivative [Line Items]
Notional amount	$ 0	100,000,000
Fixed Interest Rate	1.971%
Estimated Fair Value, Asset (Liability)	$ 0	(929,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 13, 2017 Tranche 1
Derivative [Line Items]
Notional amount	$ 300,000,000	300,000,000
Fixed Interest Rate	2.201%
Estimated Fair Value, Asset (Liability)	$ (9,122,000)	(12,557,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional amount	$ 150,000,000	150,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Asset (Liability)	$ (8,692,000)	(11,502,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 13, 2017 Tranche 5
Derivative [Line Items]
Notional amount	$ 200,000,000	200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value, Asset (Liability)	$ (11,856,000)	(16,243,000)
1-Month USD LIBOR | Interest Rate Swap Designated October 10, 2018 Tranche 1
Derivative [Line Items]
Notional amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.22%
Estimated Fair Value, Asset (Liability)	$ (7,595,000)	(9,836,000)
1-Month USD LIBOR | Interest Rate Swap Designated October 10, 2018 Tranche 2
Derivative [Line Items]
Notional amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.199%
Estimated Fair Value, Asset (Liability)	$ (7,553,000)	(9,826,000)
1-Month USD LIBOR | Interest Rate Swap Designated October 10, 2018 Tranche 3
Derivative [Line Items]
Notional amount	$ 75,000,000	75,000,000
Fixed Interest Rate	3.209%
Estimated Fair Value, Asset (Liability)	$ (7,541,000)	(9,783,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 18, 2018 Tranche 1
Derivative [Line Items]
Notional amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.885%
Estimated Fair Value, Asset (Liability)	$ (7,703,000)	(10,407,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 18, 2018 Tranche 2
Derivative [Line Items]
Notional amount	$ 100,000,000	100,000,000
Fixed Interest Rate	2.867%
Estimated Fair Value, Asset (Liability)	$ (7,592,000)	(10,431,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 15, 2020 Tranche 1
Derivative [Line Items]
Notional amount	$ 575,000,000	575,000,000
Fixed Interest Rate	1.415%
Estimated Fair Value, Asset (Liability)	$ 3,931,000	(1,907,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 15, 2020 Tranche 2
Derivative [Line Items]
Notional amount	$ 125,000,000	125,000,000
Fixed Interest Rate	1.404%
Estimated Fair Value, Asset (Liability)	$ 987,000	$ (348,000)

DERIVATIVE INSTRUMENTS - Narrat

DERIVATIVE INSTRUMENTS - Narrative (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2021USD ($)	Jun. 30, 2021CHF (SFr)	Jun. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 21, 2020USD ($)	Dec. 21, 2020CHF (SFr)	Oct. 02, 2017USD ($)	Oct. 02, 2017CHF (SFr)
Derivative [Line Items]
Gain expected to be reclassified to earnings in the next twelve months	$ 4,500,000		$ 4,500,000
Designated as Hedging Instrument
Derivative [Line Items]
Total derivatives designated as hedges — Assets	24,579,000		24,579,000			$ 12,920,000
Gain (loss) recorded in AOCL, change in fair value	(25,894,000)	$ (14,853,000)	62,391,000		$ (41,695,000)
Foreign Exchange Forward | Not Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount						$ 9,700,000
Loss on foreign currency derivatives			300,000
Total derivatives designated as hedges — Assets	300,000		300,000
Cross-currency swap
Derivative [Line Items]
Current notional amount	7,300,000		7,300,000				$ 471,600,000	SFr 420,100,000
Intercompany loan quarterly payments | SFr				SFr 5,800,000
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	(12,900,000)	30,000,000	(3,400,000)		(5,100,000)
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) reclassified into other income	1,700,000	2,200,000	3,400,000		4,400,000
Gain (loss) recorded, net investment hedge, change in fair value	100,000	(2,500,000)	13,700,000		16,400,000
Cross-currency swap | Codman | Cash Flow Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value	(11,000,000)	29,200,000	(2,300,000)		3,600,000
Gain (loss) reclassified into other income	1,300,000	$ 1,500,000	2,500,000		$ 3,000,000
Gain expected to be reclassified to earnings in the next twelve months	$ 7,000,000		$ 7,000,000
Cross-currency swap | Short | Codman
Derivative [Line Items]
Current notional amount									$ 300,000,000
Cross-currency swap | Long | Codman
Derivative [Line Items]
Current notional amount | SFr										SFr 291,200,000

DERIVATIVE INSTRUMENTS - Sche_2

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details)	Jun. 30, 2021USD ($)	Jun. 30, 2021CHF (SFr)	Dec. 31, 2020USD ($)	Dec. 31, 2020CHF (SFr)	Dec. 21, 2020USD ($)	Dec. 21, 2020CHF (SFr)	Oct. 02, 2017USD ($)	Oct. 02, 2017CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount	$ 7,300,000				$ 471,600,000	SFr 420,100,000
Codman | Cross-currency swap | Long
Derivative [Line Items]
Aggregate Notional Amount | SFr								SFr 291,200,000
Codman | Cross-currency swap | Short
Derivative [Line Items]
Aggregate Notional Amount							$ 300,000,000
Cash Flow Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Fair Value Asset (Liability)	(62,736,000)		$ (93,769,000)
Cash Flow Hedges | Designated as Hedging Instrument | Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 10,124,000
Cash Flow Hedges | Designated as Hedging Instrument | Cross Currency Interest Rate Swap Three | Long
Derivative [Line Items]
Fixed Rate	3.00%	3.00%
Aggregate Notional Amount | SFr		SFr 408,637,000		SFr 420,137,000
Cash Flow Hedges | Designated as Hedging Instrument | Cross Currency Interest Rate Swap Three | Short
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 458,730,000		471,640,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (2,228,000)		(4,335,000)
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One | Long
Derivative [Line Items]
Fixed Rate	1.85%	1.85%
Aggregate Notional Amount | SFr		SFr 48,533,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One | Short
Derivative [Line Items]
Fixed Rate	4.46%	4.46%
Aggregate Notional Amount	$ 50,000,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ (4,641,000)		(11,262,000)
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two | Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount | SFr		SFr 145,598,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two | Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount	$ 150,000,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)			(7,843,000)
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,255,000		$ (23,441,000)

DERIVATIVE INSTRUMENTS - Sche_3

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) € in Thousands, SFr in Thousands	Jun. 30, 2021USD ($)	Jun. 30, 2021CHF (SFr)	Jun. 30, 2021EUR (€)	Dec. 31, 2020USD ($)	Dec. 21, 2020USD ($)	Dec. 21, 2020CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount	$ 7,300,000				$ 471,600,000	SFr 420,100
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (864,000)			$ (1,884,000)
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One | Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount | €			€ 44,859
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One | Short
Derivative [Line Items]
Fixed Rate	3.01%	3.01%	3.01%
Aggregate Notional Amount	$ 52,000,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 901,000			(450,000)
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Two | Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount | €			€ 51,760
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Two | Short
Derivative [Line Items]
Fixed Rate	2.57%	2.57%	2.57%
Aggregate Notional Amount	$ 60,000,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 849,000			92,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Three | Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount | €			€ 38,820
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Three | Short
Derivative [Line Items]
Fixed Rate	2.19%	2.19%	2.19%
Aggregate Notional Amount	$ 45,000,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ 3,292,000			(3,794,000)
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Four | Long
Derivative [Line Items]
Fixed Rate	0.00%	0.00%	0.00%
Aggregate Notional Amount | SFr		SFr 222,300
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Four | Short
Derivative [Line Items]
Fixed Rate	1.10%	1.10%	1.10%
Aggregate Notional Amount	$ 250,000,000
Designated as Hedging Instrument | Net Investment Hedges | Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	$ 4,178,000			$ (6,036,000)

DERIVATIVE INSTRUMENTS - Fair V

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) SFr in Millions	Jun. 30, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 21, 2020USD ($)	Dec. 21, 2020CHF (SFr)
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 24,579,000	$ 12,920,000
Total derivatives designated as hedges — Liabilities	79,882,000	136,165,000
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,800,000,000	1,900,000,000
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	4,918,000	0
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument | Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	21,003,000	22,033,000
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	46,651,000	71,736,000
Cross-currency swap
Derivatives, Fair Value [Line Items]
Current notional amount	7,300,000		$ 471,600,000	SFr 420.1
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	9,206,000	7,623,000
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	4,605,000	0
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	2,228,000	4,335,000
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	8,328,000	26,728,000
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Prepaid expenses and other current assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	5,345,000	5,297,000
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	505,000	0
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Accrued expenses and other current liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	864,000	1,884,000
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 808,000	$ 9,449,000

DERIVATIVE INSTRUMENTS - Effect

DERIVATIVE INSTRUMENTS - Effect of Derivative Instruments Designated Cash Flow Hedges on Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,529,331	$ 1,341,803	$ 1,514,867	$ 1,416,736
Balance, End of Period	1,574,981	1,349,096	1,574,981	1,349,096
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(43,627)	(104,588)	(74,059)	(76,401)
Balance, End of Period	(49,963)	(103,124)	(49,963)	(103,124)
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL	(25,894)	(14,853)	62,391	(41,695)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(15,721)	(3,334)	24,435	(2,375)
Designated as Hedging Instrument | Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(59,004)	(62,541)	(107,133)	(34,740)
Balance, End of Period	(69,177)	(74,060)	(69,177)	(74,060)
Designated as Hedging Instrument | Interest rate swap | Cash Flow Hedges | Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(53,546)	(95,753)	(93,769)	(45,146)
Amount of Gain (Loss) Recognized in AOCL	(15,013)	(9,988)	19,505	(61,637)
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(5,823)	(3,614)	(11,528)	(4,656)
Balance, End of Period	(62,736)	(102,127)	(62,736)	(102,127)
Designated as Hedging Instrument | Cross-currency swap | Cash Flow Hedges | Other income (expense),net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(5,029)	6,266	(1,073)	177
Amount of Gain (Loss) Recognized in AOCL	(10,969)	(2,322)	29,225	3,585
Amount of Gain (Loss) Reclassified from AOCL into Earnings	(11,635)	(1,899)	32,515	(2,081)
Balance, End of Period	(4,363)	5,843	(4,363)	5,843
Designated as Hedging Instrument | Cross-currency swap | Net Investment Hedges | Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period	(429)	26,946	(12,291)	10,229
Amount of Gain (Loss) Recognized in AOCL	88	(2,543)	13,661	16,357
Amount of Gain (Loss) Reclassified from AOCL into Earnings	1,737	2,179	3,448	4,362
Balance, End of Period	$ (2,078)	$ 22,224	$ (2,078)	$ 22,224

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grants in period, net of forfeitures (in shares) | shares	149,558
Options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 22.59
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs | $	$ 4.6
Weighted-average period for cost recognition	3 years
Stock Options | Directors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	1 year
Stock Options | Employees
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	8 years
Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	3 years
Total unrecognized compensation costs | $	$ 32.9
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares) | shares	242,464
Other than options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 68.21
Performance Stock and Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Requisite service periods of awards	3 years
Performance Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards granted during the period (in shares) | shares	176,147
Other than options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 68.10
Minimum | Stock Options | Directors and Certain Executive Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	6 years
Maximum | Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options exercisable, vesting period	4 years
Maximum | Stock Options | Directors and Certain Executive Officers
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period	10 years

RETIREMENT PLANS - Narrative (D

RETIREMENT PLANS - Narrative (Details) - USD ($) $ in Millions	1 Months Ended	3 Months Ended		6 Months Ended
	May 31, 2019	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Retirement Benefits [Abstract]
Net periodic benefit costs		$ 0.6	$ 1	$ 1.2	$ 1.9
Service cost component		0.8	$ 0.9	1.7	$ 1.9
Estimated fair value of plan assets		33.8		33.8		$ 37.8
Defer payment and taxation, base salary, percentage (up to)	75.00%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)	100.00%
Deferred compensation plan, fair value of assets		$ 3.2		$ 3.2		$ 2

LEASES AND RELATED PARTY LEAS_3

LEASES AND RELATED PARTY LEASES - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)renewal_option	Jun. 30, 2020USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) | renewal_option	1
Operating lease expense	$ 10.6	$ 9.7
Affiliated Entity
Operating Leased Assets [Line Items]
Operating lease expense	$ 0.1	$ 0.1
Percent of manufacturing facility owned by corporation whose shareholders are trusts whose beneficiaries include family members of company's former director	50.00%
Annual rate of lease agreement	$ 0.3
Affiliated Entity | Five Year Option Lease From November 1, 2029 Through October 31, 2034
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2029 through October 31, 2034
Affiliated Entity | Five Year Option Lease From November 1, 2034 Through October 31, 2039
Operating Leased Assets [Line Items]
Option to extend lease, years	5 years
Period for extended lease	November 1, 2034 through October 31, 2039

LEASES AND RELATED PARTY LEAS_4

LEASES AND RELATED PARTY LEASES - Supplemental Balance Sheet Information (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Lessee, Lease, Description [Line Items]
ROU assets	$ 89,174	$ 83,635
Current lease liabilities	13,987	12,818
Non-current lease liabilities	95,196	88,118
Total lease liabilities	109,183	$ 100,936
Leased facilities
Lessee, Lease, Description [Line Items]
Total lease liabilities	$ 109,183
Weighted average remaining lease term (in years)	11 years 3 months 18 days	11 years 7 months 6 days
Weighted average discount rate	5.00%	4.60%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 3 months 18 days	2 years 3 months 18 days
Weighted average discount rate	2.70%	2.30%

LEASES AND RELATED PARTY LEAS_5

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 7,019	$ 6,728
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 10,528	$ 6,007

LEASES AND RELATED PARTY LEAS_6

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Dec. 31, 2020
Operating Leased Assets [Line Items]
2021	$ 8,121
2022	17,129
2023	14,241
2024	11,757
2025	11,131
2026	9,849
Thereafter	73,724
Total minimum lease payments	145,952
Less: Imputed interest	36,769
Total lease liabilities	109,183	$ 100,936
Less: Current lease liabilities	13,987	12,818
Long-term lease liabilities	95,196	$ 88,118
Related Parties
Operating Leased Assets [Line Items]
2021	148
2022	296
2023	296
2024	296
2025	296
2026	296
Thereafter	837
Total minimum lease payments	2,465
Third Parties
Operating Leased Assets [Line Items]
2021	7,973
2022	16,833
2023	13,945
2024	11,461
2025	10,835
2026	9,553
Thereafter	72,887
Total minimum lease payments	$ 143,487

TREASURY STOCK - Narrative (Det

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, shares in Millions	Jun. 30, 2021	Dec. 31, 2020	Feb. 05, 2020	Jun. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020	Dec. 07, 2020
Equity, Class of Treasury Stock [Line Items]
Treasury stock (in shares)	4.9	4.9					4.9		4.9
Treasury stock	$ 234,500,000	$ 235,100,000					$ 234,500,000		$ 235,100,000
Treasury stock, average cost per share (in dollars per share)	$ 47.86	$ 47.86
Stock repurchase program, authorized amount (up to)										$ 225,000,000
Remaining amount under share repurchase	$ 225,000,000						225,000,000
Stock repurchased during period (in shares)			1.3	0.6					2.1
Net proceeds from offering of convertible senior notes							$ 0	$ 575,000,000
Accelerated share repurchase program, payment			$ 92,400,000
Accelerated share repurchases, remaining share repurchases expected to be completed, value			$ 100,000,000
Accelerated shares repurchased, amount					$ 0	$ 92,368,000
Accelerated share repurchases, percentage of expected total repurchased			80.00%
Convertible Debt
Equity, Class of Treasury Stock [Line Items]
Net proceeds from offering of convertible senior notes									$ 100,000,000
Convertible Debt | Certain Purchasers
Equity, Class of Treasury Stock [Line Items]
Net proceeds from offering of convertible senior notes									$ 7,600,000

INCOME TAXES - Summary of Effec

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Tax Disclosure [Abstract]
Reported tax rate	21.80%	122.40%	28.20%	32.70%

INCOME TAXES - Narrative (Detai

INCOME TAXES - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Tax Disclosure [Abstract]
Effective income tax rate	21.80%	122.40%	28.20%	32.70%
Deferred tax assets, valuation allowance	$ 3.4	$ 3.4	$ 3.4	$ 3.4

NET INCOME PER SHARE - Basic an

NET INCOME PER SHARE - Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020
Basic net income per share:
Net income (loss)	$ 35,068	$ 45,394	$ (369)	$ 9,180	$ 80,462	$ 8,811
Weighted average common shares outstanding - Basic (in shares)	84,687		84,706		84,593	84,955
Basic net income (loss) per common share (in dollars per share)	$ 0.41		$ 0		$ 0.95	$ 0.10
Diluted net income per share:
Net income (loss)	$ 35,068	$ 45,394	$ (369)	$ 9,180	$ 80,462	$ 8,811
Weighted average common shares outstanding - Basic (in shares)	84,687		84,706		84,593	84,955
Effect of dilutive securities:
Stock options and restricted stock (in shares)	653		0		731	593
Weighted average common shares for diluted earnings per share (in shares)	85,340		84,706		85,324	85,548
Diluted net income (loss) per common share (in dollars per share)	$ 0.41		$ 0		$ 0.94	$ 0.10

NET INCOME PER SHARE - Narrativ

NET INCOME PER SHARE - Narrative (Details) - shares shares in Millions	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.1	0.5
Performance Shares and Restricted Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Shares included in computation (in shares)	0.5

ACCUMULATED OTHER COMPREHENSI_3

ACCUMULATED OTHER COMPREHENSIVE LOSS - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020
Equity [Abstract]
Net income (loss)	$ 35,068	$ 45,394	$ (369)	$ 9,180	$ 80,462	$ 8,811
Foreign currency translation adjustment	1,558		10,433		(5,243)	3,620
Change in unrealized loss on derivatives, net of tax	(7,804)		(8,830)		29,111	(30,136)
Pension liability adjustment, net of tax	(91)		(139)		228	(207)
Comprehensive income (loss), net	$ 28,731		$ 1,095		$ 104,558	$ (17,912)

ACCUMULATED OTHER COMPREHENSI_4

ACCUMULATED OTHER COMPREHENSIVE LOSS - Schedule of Changes in Accumulated Other Comprehensive Income by Component (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,529,331	$ 1,514,867	$ 1,341,803	$ 1,416,736	$ 1,514,867
Other comprehensive income (loss)					42,870
Less: Amounts reclassified from accumulated other comprehensive loss					18,774
Net current-period other comprehensive income (loss)	(6,336)	30,432	1,464	(28,187)	24,096
Balance, End of Period	1,574,981	1,529,331	1,349,096	1,341,803	1,574,981
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(43,627)	(74,059)	(104,588)	(76,401)	(74,059)
Net current-period other comprehensive income (loss)	(6,336)	30,432	1,464	(28,187)
Balance, End of Period	(49,963)	(43,627)	$ (103,124)	$ (104,588)	(49,963)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		(82,249)			(82,249)
Other comprehensive income (loss)					47,885
Less: Amounts reclassified from accumulated other comprehensive loss					18,774
Net current-period other comprehensive income (loss)					29,111
Balance, End of Period	(53,138)				(53,138)
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		(5,105)			(5,105)
Other comprehensive income (loss)					228
Less: Amounts reclassified from accumulated other comprehensive loss					0
Net current-period other comprehensive income (loss)					228
Balance, End of Period	(4,877)				(4,877)
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		$ 13,295			13,295
Other comprehensive income (loss)					(5,243)
Less: Amounts reclassified from accumulated other comprehensive loss					0
Net current-period other comprehensive income (loss)					(5,243)
Balance, End of Period	$ 8,052				$ 8,052

ACCUMULATED OTHER COMPREHENSI_5

ACCUMULATED OTHER COMPREHENSIVE LOSS - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2021USD ($)
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ 18,774
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	18,774
Other income (expense) | Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	25,000
Interest income | Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Line Items]
Gain (loss) reclassified from AOCI	$ (6,200)

SEGMENT AND GEOGRAPHIC INFORM_3

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details) product in Thousands	6 Months Ended
	Jun. 30, 2021Segmentproduct
Segment Reporting Information [Line Items]
Number of reportable segments | Segment	2
Codman Specialty Surgical
Segment Reporting Information [Line Items]
Number of products offered (more than) | product	40

SEGMENT AND GEOGRAPHIC INFORM_4

SEGMENT AND GEOGRAPHIC INFORMATION - Net Sales and Profit by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Segment Net Sales
Total Revenues	$ 389,992	$ 258,665	$ 750,063	$ 612,989
Segment Profit
Operating income	51,854	14,080	82,568	41,183
Amortization	(4,198)	(8,073)	(8,725)	(15,050)
Operating Segments
Segment Profit
Operating income	178,409	93,944	335,198	212,449
Corporate and other
Segment Profit
Operating income	(122,357)	(71,791)	(243,905)	(156,216)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	256,837	169,778	498,078	401,218
Codman Specialty Surgical | Operating Segments
Segment Profit
Operating income	113,996	65,256	220,774	152,491
Tissue Technologies
Segment Net Sales
Total Revenues	133,155	88,887	251,985	211,771
Tissue Technologies | Operating Segments
Segment Profit
Operating income	$ 64,413	$ 28,688	$ 114,424	$ 59,958

SEGMENT AND GEOGRAPHIC INFORM_5

SEGMENT AND GEOGRAPHIC INFORMATION - Total Revenue by Major Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Segment Reporting Information [Line Items]
Total Revenues	$ 389,992	$ 258,665	$ 750,063	$ 612,989
United States
Segment Reporting Information [Line Items]
Total Revenues	278,186	181,850	525,979	428,702
Europe
Segment Reporting Information [Line Items]
Total Revenues	48,437	32,026	94,256	77,922
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	44,306	33,501	91,601	73,461
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 19,063	$ 11,288	$ 38,227	$ 32,904

COMMITMENTS AND CONTINGENCIES -

COMMITMENTS AND CONTINGENCIES - Fair Value Contingent Consideration, Balance Information (Details) - Contingent Consideration Liability - Fair Value, Inputs, Level 3 - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Arkis | Other Current Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	$ 3,415
Transfers	(3,432)
Gain (loss) from change in fair value of contingent consideration liabilities	17
Balance, End of Period	0
Arkis | Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	11,746	$ 14,210
Transfers	3,432
Gain (loss) from change in fair value of contingent consideration liabilities	(402)	(708)
Balance, End of Period	14,776	13,502
Derma Sciences | Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	230
Gain (loss) from change in fair value of contingent consideration liabilities		0
Balance, End of Period	230	$ 230
ACell | Other Long-term Liabilities
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Additions from acquisition of ACell	23,900
Gain (loss) from change in fair value of contingent consideration liabilities	(400)
Balance, End of Period	$ 23,500

COMMITMENTS AND CONTINGENCIES_2

COMMITMENTS AND CONTINGENCIES - Narrative (Details)	Jul. 29, 2019USD ($)	Jun. 30, 2021USD ($)liability	Jun. 30, 2020USD ($)
Arkis
Loss Contingencies [Line Items]
Purchase price of business combination	$ 30,600,000
Contingent consideration, estimated fair value	25,500,000
Contingent consideration	13,100,000	$ 14,800,000	$ 13,500,000
Arkis | Development Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	10,000,000
Arkis | Commercial Sales Milestones
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value	$ 15,500,000
Derma Sciences
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value		$ 200,000	$ 200,000
Number of contingent liabilities remaining | liability		1
Contingent consideration, maximum undiscounted payment amount		$ 3,000,000
Derma Sciences | BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 33,300,000

Uncategorized Items - iart-2021

Label	Element	Value
Accounting Standards Update [Extensible Enumeration]	us-gaap_AccountingStandardsUpdateExtensibleList	Accounting Standards Update 2016-13 [Member]