Integra LifeSciences (IART) 10-Q 27 Jul 22 2022 Q2 Quarterly report Financial data

DOCUMENT AND ENTITY INFORMATION

DOCUMENT AND ENTITY INFORMATION - shares	6 Months Ended
	Jun. 30, 2022	Jul. 25, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2022
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 Common Stock, Shares Outstanding (in shares)		83,504,470
Amendment Flag	false
Document Fiscal Year Focus	2022
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 (UNAUDITED) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Income Statement [Abstract]
Total revenue, net	$ 397,815	$ 389,992	$ 774,453	$ 750,063
Costs and expenses:
Cost of goods sold	148,404	151,267	290,973	297,090
Research and development	25,589	20,121	49,674	42,495
Selling, general and administrative	160,651	162,552	320,577	319,185
Intangible asset amortization	3,304	4,198	7,198	8,725
Total costs and expenses	337,948	338,138	668,422	667,495
Operating income	59,867	51,854	106,031	82,568
Interest income	1,965	1,764	3,342	3,512
Interest expense	(12,236)	(13,149)	(23,891)	(26,078)
Gain (loss) from the sale of business	0	(679)	0	42,197
Other income, net	1,979	5,034	5,408	9,903
Income before income taxes	51,575	44,824	90,890	112,102
Provision for income taxes	6,787	9,756	13,201	31,640
Net income	$ 44,788	$ 35,068	$ 77,689	$ 80,462
Net income per share
Basic (in dollars per share)	$ 0.54	$ 0.41	$ 0.93	$ 0.95
Diluted (in dollars per share)	$ 0.54	$ 0.41	$ 0.93	$ 0.94
Weighted average common shares outstanding (See Note 14):
Basic (in shares)	83,168	84,687	83,400	84,593
Diluted (in shares)	83,622	85,340	83,979	85,324
Comprehensive income (See Note 15)	$ 52,598	$ 28,731	$ 109,630	$ 104,558

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 447,152	$ 513,448
Trade accounts receivable, net of allowances of $3,995 and $4,735	237,361	231,831
Inventories, net	320,208	317,386
Prepaid expenses and other current assets	102,168	91,051
Assets held for sale	30,525	0
Total current assets	1,137,414	1,153,716
Property, plant and equipment, net	302,423	311,703
Right of use asset - operating leases	145,135	84,543
Intangible assets, net	1,082,275	1,145,573
Goodwill	990,406	1,013,458
Deferred tax assets, net	46,982	56,950
Other assets	48,227	16,440
Total assets	3,752,862	3,782,383
Current liabilities:
Current portion of borrowings under senior credit facility	50,625	45,000
Current portion of lease liability - operating leases	12,743	14,775
Accounts payable, trade	69,498	61,837
Contract liabilities	5,425	5,295
Accrued compensation	69,599	92,656
Accrued expenses and other current liabilities	85,403	120,458
Liabilities held for sale	2,303	0
Total current liabilities	295,596	340,021
Long-term borrowings under senior credit facility	819,654	824,257
Long-term borrowings under securitization facility	112,500	112,500
Long-term convertible securities	565,883	564,426
Lease liability - operating leases	154,029	90,329
Deferred tax liabilities	61,287	45,788
Other liabilities	82,996	120,258
Total liabilities	2,091,945	2,097,579
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; 90,334 and 89,600 issued at June 30, 2022 and December 31, 2021, respectively	903	896
Additional paid-in capital	1,259,852	1,264,943
Treasury stock, at cost; 6,823 shares and 4,899 shares at June 30, 2022 and December 31, 2021, respectively	(362,880)	(234,448)
Accumulated other comprehensive loss	(13,215)	(45,155)
Retained earnings	776,257	698,568
Total stockholders’ equity	1,660,917	1,684,804
Total liabilities and stockholders’ equity	$ 3,752,862	$ 3,782,383

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (UNAUDITED) (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance	$ 3,995	$ 4,735
Preferred stock, par value (in dollars per share)	$ 0	$ 0
Preferred stock, authorized shares (in shares)	15,000,000	15,000,000
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)	90,334,000	89,600,000
Treasury stock (in shares)	6,823,000	4,899,000

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, 2022	Mar. 31, 2022	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
OPERATING ACTIVITIES:
Net income	$ 44,788	$ 32,901	$ 35,068	$ 45,394	$ 77,689	$ 80,462
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization					59,336	58,968
Non-cash impairment charges					0	2,754
Deferred income tax provision (benefit)					7,542	(4,907)
Share-based compensation					13,027	22,033
Amortization of debt issuance costs and expenses associated with debt refinancing					3,392	3,569
Non-cash lease expense					1,393	2,528
Loss on disposal of property and equipment					732	86
Gain from the sale of business	0		679		0	(42,197)
Change in fair value of contingent consideration and others					(5,799)	(385)
Changes in assets and liabilities:
Accounts receivable					(9,632)	10,802
Inventories					(17,576)	2,893
Prepaid expenses and other current assets					(4,120)	(8,061)
Other non-current assets					6,738	4,067
Accounts payable, accrued expenses and other current liabilities					(14,556)	27,277
Contract liabilities					774	0
Other non-current liabilities					(8,118)	482
Net cash provided by operating activities					110,822	160,371
INVESTING ACTIVITIES:
Purchases of property and equipment					(18,732)	(13,309)
Proceeds from sale of Extremity Orthopedics business					0	191,736
Acquired in-process research and development milestone					(4,742)	0
Net proceeds from swaps designated as net investment hedges					4,909	0
Cash paid for business acquisitions, net of cash acquired					0	(303,910)
Net cash used in investing activities					(18,565)	(125,483)
FINANCING ACTIVITIES:
Proceeds from borrowings of long-term indebtedness					23,000	2,200
Payments on debt					(23,000)	(102,200)
Payment of debt issuance costs					0	(249)
Purchases of treasury stock					(125,000)	0
Proceeds from exercised stock options					1,592	3,603
Cash taxes paid in net equity settlement					(23,204)	(3,844)
Net cash used in financing activities					(146,612)	(100,490)
Effect of exchange rate changes on cash and cash equivalents					(11,941)	(7,150)
Net decrease in cash and cash equivalents					(66,296)	(72,752)
Cash and cash equivalents at beginning of period		$ 513,448		$ 470,166	513,448	470,166	$ 470,166
Cash and cash equivalents at end of period	$ 447,152		$ 397,414		$ 447,152	$ 397,414	$ 513,448

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDERS' EQUITY (UNAUDITED) - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Treasury Stock	Additional Paid-In Capital	Additional Paid-In Capital Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Loss	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment
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)
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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	80,462
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)
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		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)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2021			89,600,000
Balance, Beginning of Period at Dec. 31, 2021	$ 1,684,804		$ 896	$ (234,448)	1,264,943		(45,155)	698,568
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2021	(4,899,000)			(4,899,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 32,901							32,901
Other comprehensive income (loss), net of tax	24,130						24,130
Issuance of common stock through employee stock purchase plan (in shares)			17,000
Issuance of common stock through employee stock purchase plan	1,078				1,078
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			339,000	14,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(9,040)		$ 4	$ 714	(9,758)
Share-based compensation	6,324				6,324
Accelerated shares repurchased (shares)				(1,938,000)
Accelerated shares repurchased	(125,000)			$ (129,152)	4,152
Balance End of Period, Shares (in shares) at Mar. 31, 2022			89,956,000
Balance, End of Period at Mar. 31, 2022	1,615,197		$ 900	$ (362,886)	1,266,739		(21,025)	731,469
Balance, End of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2022				(6,823,000)
Balance Beginning of Period, Shares (in shares) at Dec. 31, 2021			89,600,000
Balance, Beginning of Period at Dec. 31, 2021	$ 1,684,804		$ 896	$ (234,448)	1,264,943		(45,155)	698,568
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Dec. 31, 2021	(4,899,000)			(4,899,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	$ 77,689
Other comprehensive income (loss), net of tax	31,940
Balance End of Period, Shares (in shares) at Jun. 30, 2022			90,334,000
Balance, End of Period at Jun. 30, 2022	$ 1,660,917		$ 903	$ (362,880)	1,259,852		(13,215)	776,257
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2022	(6,823,000)			(6,823,000)
Balance Beginning of Period, Shares (in shares) at Mar. 31, 2022			89,956,000
Balance, Beginning of Period at Mar. 31, 2022	$ 1,615,197		$ 900	$ (362,886)	1,266,739		(21,025)	731,469
Balance, Beginning of Period, Treasury Stock, Shares (in shares) at Mar. 31, 2022				(6,823,000)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income	44,788							44,788
Other comprehensive income (loss), net of tax	7,810						7,810
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes (in shares)			378,000
Issuance of common stock for vesting of share based awards, net of shares withheld for taxes	(13,646)		$ 3	$ 6	(13,655)
Share-based compensation	6,768				6,768
Balance End of Period, Shares (in shares) at Jun. 30, 2022			90,334,000
Balance, End of Period at Jun. 30, 2022	$ 1,660,917		$ 903	$ (362,880)	$ 1,259,852		$ (13,215)	$ 776,257
Balance, End of Period, Treasury Stock, Shares (in shares) at Jun. 30, 2022	(6,823,000)			(6,823,000)

BASIS OF PRESENTATION

BASIS OF PRESENTATION	6 Months Ended
	Jun. 30, 2022
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, 2022 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 shareholders' 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, 2021 included in the Company’s Annual Report on Form 10-K. The December 31, 2021 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, 2022 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, including reductions in capital and overall spending by our customers, increased freight costs, decreased availability of certain raw materials used in certain of our products and labor constraints. The COVID-19 pandemic has had, and may continue to have, an adverse effect on the Company’s business, results of operations, financial condition, and cash flows, and its future impacts remain highly uncertain and unpredictable. Although there was not a material impact to the Company’s consolidated financial statements as of and for the six months ended June 30, 2022, changes in the Company’s assessment about the length and severity of the pandemic, as well as other factors, could result in actual results differing from estimates. 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 duration of direct and indirect economic effects of the pandemic, containment measures and other macroeconomic factors which could cause a local/or global economic recession. 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. Employee Termination Benefits The Company incurred restructuring costs related to employee terminations associated with a plant closure and future outsourcing plans for select transactional back office activities in the consolidated statement of operations for the six months ended June 30, 2022. The following table summarizes our restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the six months ended June 30, 2022. All balances are expected to be paid within the current fiscal year. (Dollars in thousands) Amount Balance at December 31,2021 $ 10,226 Charges: Cost of Goods Sold $ 1,417 Research and development 133 Selling, general and administrative 1,807 Payments and other adjustments $ (6,885) Balance at June 30,2022 $ 6,698 Recent Accounting Pronouncements 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 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 significant impact on the Company's consolidated financial statements and related disclosures. 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 currently has contracts that are indexed to LIBOR and are continuing to evaluate the scope of impacted contracts and potential risk. The Company is also monitoring the developments regarding alternative rates and may amend certain contracts to accommodate those rates if the contract does not already specify a replacement rate. While the notional value of agreements potentially indexed to LIBOR is material, the Company does not expect a material impact to the consolidated financial statements and related disclosures associated with this transition. 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 was effective for annual and interim periods beginning after December 15, 2021, and early adoption was 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 7, 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) On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its 2025 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. Upon adoption of ASU 2020-06, the Company’s 2025 Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount. 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 regulations of the U.S. Securities and Exchange Commission (the "SEC"). The ASU has been 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 significant impact on the Company's consolidated financial statements and related disclosures. In May 2021, the FASB issued ASU 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 had 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.

ASSETS AND LIABILITIES HELD FOR

ASSETS AND LIABILITIES HELD FOR SALE	6 Months Ended
	Jun. 30, 2022
Discontinued Operations and Disposal Groups [Abstract]
ASSETS AND LIABILITIES HELD FOR SALE	ASSETS AND LIABILITIES HELD FOR SALE On May 20 2022, the Company and certain of its subsidiaries, entered into an agreement to sell its non-core traditional wound care ("TWC") business to Gentell, LLC for $28.8 million, which consists of $27.8 million in cash plus $1.0 million in contingent consideration which may be received upon achieving certain revenue-based performance milestones. The transaction includes the sale of the Company's TWC products, such as sponges, gauze and conforming bandages, and certain advanced wound care dressings, such as supportive, calcium alginate, hydrogel, and foam dressings. This transaction is expected to close during the third quarter of 2022, subject to the satisfaction of customary conditions. The Company considered the assets and liabilities associated with the TWC business to be accounted as held-for-sale as the six criteria under ASC 260 were met during the second quarter of 2022. Upon designation of the assets and liabilities as held for sale, the Company recorded the assets at the lower of their carrying value or their estimated fair value, less estimated costs to sell. Goodwill was allocated to the assets and liabilities held for sale using the relative fair value method of the TWC business to the Company's Tissue Technologies reporting unit. The fair value of the business less costs to sell exceeded the related carrying value. The TWC business was treated as a single disposal group and presented separately in the condensed consolidated balance sheet as assets and liabilities held for sale as of June 30, 2022. These balances are presented as current assets and liabilities as they are expected to be sold within twelve months. The sale of the TWC business does not represent a strategic shift that will have a major effect on the Company's operations and financial statements. The major classes of assets and liabilities classified as a held for sale consisted of the following as of June 30, 2022 (dollar amounts in thousands): Other assets $ 53 Deferred tax assets 178 Prepaid expenses and other current assets 338 Right of use asset - operating leases 1,316 Property, plant, and equipment, net 3,752 Goodwill 5,083 Inventories, net 9,275 Intangible assets, net 10,530 Total assets held for sale $ 30,525 Accrued expenses and other current liabilities $ 102 Current portion of lease liability - operating leases 584 Lease liability - operating leases 742 Deferred tax liabilities 875 Total liabilities held for sale $ 2,303

ACQUISITIONS AND DIVESTITURES

ACQUISITIONS AND DIVESTITURES	6 Months Ended
	Jun. 30, 2022
Mergers, Acquisitions and Dispositions [Abstract]
ACQUISITIONS AND DIVESTITURES	ACQUISITIONS AND DIVESTITURES Sale of Extremity Orthopedics Business On January 4, 2021, the Company completed the 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 & Nephew and concurrently paid $41.5 million to the Consortium of Focused Orthopedists, LLC ("CFO") effectively terminating the licensing agreement between Integra and the CFO relating to the development of shoulder arthroplasty products. The divestiture did not represent a strategic shift that had 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 reportable business segment. In connection with the sale, the Company recognized a $41.8 million as Gain from the sale of business in the consolidated statement of operations for the year ended December 31, 2021. The Company finalized the net working capital and paid an additional $1.3 million to Smith & Nephew as of December 31, 2021. The Company also entered into a transition services agreement ("TSA") with Smit h & 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 TSA. The Company recognized a payable due to Smith & Nephew of $6.5 million as of June 30, 2022, which is included in the consolidated balance sheets within accrued expenses and other current liabilities. The TSA includes services such as invoicing and cash collections from customers on behalf of Smith & Nephew. As of June 30, 2022, the Company has concluded the majority of the transition services agreement, pending final payment. ACell, Inc. Acquisition On January 20, 2021, the Company acquired ACell, Inc. (the "ACell Acquisition") for a total purchase price of $306.9 million plus contingent consideration of up to $100 million, which may be payable upon the Company 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. Prior to the acquisition, 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, 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 final fair values of the assets acquired and liabilities assumed at the acquisition date: Dollars in thousands Final Valuation Weighted Average Life Current assets: Cash $ 2,726 Trade accounts receivable, net 16,469 Inventories, net 18,299 Prepaid 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 94,147 Right of use asset - operating leases 9,259 Deferred tax assets 7,465 Other assets 148 Total assets acquired $ 408,780 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 61,724 Contingent consideration 23,900 Total liabilities assumed $ 101,842 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 reportable business 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 ACell Acquisition, the Company is required to make payments to the former shareholders of ACell up to $100 million based on the achievement by the Company of certain revenue-based performance milestones in 2022, 2023, and 2025. The 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, 2022 was $18.1 million. The Company recorded $18.1 million and $23.5 million in other liabilities at June 30, 2022 and June 30, 2021, respectively, in the consolidated balance sheets of the Company. The change in the fair value of the contingent obligation was primarily as a result of changes in estimates related to the timing of achieving these revenue-based performance milestones for each given year. The Company determined 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 obligations are 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.

REVENUES FROM CONTRACTS WITH CU

REVENUES FROM CONTRACTS WITH CUSTOMERS	6 Months Ended
	Jun. 30, 2022
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'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 summarized the changes in the contract asset and liability balances for the six months ended June 30, 2022: Dollars in thousands Total Contract Asset Contract asset, January 1, 2022 $ 11,412 Transferred to trade receivable of contract asset included in beginning of the year contract asset (11,412) Contract asset, net of transferred to trade receivables on contracts during the period 10,568 Contract asset, June 30, 2022 $ 10,568 Contract Liability Contract liability, January 1, 2022 $ 11,946 Recognition of revenue included in beginning of year contract liability $ (3,591) Contract liability, net of revenue recognized on contracts during the period 4,347 Foreign currency translation (60) Contract liability, June 30, 2022 $ 12,642 At June 30, 2022, the short-term portion of the contract liability of $5.4 million and the long-term portion of $7.2 million is included in current liabilities and other liabilities, respectively, in the consolidated balance sheets. As of June 30, 2022, the Company is expected to recognize revenue of approximately 43% 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, 2022 and 2021 (dollar amounts in thousands): Three Months Ended June 30, 2022 Three Months Ended June 30, 2021 Six Months Ended June 30, 2022 Six Months Ended June 30, 2021 Neurosurgery $ 200,295 $ 202,600 $ 394,970 $ 391,854 Instruments 57,568 54,237 110,201 106,224 Total Codman Specialty Surgical 257,863 256,837 505,171 498,078 Wound Reconstruction and Care 104,894 102,616 199,524 191,314 Private Label 35,058 30,539 69,758 60,671 Total Tissue Technologies 139,952 133,155 269,282 251,985 Total revenue $ 397,815 $ 389,992 $ 774,453 $ 750,063 On May 20 2022, the Company and certain of its subsidiaries, entered into an agreement to sell its non-core traditional wound care ("TWC") business. See Note 2. Assets and Liabilities Held for Sale. See Note 16, Segment and Geographical Information , for details of revenues based on the location of the customer.

INVENTORIES

INVENTORIES	6 Months Ended
	Jun. 30, 2022
Inventory Disclosure [Abstract]
INVENTORIES	INVENTORIES Inventories, net consisted of the following: Dollars in thousands June 30, 2022 December 31, 2021 Finished goods $ 164,277 $ 162,528 Work in process 72,779 65,323 Raw materials 83,152 89,535 Total inventories, net $ 320,208 $ 317,386 At June 30, 2022, $9.3 million of inventories, net were presented separately as "assets held for sale" in conjunction with the sale of the TWC business. See Note 2. Assets and Liabilities Held for Sale.

GOODWILL AND OTHER INTANGIBLE A

GOODWILL AND OTHER INTANGIBLE ASSETS	6 Months Ended
	Jun. 30, 2022
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, 2022 were as follows: Dollars in thousands Codman Specialty Tissue Technologies Total Goodwill at December 31, 2021 $ 663,428 $ 350,030 $ 1,013,458 Transfer to assets held for sale (1) — (5,083) (5,083) Foreign currency translation (11,822) (6,147) (17,969) Goodwill at June 30, 2022 $ 651,606 $ 338,800 $ 990,406 (1) See Note 2. Assets and Liabilities Held for Sale Other Intangible Assets The components of the Company’s identifiable intangible assets were as follows: June 30, 2022 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,122,233 $ (336,288) $ 785,945 Customer relationships 12 years $ 192,929 $ (140,184) $ 52,745 Trademarks/brand names 28 years $ 96,745 $ (32,847) $ 63,898 Codman tradename Indefinite $ 164,150 $ — $ 164,150 Supplier relationships 30 years $ 30,211 $ (16,681) $ 13,530 All other 11 years $ 5,859 $ (3,852) $ 2,007 $ 1,612,127 $ (529,852) $ 1,082,275 December 31, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,132,954 $ (307,013) $ 825,941 Customer relationships 12 years 211,344 (142,755) 68,589 Trademarks/brand names 28 years 98,367 (31,468) 66,899 Codman tradename Indefinite 167,758 — 167,758 Supplier relationships 30 years 30,211 (16,192) 14,019 All other 11 years 6,258 (3,891) 2,367 $ 1,646,892 $ (501,319) $ 1,145,573 At June 30, 2022, $10.5 million of customer relationships, net were presented separately as "assets held for sale" in conjunction with the sale of the TWC business. See Note 2. Assets and Liabilities Held for Sale. Based on quarter-end exchange rates, amortization expense (including amounts reported in cost of goods sold) is expected to be approximately $38.4 million for the remainder of 2022, $76.5 million in 2023, $75.8 million in 2024, $75.8 million in 2025, $75.7 million in 2026, $73.7 million in 2027 and $499.8 million thereafter.

DEBT

DEBT	6 Months Ended
	Jun. 30, 2022
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. The Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) is the following: Fiscal Quarter Maximum Consolidated Total Leverage Ratio 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, 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, 2022, the Company was in compliance with all such covenants. At June 30, 2022 and December 31, 2021, there wa s $53.8 million an d $31.3 million, respectively, ou tstanding under the revolving portion of the Senior Credit Facility at weighted average interest rates of 3.0% and 1.4%, respectively. At June 30, 2022 and December 31, 2021, there was $821.3 million and $843.8 million, respectively, outstanding under the Term Loan component of the Senior Credit Facility at a weighted average interest rate of 3.0% and 1.4%, respectively. At June 30, 2022 and December 31, 2021, there was $50.6 million and $45.0 million, respectively of the Term Loan component of the Senior Credit Facility classified as current on the consolidated balance sheets. The fair value of outstanding borrowings of the Senior Credit Facility's revolving credit and Term Loan components at June 30, 2022 wer e $52.5 million and $803.6 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, 2022 and December 31, 2021 to taled $1.6 million. There were no amounts drawn as of June 30, 2022. Contractual repayments of the Term Loan component of the Senior Credit Facility are due as follows: Quarter Ended June 30, 2022 Principal Repayment Dollars in thousands Remainder of 2022 $ 22,500 2023 $ 61,875 2024 $ 67,500 2025 $ 669,375 $ 821,250 Future interest payments on the term loan component of the Senior Credit Facility based on current interest rates are expected to approximate $12.2 million for remainder of 2022, $23.2 million in 2023, $21.1 million in 2024, and $1.9 million in 2025. Interest is calculated on the term loan portion of the Senior Credit Facility based on LIBOR plus the certain amounts set forth in the Sixth Amended and Restated Credit Agreement. As the revolving credit facility and Securitization Facility can be repaid at any time, no interest has been included in the calculation. 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 2025 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, 2022, 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, 2022 , the carrying amount of the liability w as $575.0 million. The fair value of the 2025 Notes at June 30, 2022 was $542.1 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. As a result of the adoption of ASU 2020-06, the Company recognized only cash interest related to the contractual interest coupon of $1.4 million on the 2025 Notes for both the six months ended June 30, 2022 and June 30, 2021. 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, 2022, 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, 2022 and December 31, 2021, the Company had $112.5 million of outstanding borrowings under its Securitization Facility at a weighted average interest rate of 2.1% and 1.1%, respectively. The fair value of the outstanding borrowing of the Securitization Facility at June 30, 2022 was $110.0 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, 2022
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, 2022 and December 31, 2021 (dollar amounts in thousands): June 30, 2022 December 31, 2021 June 30, 2022 December 31, 2021 Hedged Item Notional Amount Designation Date Effective Date Termination Date Fixed Interest Rate Estimated Fair Value Asset (Liability) 1-month USD LIBOR Loan 300,000 300,000 December 13, 2017 January 1, 2018 December 31, 2022 2.201 % 681 (5,268) 1-month USD LIBOR Loan 150,000 150,000 December 13, 2017 July 1, 2019 June 30, 2024 2.423 % 1,937 (5,520) 1-month USD LIBOR Loan 200,000 200,000 December 13, 2017 January 1, 2018 December 31, 2024 2.313 % 3,322 (7,421) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.220 % (660) (5,512) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.199 % (361) (5,464) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.209 % (485) (5,494) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.885 % 253 (6,886) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.867 % 19 (6,764) 1-month USD LIBOR Loan 575,000 575,000 December 15, 2020 July 31, 2025 December 31, 2027 1.415 % 17,938 3,552 1-month USD LIBOR Loan 125,000 125,000 December 15, 2020 July 1, 2025 December 31, 2027 1.404 % 4,295 821 $ 1,775,000 $ 1,775,000 $ 26,939 $ (43,957) 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 $4.2 million, to mitigate the foreign exchange risk related to certain intercompany loans denominated in Canadian Dollar ("CAD"). During the second quarter of 2022, the Company entered into foreign currency forward contract, with a notional amount of $4.2 million, to mitigate the foreign exchange risk related to certain intercompany receivables denominated in Japanese Yen ("JPY"). The contracts are n ot designated as hedging instruments. The Company recognized $0.1 million and $0.3 million losses from the change in fair value of such contracts, which was included in other income, net in the consolidated statement of operations as of June 30, 2022 and June 30, 2021, respectively. The fair value of the foreign currency forward contracts was less than $0.1 million and $0.2 million as of June 30, 2022 and December 31, 2021, respectively. During the second quarter of 2021, the Company entered into a foreign currency swap, with a notional amount 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 Company subsequently paid down a portion of this swap, bringing the notional amount down to $6.4 million. The change in fair value of the foreign currency swap was $1.6 million as of June 30, 2022. 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 $471.6 million equivalent to 420.1 million of a CHF-denominated intercompany loan into U.S. dollars. The CHF-denominated intercompany loan was the result of an intra-entity transfer of certain intellectual property rights to a subsidiary in Switzerland completed during the fourth quarter of 2020. The intercompany loan requires quarterly payments of CHF 5.8 million plus accrued interest. As a result, the aggregate notional amount of the related cross-currency swaps will decrease by a corresponding amount. The objective of these cross-currency swaps is to reduce volatility of earnings and cash flows associated with changes in the foreign currency exchange rate. Under the terms of these contracts, which have been designated as cash flow hedges, the Company will make interest payments in Swiss Francs and receive interest in U.S. dollars. Upon the maturity of these contracts, the Company will pay the principal amount of the loans in Swiss Francs and receive U.S. dollars from the counterparties. The Company held the following cross-currency rate swaps as of June 30, 2022 and December 31, 2021 (dollar amounts in thousands): June 30, 2022 December 31, 2021 June 30, 2022 December 31, 2021 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay CHF October 2, 2017 October 2, 2022 1.95% CHF 145,598 145,598 (2,557) (8,283) Receive U.S.$ 4.52% $ 150,000 150,000 Pay CHF December 21, 2020 December 22, 2025 3.00% CHF 385,637 397,137 11,919 41 Receive U.S.$ 3.98% $ 432,911 445,821 Total $ 9,362 $ (8,242) On October 4, 2021 in accordance with the termination date, the Company settled a cross-currency swap designated as a cash flow hedge of an intercompany loan with an aggregate notional amount of $50.0 million. The gain recorded by the Company upon the settlement of the swap was not material for the period. 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, 2022, the Company recorded gains of $19.3 million and $25.8 million, respectively, in other income, net related to change in fair value related to the foreign currency rate translation to offset the losses recognized on the intercompany loans. 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 gain or losses recognized on the intercompany loans. For the three and six months ended June 30, 2022, the Company recorded gains of $21.1 million and $21.5 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 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, 2022, the Company recorded gains of $2.0 million and $3.8 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, 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. The estimated gain that is expected to be reclassified to other income, net from AOCL as of June 30, 2022 within the next twelve months is $3.6 million. As of June 30, 2022, the Company does not expect any gains or losses will be reclassified into earnings as a result of the discontinuance of these cash flow hedges because the original forecasted transaction will not occur. Net Investment Hedges The Company manages certain foreign exchange risks through a variety of strategies, including hedging. The Company is exposed to foreign exchange risk from its international operations through foreign currency purchases, net investments in foreign subsidiaries, and foreign currency assets and liabilities created in the normal course of business. On October 1, 2018, December 16, 2020 and May 26, 2022, the Company entered into cross-currency swap agreements designated as net investment hedges to partially offset the effects of foreign currency on foreign subsidiaries. The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 2022 and December 31, 2021, respectively (dollar amounts in thousands): June 30, 2022 December 31, 2021 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay EUR October 3, 2018 September 30, 2023 —% EUR 51,760 5,740 2,503 Receive U.S.$ 2.57% $ 60,000 Pay EUR October 3, 2018 September 30, 2025 —% EUR 38,820 4,784 2,147 Receive U.S.$ 2.19% $ 45,000 Pay CHF (1) December 16, 2020 December 16, 2027 —% CHF 222,300 — (792) Receive U.S.$ 1.10% $ 250,000 Pay CHF May 26, 2022 December 16, 2028 —% CHF 288,210 (1,824) — Receive U.S.$ 1.94% $ 300,000 Total $ 8,700 $ 3,858 (1) The following currency swaps designated as a net investment hedge were early settled during the three months ended June 30, 2022. During the six months ended June 30, 2022 , the Company early settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $250.0 million equivalent to 222.3 million Swiss Franc. The original settlement date was December 16, 2027. As a result of the settlement, the Company recorded a gain of $4.9 million in AOCL. On May 26, 2022, the Company entered into cross-currency swap agreements designated as net investment hedge to replace the following swaps of a notional amount of $300.0 million equivalent to 288.2 million Swiss Franc. On September 30, 2021, in accordance with the termination date, the Company settled cross-currency swaps designated as net investment hedge with an aggregate notional amount of $52 million equivalent to 44.9 million Euros based on the termination date. As a result of the settlement, the Company recorded a gain of $0.1 million in AOCL. 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, 2022, the Company recorded gains of $10.8 million and $12.1 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 $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, 2022, the Company recorded gains of $1.0 million and $2.3 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, 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. The estimated gain that is expected to be reclassified to interest income from AOCL as of June 30, 2022 within the next twelve months is $8.5 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, 2022 and December 31, 2021: Fair Value as of Location on Balance Sheet (1) : June 30, 2022 December 31, 2021 Dollars in thousands Derivatives designated as hedges — Assets: Prepaid expenses and other current assets Cash Flow Hedges Interest rate swap (2) 4,369 $ — Cross-currency swap $ 6,122 $ 4,900 Net Investment Hedges Cross-currency swap 8,472 5,120 Other assets Cash Flow Hedges Interest rate swap (2) 24,619 4,373 Cross-currency swap 5,797 — Net Investment Hedges Cross-currency swap 7,964 2,104 Total derivatives designated as hedges — Assets $ 57,343 $ 16,497 Derivatives designated as hedges — Liabilities: Accrued expenses and other current liabilities Cash Flow Hedges Interest rate swap (2) $ 62 $ 18,187 Cross-currency swap $ 2,558 8,283 Net Investment Hedges Other liabilities Cash Flow Hedges Interest rate swap (2) $ 1,987 30,143 Cross-currency swap $ — 4,859 Net Investment Hedges Cross-currency swap $ 7,736 3,366 Total derivatives designated as hedges — Liabilities $ 12,343 $ 64,838 (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, 2022 and December 31, 2021, the total notional amounts related to the Company’s interest rate swaps were both $1.8 billion, respectively. The following presents the effect of derivative instruments designated as cash flow hedges and net investment hedges on the accompanying condensed consolidated statement of operations during the three and six months ended June 30, 2022 and 2021: Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Three Months Ended June 30, 2022 Cash Flow Hedges Interest rate swap $ 2,932 $ 20,116 $ (3,891) $ 26,939 Interest expense Cross-currency swap (17,703) 21,136 21,268 (17,835) Other income, net Net Investment Hedges Cross-currency swap (2,332) 10,816 978 7,506 Interest income $ (17,103) $ 52,068 $ 18,355 $ 16,610 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, net Net Investment Hedges Cross-currency swap (429) 88 1,737 (2,078) Interest income $ (59,004) $ (25,894) $ (15,721) $ (69,177) Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Six Months Ended June 30, 2022 Cash Flow Hedges Interest rate swap $ (43,956) $ 61,790 $ (9,105) $ 26,939 Interest expense Cross-currency swap (9,688) 21,452 29,599 (17,835) Other income, net Net Investment Hedges Cross-currency swap (2,321) 12,125 2,298 7,506 Interest income $ (55,965) $ 95,367 $ 22,792 $ 16,610 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, 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)

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	6 Months Ended
	Jun. 30, 2022
Share-Based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION As of June 30, 2022, the Company had stock options, restricted stock awards, performance stock awards, contract stock awards and restricted stock unit awards outstanding under the Integra LifeSciences Holdings Corporation Fifth Amended and Restated 2003 Equity Incentive Plan (the “2003 Plan”). 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, 2022, there were approx imately $5.3 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 145,565 stock options granted during the six months ended June 30, 2022. For the six months ended June 30, 2022, the weighted average grant date fair value for stock options was $23.15 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. A s of June 30, 2022, there was approximately $40.2 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 363,326 restricted stock awards and 130,753 performance stock awards during the six months ended June 30, 2022. For the six months ended June 30, 2022, the weighted average grant date fair value for restricted stock awards and performance stock units was $64.65 and $65.11 per award, respectively. The Company also maintains an Employee Stock Purchase Plan (the “ESPP”), which provides eligible employees with the opportunity to acquire shares of common stock at periodic intervals by means of accumulated payroll deductions. The ESPP is a non-compensatory plan based on its terms.

RETIREMENT PLANS

RETIREMENT PLANS	6 Months Ended
	Jun. 30, 2022
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 cost for the Company’s defined benefit pension plans for the three and six months ended June 30, 2022 were $0.3 million and $0.5 million. The components of the net periodic benefit costs other than the service cost component of $0.6 million and $1.3 million for the three and six months ended June 30, 2022 are included in other income, 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, 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, net in the consolidated statements of operations. The estimated fair values of plan assets were $34.4 million and $39.9 million as of June 30, 2022 and December 31, 2021, respectively. The net plan assets of the pension plans are invested in common trusts as of June 30, 2022 and December 31, 2021. 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. 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 $4.3 million and $3.8 million as of June 30, 2022 and December 31, 2021. 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, 2022
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, 2022. 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, 2022 and June 30, 2021 was $10.2 million and $10.6 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, 2022 December 31, 2021 ROU assets $ 145,135 $ 84,543 Current lease liabilities 12,743 14,775 Non-current lease liabilities 154,029 90,329 Total lease liabilities $ 166,772 $ 105,104 Weighted average remaining lease term (in years): Leased facilities 17.9 years 10.4 years Leased vehicles 2.1 years 2.1 years Weighted average discount rate: Leased facilities 5.2 % 5.1 % Leased vehicles 2.7 % 2.6 % Supplemental cash flow information related to leases for the six months ended June 30, 2022 and 2021 were as follows: Dollars in thousands June 30, 2022 June 30, 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 8,798 $ 7,019 ROU assets obtained in exchange for lease liabilities: Operating leases $ 69,489 $ 10,528 Future minimum lease payments under operating leases at June 30, 2022 were as follows: Dollars in thousands Related Parties Third Parties Total Remainder of 2022 $ 148 $ 7,824 $ 7,972 2023 296 18,022 18,318 2024 296 18,008 18,304 2025 296 16,505 16,801 2026 296 14,981 15,277 2027 296 14,580 14,876 Thereafter 246 164,917 165,163 Total minimum lease payments $ 1,874 $ 254,837 $ 256,711 Less: Imputed interest 89,939 Total lease liabilities 166,772 Less: Current lease liabilities 12,743 Long-term lease liabilities 154,029 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 stockholders are trusts, whose beneficiaries include family members of the Company’s 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, 2022
Equity [Abstract]
TREASURY STOCK	TREASURY STOCK On April 26 2022, the Board of Directors 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 2024. This stock repurchase authorization replaces the previous $225 million stock repurchase authorization, of which $100 million remained authorized at the time of its replacement, and which was otherwise set to expire on December 31, 2022. Purchases may be affected through one or more open market transactions, privately negotiated transactions, transactions structured through investment banking institutions, or a combination of the foregoing. As of June 30, 2022 and December 31, 2021, there were 6.8 million and 4.9 million shares of treasury stock outstanding with a cost of $362.9 million and $234.4 million, at a weighted average cost per share of $53.18 and $47.86, respectively. On January 12, 2022, the Company entered into a $125.0 million accelerated share repurchase ("2022 ASR") and received 1.48 million shares of Company common stock at inception, which represented approximately 80% of the expected total shares under the 2022 ASR. On March 24, 2022, the early exercise provision was exercised by 2022 ASR counterparty. Upon settlement on March 24, 2022, the Company received an additional 0.46 million shares determined using the volume-weighted average price of the Company's common stock during the term of the 2022 ASR.

INCOME TAXES

INCOME TAXES	6 Months Ended
	Jun. 30, 2022
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, 2022 2021 2022 2021 Reported tax rate 13.2 % 21.8 % 14.5 % 28.2 % The Company’s effective income tax rates for the three months ended June 30, 2022 and 2021 were 13.2% and 21.8%, respectively. For the three months ended June 30, 2022, the primary driver of the lower tax rate is a $4.8 million benefit related to excess tax benefits from stock compensation. The Company’s effective income tax rates for the six months ended June 30, 2022 and 2021 were 14.5% and 28.2%, respectively. For the six months ended June 30, 2022, the primary driver of the tax rate is a $5.7 million benefit related to excess tax benefits from stock compensation. For the six months ended June 30, 2021, the primary driver of the higher tax rate was the tax impact of the gain on the sale of the Extremity Orthopedics business which was completed during the first quarter of 2021. Changes to income tax laws and regulations, in any of the tax jurisdictions in which the Company operates, could impact the effective tax rate. Various governments, both U.S. and non-U.S., are increasingly focused on tax reform and revenue-raising legislation. The current U.S. administration has proposed tax reform which, if enacted, may increase the Company’s U.S. federal income tax liability. Further, legislation in foreign jurisdictions may be enacted, in response to the base erosion and profit-sharing project begun by the Organization for Economic Cooperation and Development ("OECD"). The OECD recently finalized major reform of the international tax system with respect to a global minimum tax rate. Such changes in U.S. and non-U.S. jurisdictions could have an adverse effect on the Company’s effective tax rate. As of June 30, 2022, the Company has not provided deferred income taxes on unrepatriated earnings from foreign subsidiaries as they are deemed to be indefinitely reinvested unless there is a manner under which to remit the earnings with no material tax cost. Material taxes would primarily be attributable to foreign withholding taxes and local income taxes when such earnings are distributed. The Company will repatriate foreign earnings when there is no need for reinvestment overseas and there is no material cost to bring the earnings back to the United States. Reinvestment considerations would include future acquisitions, transactions, and capital expenditure plans. As such, the Company has determined the tax impact of repatriating these foreign earnings would not be material as of June 30, 2022.

NET INCOME PER SHARE

NET INCOME PER SHARE	6 Months Ended
	Jun. 30, 2022
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 2022 2021 2022 2021 Basic net income per share: Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Weighted average common shares outstanding 83,168 84,687 83,400 84,593 Basic net income per common share $ 0.54 $ 0.41 $ 0.93 $ 0.95 Diluted net income per share: Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Weighted average common shares outstanding — Basic 83,168 84,687 83,400 84,593 Effect of dilutive securities: Stock options and restricted stock 454 653 579 731 Weighted average common shares for diluted earnings per share 83,622 85,340 83,979 85,324 Diluted net income per common share $ 0.54 $ 0.41 $ 0.93 $ 0.94 Common stock of approximately 0.2 million an d 0.1 million shares at June 30, 2022, and 2021, res pectively 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. 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, 2022
Equity [Abstract]
ACCUMULATED OTHER COMPREHENSIVE LOSS	ACCUMULATED OTHER COMPREHENSIVE LOSS Comprehensive income for the six months ended June 30, 2022 and 2021 was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Foreign currency translation adjustment (18,067) 1,558 (23,749) (5,243) Change in unrealized gain (loss) on derivatives, net of tax 25,922 (7,804) 55,744 29,111 Pension liability adjustment, net of tax (45) (91) (54) 228 Comprehensive income, net $ 52,598 $ 28,731 $ 109,630 $ 104,558 Changes in accumulated other comprehensive loss by component between December 31, 2021 and June 30, 2022 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, 2022 $ (42,981) $ 1,893 $ (4,067) $ (45,155) Other comprehensive gain (loss) 72,499 (54) (23,750) 48,695 Less: Amounts reclassified from accumulated other comprehensive income, net 16,755 — — 16,755 Net current-period other comprehensive gain (loss) 55,744 (54) (23,750) 31,940 Balance at June 30, 2022 $ 12,763 $ 1,839 $ (27,817) $ (13,215) For the six months ended June 30, 2022, the Company reclassified a gain of $22.8 million and a loss of $5.2 million from accumulated other comprehensive loss to other income, net and interest income, respectively.

SEGMENT AND GEOGRAPHIC INFORMAT

SEGMENT AND GEOGRAPHIC INFORMATION	6 Months Ended
	Jun. 30, 2022
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, cranial stabilization equipment, and solutions for use in minimally invasive neurosurgery and in the management of intracerebral hemorrhages, 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 a large, complementary portfolio of products to address plastic and surgical reconstructive procedures such as complex and traumatic wounds, hernia and abdominal wall repair, breast reconstruction, and peripheral nerve repair. The Tissue Technologies segment has four unique technology platforms, including bovine engineered collagen matrix, bovine dermal matrix, amniotic technology and porcine bladder matrix technology, to address regenerative soft tissue reconstruction procedures. 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, 2022 and 2021 are as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 Segment Net Sales Codman Specialty Surgical $ 257,863 $ 256,837 $ 505,171 $ 498,078 Tissue Technologies 139,952 133,155 269,282 251,985 Total revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063 Segment Profit Codman Specialty Surgical $ 92,196 $ 113,996 $ 202,356 $ 220,774 Tissue Technologies 61,626 64,413 115,519 114,424 Segment profit 153,822 178,409 317,875 335,198 Amortization (3,304) (4,198) (7,198) (8,725) Corporate and other (90,651) (122,357) (204,646) (243,905) Operating income $ 59,867 $ 51,854 $ 106,031 $ 82,568 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 2022 2021 2022 2021 United States $ 287,347 $ 278,186 $ 550,698 $ 525,979 Europe 46,862 48,437 90,606 94,256 Asia Pacific 43,365 44,306 91,082 91,601 Rest of World 20,241 19,063 42,067 38,227 Total Revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES In consideration for certain technology, manufacturing, distribution, and 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, 2022 and June 30, 2021 to reflect the change in estimate, 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, 2022 and June 30, 2021 is as follows (in thousands): Six Months Ended June 30, 2022 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 Short-term Long-term Balance as of January 1, 2022 $ 3,691 $ 11,408 $ 230 $ — $ 21,800 Transfers — 4,885 (4,885) Change in fair value of contingent consideration liabilities (155) $ (1,978) Research and development — (4,885) 1,219 Selling, general and administrative Balance as of June 30, 2022 $ 3,536 $ 9,430 $ 230 $ — $ 18,134 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 — — 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 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 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, 2022 and June 30, 2021 was $13.0 million and $14.8 million, respectively. The Company recorded $9.4 million and $14.8 million in other liabilities at June 30, 2022 and June 30, 2021, respectively, and $3.5 million in accrued expenses and other current liabilities at June 30, 2022, in the consolidated balance sheet of the Company. Derma Sciences

BASIS OF PRESENTATION (Policies

BASIS OF PRESENTATION (Policies)	6 Months Ended
	Jun. 30, 2022
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, 2022 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 shareholders' 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, 2021 included in the Company’s Annual Report on Form 10-K. The December 31, 2021 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, 2022 are not necessarily indicative of the results to be expected for the entire year.
Risks and Uncertainties	Risks and Uncertainties The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic, including reductions in capital and overall spending by our customers, increased freight costs, decreased availability of certain raw materials used in certain of our products and labor constraints. The COVID-19 pandemic has had, and may continue to have, an adverse effect on the Company’s business, results of operations, financial condition, and cash flows, and its future impacts remain highly uncertain and unpredictable. Although there was not a material impact to the Company’s consolidated financial statements as of and for the six months ended June 30, 2022, changes in the Company’s assessment about the length and severity of the pandemic, as well as other factors, could result in actual results differing from estimates. 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 duration of direct and indirect economic effects of the pandemic, containment measures and other macroeconomic factors which could cause a local/or global economic recession. 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.
Employee Termination Benefits	Employee Termination Benefits The Company incurred restructuring costs related to employee terminations associated with a plant closure and future outsourcing plans for select transactional back office activities in the consolidated statement of operations for the six months ended June 30, 2022.
Recent Accounting Pronouncements	Recent Accounting Pronouncements 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 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 significant impact on the Company's consolidated financial statements and related disclosures. 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 currently has contracts that are indexed to LIBOR and are continuing to evaluate the scope of impacted contracts and potential risk. The Company is also monitoring the developments regarding alternative rates and may amend certain contracts to accommodate those rates if the contract does not already specify a replacement rate. While the notional value of agreements potentially indexed to LIBOR is material, the Company does not expect a material impact to the consolidated financial statements and related disclosures associated with this transition. 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 was effective for annual and interim periods beginning after December 15, 2021, and early adoption was 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 7, 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) On December 9, 2020, the Company made an irrevocable election under the indenture to require the principal portion of its 2025 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. Upon adoption of ASU 2020-06, the Company’s 2025 Notes were reflected entirely as a liability since the embedded conversion feature will no longer be separately presented within stockholders’ equity. Additionally, from January 1, 2021, the Company is no longer incurring non-cash interest expense for the amortization of debt discount. 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 regulations of the U.S. Securities and Exchange Commission (the "SEC"). The ASU has been 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 significant impact on the Company's consolidated financial statements and related disclosures. In May 2021, the FASB issued ASU 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 had 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'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. 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	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 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.

BASIS OF PRESENTATION (Tables)

BASIS OF PRESENTATION (Tables)	6 Months Ended
	Jun. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Restructuring and Related Costs	The following table summarizes our restructuring related accrual balances included within accrued expenses and other current liabilities in the consolidated balance sheet for the six months ended June 30, 2022. All balances are expected to be paid within the current fiscal year. (Dollars in thousands) Amount Balance at December 31,2021 $ 10,226 Charges: Cost of Goods Sold $ 1,417 Research and development 133 Selling, general and administrative 1,807 Payments and other adjustments $ (6,885) Balance at June 30,2022 $ 6,698
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)

ASSETS AND LIABILITIES HELD F_2

ASSETS AND LIABILITIES HELD FOR SALE (Tables)	6 Months Ended
	Jun. 30, 2022
Discontinued Operations and Disposal Groups [Abstract]
Schedule of Fair Values of Assets and Liabilities Held For Sale	The major classes of assets and liabilities classified as a held for sale consisted of the following as of June 30, 2022 (dollar amounts in thousands): Other assets $ 53 Deferred tax assets 178 Prepaid expenses and other current assets 338 Right of use asset - operating leases 1,316 Property, plant, and equipment, net 3,752 Goodwill 5,083 Inventories, net 9,275 Intangible assets, net 10,530 Total assets held for sale $ 30,525 Accrued expenses and other current liabilities $ 102 Current portion of lease liability - operating leases 584 Lease liability - operating leases 742 Deferred tax liabilities 875 Total liabilities held for sale $ 2,303

ACQUISITIONS AND DIVESTITURES (

ACQUISITIONS AND DIVESTITURES (Tables)	6 Months Ended
	Jun. 30, 2022
Mergers, Acquisitions and Dispositions [Abstract]
Schedule of Assets Acquired and Liabilities Assumed	The following table summarizes the final fair values of the assets acquired and liabilities assumed at the acquisition date: Dollars in thousands Final Valuation Weighted Average Life Current assets: Cash $ 2,726 Trade accounts receivable, net 16,469 Inventories, net 18,299 Prepaid 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 94,147 Right of use asset - operating leases 9,259 Deferred tax assets 7,465 Other assets 148 Total assets acquired $ 408,780 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 61,724 Contingent consideration 23,900 Total liabilities assumed $ 101,842 Net assets acquired $ 306,938

REVENUES FROM CONTRACTS WITH _2

REVENUES FROM CONTRACTS WITH CUSTOMERS (Tables)	6 Months Ended
	Jun. 30, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Changes in Contract Assets and Contract Liabilities	The following table summarized the changes in the contract asset and liability balances for the six months ended June 30, 2022: Dollars in thousands Total Contract Asset Contract asset, January 1, 2022 $ 11,412 Transferred to trade receivable of contract asset included in beginning of the year contract asset (11,412) Contract asset, net of transferred to trade receivables on contracts during the period 10,568 Contract asset, June 30, 2022 $ 10,568 Contract Liability Contract liability, January 1, 2022 $ 11,946 Recognition of revenue included in beginning of year contract liability $ (3,591) Contract liability, net of revenue recognized on contracts during the period 4,347 Foreign currency translation (60) Contract liability, June 30, 2022 $ 12,642
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, 2022 and 2021 (dollar amounts in thousands): Three Months Ended June 30, 2022 Three Months Ended June 30, 2021 Six Months Ended June 30, 2022 Six Months Ended June 30, 2021 Neurosurgery $ 200,295 $ 202,600 $ 394,970 $ 391,854 Instruments 57,568 54,237 110,201 106,224 Total Codman Specialty Surgical 257,863 256,837 505,171 498,078 Wound Reconstruction and Care 104,894 102,616 199,524 191,314 Private Label 35,058 30,539 69,758 60,671 Total Tissue Technologies 139,952 133,155 269,282 251,985 Total revenue $ 397,815 $ 389,992 $ 774,453 $ 750,063

INVENTORIES (Tables)

INVENTORIES (Tables)	6 Months Ended
	Jun. 30, 2022
Inventory Disclosure [Abstract]
Schedule of Inventories, Net	Inventories, net consisted of the following: Dollars in thousands June 30, 2022 December 31, 2021 Finished goods $ 164,277 $ 162,528 Work in process 72,779 65,323 Raw materials 83,152 89,535 Total inventories, net $ 320,208 $ 317,386

GOODWILL AND OTHER INTANGIBLE_2

GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)	6 Months Ended
	Jun. 30, 2022
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, 2022 were as follows: Dollars in thousands Codman Specialty Tissue Technologies Total Goodwill at December 31, 2021 $ 663,428 $ 350,030 $ 1,013,458 Transfer to assets held for sale (1) — (5,083) (5,083) Foreign currency translation (11,822) (6,147) (17,969) Goodwill at June 30, 2022 $ 651,606 $ 338,800 $ 990,406 (1) See Note 2. Assets and Liabilities Held for Sale
Schedule of Finite-Lived Intangible Assets	The components of the Company’s identifiable intangible assets were as follows: June 30, 2022 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,122,233 $ (336,288) $ 785,945 Customer relationships 12 years $ 192,929 $ (140,184) $ 52,745 Trademarks/brand names 28 years $ 96,745 $ (32,847) $ 63,898 Codman tradename Indefinite $ 164,150 $ — $ 164,150 Supplier relationships 30 years $ 30,211 $ (16,681) $ 13,530 All other 11 years $ 5,859 $ (3,852) $ 2,007 $ 1,612,127 $ (529,852) $ 1,082,275 December 31, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,132,954 $ (307,013) $ 825,941 Customer relationships 12 years 211,344 (142,755) 68,589 Trademarks/brand names 28 years 98,367 (31,468) 66,899 Codman tradename Indefinite 167,758 — 167,758 Supplier relationships 30 years 30,211 (16,192) 14,019 All other 11 years 6,258 (3,891) 2,367 $ 1,646,892 $ (501,319) $ 1,145,573
Schedule of Indefinite-Lived Intangible Assets	The components of the Company’s identifiable intangible assets were as follows: June 30, 2022 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,122,233 $ (336,288) $ 785,945 Customer relationships 12 years $ 192,929 $ (140,184) $ 52,745 Trademarks/brand names 28 years $ 96,745 $ (32,847) $ 63,898 Codman tradename Indefinite $ 164,150 $ — $ 164,150 Supplier relationships 30 years $ 30,211 $ (16,681) $ 13,530 All other 11 years $ 5,859 $ (3,852) $ 2,007 $ 1,612,127 $ (529,852) $ 1,082,275 December 31, 2021 Dollars in thousands Weighted Cost Accumulated Net Completed technology 18 years $ 1,132,954 $ (307,013) $ 825,941 Customer relationships 12 years 211,344 (142,755) 68,589 Trademarks/brand names 28 years 98,367 (31,468) 66,899 Codman tradename Indefinite 167,758 — 167,758 Supplier relationships 30 years 30,211 (16,192) 14,019 All other 11 years 6,258 (3,891) 2,367 $ 1,646,892 $ (501,319) $ 1,145,573

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt Maximum Leverage Ratios	The Company’s maximum consolidated total leverage ratio in the financial covenants (as defined in the Senior Credit Facility) is the following: Fiscal Quarter Maximum Consolidated Total Leverage Ratio 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, 2022 Principal Repayment Dollars in thousands Remainder of 2022 $ 22,500 2023 $ 61,875 2024 $ 67,500 2025 $ 669,375 $ 821,250

DERIVATIVE INSTRUMENTS (Tables)

DERIVATIVE INSTRUMENTS (Tables)	6 Months Ended
	Jun. 30, 2022
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Instruments	The Company held the following interest rate swaps as of June 30, 2022 and December 31, 2021 (dollar amounts in thousands): June 30, 2022 December 31, 2021 June 30, 2022 December 31, 2021 Hedged Item Notional Amount Designation Date Effective Date Termination Date Fixed Interest Rate Estimated Fair Value Asset (Liability) 1-month USD LIBOR Loan 300,000 300,000 December 13, 2017 January 1, 2018 December 31, 2022 2.201 % 681 (5,268) 1-month USD LIBOR Loan 150,000 150,000 December 13, 2017 July 1, 2019 June 30, 2024 2.423 % 1,937 (5,520) 1-month USD LIBOR Loan 200,000 200,000 December 13, 2017 January 1, 2018 December 31, 2024 2.313 % 3,322 (7,421) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.220 % (660) (5,512) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.199 % (361) (5,464) 1-month USD LIBOR Loan 75,000 75,000 October 10, 2018 July 1, 2020 June 30, 2025 3.209 % (485) (5,494) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.885 % 253 (6,886) 1-month USD LIBOR Loan 100,000 100,000 December 18, 2018 December 30, 2022 December 31, 2027 2.867 % 19 (6,764) 1-month USD LIBOR Loan 575,000 575,000 December 15, 2020 July 31, 2025 December 31, 2027 1.415 % 17,938 3,552 1-month USD LIBOR Loan 125,000 125,000 December 15, 2020 July 1, 2025 December 31, 2027 1.404 % 4,295 821 $ 1,775,000 $ 1,775,000 $ 26,939 $ (43,957) The Company held the following cross-currency rate swaps as of June 30, 2022 and December 31, 2021 (dollar amounts in thousands): June 30, 2022 December 31, 2021 June 30, 2022 December 31, 2021 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay CHF October 2, 2017 October 2, 2022 1.95% CHF 145,598 145,598 (2,557) (8,283) Receive U.S.$ 4.52% $ 150,000 150,000 Pay CHF December 21, 2020 December 22, 2025 3.00% CHF 385,637 397,137 11,919 41 Receive U.S.$ 3.98% $ 432,911 445,821 Total $ 9,362 $ (8,242) The Company held the following cross-currency rate swaps designated as net investment hedges as of June 30, 2022 and December 31, 2021, respectively (dollar amounts in thousands): June 30, 2022 December 31, 2021 Effective Date Termination Date Fixed Rate Aggregate Notional Amount Fair Value Pay EUR October 3, 2018 September 30, 2023 —% EUR 51,760 5,740 2,503 Receive U.S.$ 2.57% $ 60,000 Pay EUR October 3, 2018 September 30, 2025 —% EUR 38,820 4,784 2,147 Receive U.S.$ 2.19% $ 45,000 Pay CHF (1) December 16, 2020 December 16, 2027 —% CHF 222,300 — (792) Receive U.S.$ 1.10% $ 250,000 Pay CHF May 26, 2022 December 16, 2028 —% CHF 288,210 (1,824) — Receive U.S.$ 1.94% $ 300,000 Total $ 8,700 $ 3,858 (1) The following currency swaps designated as a net investment hedge were early settled during the three months ended June 30, 2022.
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, 2022 and December 31, 2021: Fair Value as of Location on Balance Sheet (1) : June 30, 2022 December 31, 2021 Dollars in thousands Derivatives designated as hedges — Assets: Prepaid expenses and other current assets Cash Flow Hedges Interest rate swap (2) 4,369 $ — Cross-currency swap $ 6,122 $ 4,900 Net Investment Hedges Cross-currency swap 8,472 5,120 Other assets Cash Flow Hedges Interest rate swap (2) 24,619 4,373 Cross-currency swap 5,797 — Net Investment Hedges Cross-currency swap 7,964 2,104 Total derivatives designated as hedges — Assets $ 57,343 $ 16,497 Derivatives designated as hedges — Liabilities: Accrued expenses and other current liabilities Cash Flow Hedges Interest rate swap (2) $ 62 $ 18,187 Cross-currency swap $ 2,558 8,283 Net Investment Hedges Other liabilities Cash Flow Hedges Interest rate swap (2) $ 1,987 30,143 Cross-currency swap $ — 4,859 Net Investment Hedges Cross-currency swap $ 7,736 3,366 Total derivatives designated as hedges — Liabilities $ 12,343 $ 64,838 (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, 2022 and December 31, 2021, the total notional amounts related to the Company’s interest rate swaps were both $1.8 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 and net investment hedges on the accompanying condensed consolidated statement of operations during the three and six months ended June 30, 2022 and 2021: Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Three Months Ended June 30, 2022 Cash Flow Hedges Interest rate swap $ 2,932 $ 20,116 $ (3,891) $ 26,939 Interest expense Cross-currency swap (17,703) 21,136 21,268 (17,835) Other income, net Net Investment Hedges Cross-currency swap (2,332) 10,816 978 7,506 Interest income $ (17,103) $ 52,068 $ 18,355 $ 16,610 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, net Net Investment Hedges Cross-currency swap (429) 88 1,737 (2,078) Interest income $ (59,004) $ (25,894) $ (15,721) $ (69,177) Dollars in thousands Balance in AOCL Amount of Amount of Gain (Loss) Balance in AOCL Location in Six Months Ended June 30, 2022 Cash Flow Hedges Interest rate swap $ (43,956) $ 61,790 $ (9,105) $ 26,939 Interest expense Cross-currency swap (9,688) 21,452 29,599 (17,835) Other income, net Net Investment Hedges Cross-currency swap (2,321) 12,125 2,298 7,506 Interest income $ (55,965) $ 95,367 $ 22,792 $ 16,610 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, 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)

LEASES AND RELATED PARTY LEAS_2

LEASES AND RELATED PARTY LEASES (Tables)	6 Months Ended
	Jun. 30, 2022
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, 2022 December 31, 2021 ROU assets $ 145,135 $ 84,543 Current lease liabilities 12,743 14,775 Non-current lease liabilities 154,029 90,329 Total lease liabilities $ 166,772 $ 105,104 Weighted average remaining lease term (in years): Leased facilities 17.9 years 10.4 years Leased vehicles 2.1 years 2.1 years Weighted average discount rate: Leased facilities 5.2 % 5.1 % Leased vehicles 2.7 % 2.6 %
Supplemental Cash Flow Information	Supplemental cash flow information related to leases for the six months ended June 30, 2022 and 2021 were as follows: Dollars in thousands June 30, 2022 June 30, 2021 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 8,798 $ 7,019 ROU assets obtained in exchange for lease liabilities: Operating leases $ 69,489 $ 10,528
Schedule of Operating Lease Maturities	Future minimum lease payments under operating leases at June 30, 2022 were as follows: Dollars in thousands Related Parties Third Parties Total Remainder of 2022 $ 148 $ 7,824 $ 7,972 2023 296 18,022 18,318 2024 296 18,008 18,304 2025 296 16,505 16,801 2026 296 14,981 15,277 2027 296 14,580 14,876 Thereafter 246 164,917 165,163 Total minimum lease payments $ 1,874 $ 254,837 $ 256,711 Less: Imputed interest 89,939 Total lease liabilities 166,772 Less: Current lease liabilities 12,743 Long-term lease liabilities 154,029

INCOME TAXES (Tables)

INCOME TAXES (Tables)	6 Months Ended
	Jun. 30, 2022
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, 2022 2021 2022 2021 Reported tax rate 13.2 % 21.8 % 14.5 % 28.2 %

NET INCOME PER SHARE (Tables)

NET INCOME PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2022
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 2022 2021 2022 2021 Basic net income per share: Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Weighted average common shares outstanding 83,168 84,687 83,400 84,593 Basic net income per common share $ 0.54 $ 0.41 $ 0.93 $ 0.95 Diluted net income per share: Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Weighted average common shares outstanding — Basic 83,168 84,687 83,400 84,593 Effect of dilutive securities: Stock options and restricted stock 454 653 579 731 Weighted average common shares for diluted earnings per share 83,622 85,340 83,979 85,324 Diluted net income per common share $ 0.54 $ 0.41 $ 0.93 $ 0.94

ACCUMULATED OTHER COMPREHENSI_2

ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)	6 Months Ended
	Jun. 30, 2022
Equity [Abstract]
Schedule of Comprehensive Income (Loss)	Comprehensive income for the six months ended June 30, 2022 and 2021 was as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 Net income $ 44,788 $ 35,068 $ 77,689 $ 80,462 Foreign currency translation adjustment (18,067) 1,558 (23,749) (5,243) Change in unrealized gain (loss) on derivatives, net of tax 25,922 (7,804) 55,744 29,111 Pension liability adjustment, net of tax (45) (91) (54) 228 Comprehensive income, net $ 52,598 $ 28,731 $ 109,630 $ 104,558
Schedule of Changes in Accumulated Other Comprehensive Loss by Component	Changes in accumulated other comprehensive loss by component between December 31, 2021 and June 30, 2022 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, 2022 $ (42,981) $ 1,893 $ (4,067) $ (45,155) Other comprehensive gain (loss) 72,499 (54) (23,750) 48,695 Less: Amounts reclassified from accumulated other comprehensive income, net 16,755 — — 16,755 Net current-period other comprehensive gain (loss) 55,744 (54) (23,750) 31,940 Balance at June 30, 2022 $ 12,763 $ 1,839 $ (27,817) $ (13,215)

SEGMENT AND GEOGRAPHIC INFORM_2

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)	6 Months Ended
	Jun. 30, 2022
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, 2022 and 2021 are as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 Segment Net Sales Codman Specialty Surgical $ 257,863 $ 256,837 $ 505,171 $ 498,078 Tissue Technologies 139,952 133,155 269,282 251,985 Total revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063 Segment Profit Codman Specialty Surgical $ 92,196 $ 113,996 $ 202,356 $ 220,774 Tissue Technologies 61,626 64,413 115,519 114,424 Segment profit 153,822 178,409 317,875 335,198 Amortization (3,304) (4,198) (7,198) (8,725) Corporate and other (90,651) (122,357) (204,646) (243,905) Operating income $ 59,867 $ 51,854 $ 106,031 $ 82,568 Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 United States $ 287,347 $ 278,186 $ 550,698 $ 525,979 Europe 46,862 48,437 90,606 94,256 Asia Pacific 43,365 44,306 91,082 91,601 Rest of World 20,241 19,063 42,067 38,227 Total Revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063
Schedule of Geographic Revenue by Area	Net sales and profit by each reportable segment for the three and six months ended June 30, 2022 and 2021 are as follows: Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 Segment Net Sales Codman Specialty Surgical $ 257,863 $ 256,837 $ 505,171 $ 498,078 Tissue Technologies 139,952 133,155 269,282 251,985 Total revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063 Segment Profit Codman Specialty Surgical $ 92,196 $ 113,996 $ 202,356 $ 220,774 Tissue Technologies 61,626 64,413 115,519 114,424 Segment profit 153,822 178,409 317,875 335,198 Amortization (3,304) (4,198) (7,198) (8,725) Corporate and other (90,651) (122,357) (204,646) (243,905) Operating income $ 59,867 $ 51,854 $ 106,031 $ 82,568 Three Months Ended June 30, Six Months Ended June 30, Dollars in thousands 2022 2021 2022 2021 United States $ 287,347 $ 278,186 $ 550,698 $ 525,979 Europe 46,862 48,437 90,606 94,256 Asia Pacific 43,365 44,306 91,082 91,601 Rest of World 20,241 19,063 42,067 38,227 Total Revenues $ 397,815 $ 389,992 $ 774,453 $ 750,063

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Tables)	6 Months Ended
	Jun. 30, 2022
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, 2022 and June 30, 2021 is as follows (in thousands): Six Months Ended June 30, 2022 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 Short-term Long-term Balance as of January 1, 2022 $ 3,691 $ 11,408 $ 230 $ — $ 21,800 Transfers — 4,885 (4,885) Change in fair value of contingent consideration liabilities (155) $ (1,978) Research and development — (4,885) 1,219 Selling, general and administrative Balance as of June 30, 2022 $ 3,536 $ 9,430 $ 230 $ — $ 18,134 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 — — 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

BASIS OF PRESENTATION - Schedul

BASIS OF PRESENTATION - Schedule of Restructuring Charges (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2022 USD ($)
Restructuring Reserve [Roll Forward]
Balance at December 31,2021	$ 10,226
Payments and other adjustments	(6,885)
Balance at June 30,2022	6,698
Cost of Goods Sold
Restructuring Reserve [Roll Forward]
Charges:	1,417
Research and development
Restructuring Reserve [Roll Forward]
Charges:	133
Selling, general and administrative
Restructuring Reserve [Roll Forward]
Charges:	$ 1,807

BASIS OF PRESENTATION - Narrati

BASIS OF PRESENTATION - Narrative (Details) - 2025 Notes $ in Millions	Feb. 04, 2020 USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Convertible debt	$ 575
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, 2022	Dec. 31, 2021	Dec. 31, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Deferred tax liabilities	$ 61,287	$ 45,788
Long-term convertible securities	565,883	564,426
Retained earnings	$ 776,257	$ 698,568
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)

ASSETS AND LIABILITIES HELD F_3

ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details) - Traditional Wound Care Business - Disposal Group, Held-for-sale, Not Discontinued Operations $ in Thousands	May 20, 2022 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sale of business, disposition price	$ 28,800
Cash consideration for sale of business	27,800
Sale of business, contingent consideration	$ 1,000

ASSETS AND LIABILITIES HELD F_4

ASSETS AND LIABILITIES HELD FOR SALE - Assets and Liabilities Held For Sale (Details) - Traditional Wound Care Business - Disposal Group, Held-for-sale, Not Discontinued Operations $ in Thousands	Jun. 30, 2022 USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Other assets	$ 53
Deferred tax assets	178
Prepaid expenses and other current assets	338
Right of use asset - operating leases	1,316
Property, plant, and equipment, net	3,752
Goodwill	5,083
Inventories, net	9,275
Intangible assets, net	10,530
Total assets held for sale	30,525
Accrued expenses and other current liabilities	102
Current portion of lease liability - operating leases	584
Lease liability - operating leases	742
Deferred tax liabilities	875
Total liabilities held for sale	$ 2,303

ACQUISITIONS AND DIVESTITURES -

ACQUISITIONS AND DIVESTITURES - Divestitures, Narrative (Details) - USD ($) $ in Thousands			3 Months Ended		6 Months Ended		12 Months Ended
	Dec. 31, 2021	Jan. 04, 2021	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain (loss) from the sale of business			$ 0	$ (679)	$ 0	$ 42,197
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							$ 41,800
Disposal group, payment related to working capital and closing adjustments	$ 1,300
Transitional supply agreement, payable			$ 6,500		$ 6,500
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-

ACQUISITIONS AND DIVESTITURES- Business Combination, Narrative (Details) - ACell, Inc. - USD ($)	Jan. 20, 2021	Jun. 30, 2022	Jun. 30, 2021
Business Acquisition [Line Items]
Payments to acquire businesses, gross	$ 306,900,000
Contingent consideration, maximum undiscounted payment amount	$ 100,000,000	$ 100,000,000
Business combination, working capital adjustment			$ 1,300,000
Intangible asset acquired, discount rate (percent)	8.50%
Contingent consideration, estimated fair value	$ 23,900,000	18,100,000
Contingent consideration, noncurrent		$ 18,100,000	$ 23,500,000

ACQUISITIONS AND DIVESTITURES_2

ACQUISITIONS AND DIVESTITURES - Business Combination, Schedule of Purchase Price Allocation (Details) - USD ($) $ in Thousands	Jun. 30, 2021	Jun. 30, 2022	Dec. 31, 2021
Current assets:
Goodwill		$ 990,406	$ 1,013,458
ACell, Inc.
Current assets:
Cash	$ 2,726
Trade accounts receivable, net	16,469
Inventories, net	18,299
Prepaid expenses and other current assets	1,498
Total current assets	38,992
Property, plant and equipment, net	13,769
Intangible assets	245,000
Goodwill	94,147
Right of use asset - operating leases	9,259
Deferred tax assets	7,465
Other assets	148
Total assets acquired	408,780
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	61,724
Contingent consideration	23,900
Total liabilities assumed	101,842
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, 2022	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Number of days from shipment to issue a credit	90 days
Short-term portion of contract liability	$ 5,425	$ 5,295
Long-term portion of contract liability	$ 7,200
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]: 2022-07-01	Jun. 30, 2022
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Expected performance obligation through 2022, percentage	43%
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, 2022 USD ($)
Contract Asset
Contract asset, Beginning of period	$ 11,412
Transferred to trade receivable of contract asset included in beginning of the year contract asset	(11,412)
Contract asset, net of transferred to trade receivables on contracts during the period	10,568
Contract asset, End of Period	10,568
Contract Liability
Contract liability, Beginning of Period	11,946
Recognition of revenue included in beginning of year contract liability	(3,591)
Contract liability, net of revenue recognized on contracts during the period	4,347
Foreign currency translation	(60)
Contract liability, End of Period	$ 12,642

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, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Disaggregation of Revenue [Line Items]
Total Revenues	$ 397,815	$ 389,992	$ 774,453	$ 750,063
Codman Specialty Surgical
Disaggregation of Revenue [Line Items]
Total Revenues	257,863	256,837	505,171	498,078
Codman Specialty Surgical | Neurosurgery
Disaggregation of Revenue [Line Items]
Total Revenues	200,295	202,600	394,970	391,854
Codman Specialty Surgical | Instruments
Disaggregation of Revenue [Line Items]
Total Revenues	57,568	54,237	110,201	106,224
Tissue Technologies
Disaggregation of Revenue [Line Items]
Total Revenues	139,952	133,155	269,282	251,985
Tissue Technologies | Wound Reconstruction and Care
Disaggregation of Revenue [Line Items]
Total Revenues	104,894	102,616	199,524	191,314
Tissue Technologies | Private Label
Disaggregation of Revenue [Line Items]
Total Revenues	$ 35,058	$ 30,539	$ 69,758	$ 60,671

INVENTORIES - Schedule of Net I

INVENTORIES - Schedule of Net Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Finished goods	$ 164,277	$ 162,528
Work in process	72,779	65,323
Raw materials	83,152	89,535
Total inventories, net	$ 320,208	$ 317,386

INVENTORIES - Narrative (Detail

INVENTORIES - Narrative (Details) $ in Thousands	Jun. 30, 2022 USD ($)
Disposal Group, Held-for-sale, Not Discontinued Operations | Traditional Wound Care Business
Inventory [Line Items]
Inventories, net	$ 9,275

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, 2022 USD ($)
Goodwill [Roll Forward]
Beginning of Period	$ 1,013,458
Transfer to assets held for sale(1)	(5,083)
Foreign currency translation	(17,969)
End of Period	990,406
Codman Specialty Surgical
Goodwill [Roll Forward]
Beginning of Period	663,428
Transfer to assets held for sale(1)	0
Foreign currency translation	(11,822)
End of Period	651,606
Tissue Technologies
Goodwill [Roll Forward]
Beginning of Period	350,030
Transfer to assets held for sale(1)	(5,083)
Foreign currency translation	(6,147)
End of Period	$ 338,800

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, 2022	Dec. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	$ 1,612,127	$ 1,646,892
Accumulated Amortization	(529,852)	(501,319)
Net	1,082,275	1,145,573
Codman tradename
Acquired Finite-Lived Intangible Assets [Line Items]
Cost	164,150	167,758
Net	$ 164,150	$ 167,758
Completed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	18 years	18 years
Cost	$ 1,122,233	$ 1,132,954
Accumulated Amortization	(336,288)	(307,013)
Net	$ 785,945	$ 825,941
Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	12 years	12 years
Cost	$ 192,929	$ 211,344
Accumulated Amortization	(140,184)	(142,755)
Net	$ 52,745	$ 68,589
Trademarks/brand names
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	28 years	28 years
Cost	$ 96,745	$ 98,367
Accumulated Amortization	(32,847)	(31,468)
Net	$ 63,898	$ 66,899
Supplier relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	30 years	30 years
Cost	$ 30,211	$ 30,211
Accumulated Amortization	(16,681)	(16,192)
Net	$ 13,530	$ 14,019
All other
Acquired Finite-Lived Intangible Assets [Line Items]
Weighted Average Life	11 years	11 years
Cost	$ 5,859	$ 6,258
Accumulated Amortization	(3,852)	(3,891)
Net	$ 2,007	$ 2,367

GOODWILL AND OTHER INTANGIBLE_5

GOODWILL AND OTHER INTANGIBLE ASSETS - Narrative (Details) $ in Thousands	Jun. 30, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Expected annual amortization expense, remainder of 2022	$ 38,400
Expected annual amortization expense, in 2023	76,500
Expected annual amortization expense, in 2024	75,800
Expected annual amortization expense, in 2025	75,800
Expected annual amortization expense, in 2026	75,700
Expected annual amortization expense, in 2027	73,700
Expected annual amortization expense, thereafter	499,800
Disposal Group, Held-for-sale, Not Discontinued Operations | Traditional Wound Care Business
Goodwill [Line Items]
Intangible assets, net	$ 10,530

DEBT - Narrative (Details)

DEBT - Narrative (Details)		6 Months Ended
	Feb. 04, 2020 USD ($) $ / shares	Jun. 30, 2022 USD ($)	Jun. 30, 2021 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Feb. 03, 2020 USD ($)
Debt Instrument [Line Items]
Term loan component of senior credit facility		$ 50,625,000		$ 45,000,000
Interest payments, year one		12,200,000
Interest payments, year two		23,200,000
Interest payments, year three		21,100,000
Interest payments, year four		1,900,000
Carrying amount, liability component		565,883,000		564,426,000
Securitization program outstanding borrowings, maximum limit		150,000,000
Secured long-term debt, securitization program		$ 112,500,000		$ 112,500,000
Weighted average interest rate, accounts receivable securitization revolving loan facility		2.10%		1.10%
Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Securitization facility, outstanding borrowings, fair value		$ 110,000,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity						$ 1,300,000,000
Line of credit facility outstanding		$ 53,800,000		$ 31,300,000
Weighted average interest rate on debt		3%		1.40%
Revolving Credit Facility | Fair Value, Inputs, Level 2
Debt Instrument [Line Items]
Line of credit facility, fair value of amount outstanding		$ 52,500,000
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
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%
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%
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		$ 821,300,000		$ 843,800,000
Weighted average interest rate on debt		3%		1.40%
Term loan component of senior credit facility		$ 50,600,000		$ 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		803,600,000
2025 Notes | Convertible Debt
Debt Instrument [Line Items]
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%
Incremental financing costs capitalized	$ 13,200,000
Initial conversion rate	0.0135739
Initial conversion price (in dollars per share) | $ / shares	$ 73.67
Maximum selling price of the company's common stock of the conversion price	130%
Maximum average conversion value of notes	98%
Redemption price, percentage	100%
Warrant strike price (in dollars per share) | $ / shares	$ 113.34
Carrying amount, liability component					485,900,000
Unamortized discount					$ 89,100,000
Fair value		542,100,000
Cash interest		$ 1,400,000	$ 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

DEBT - Maximum Total Leverage R

DEBT - Maximum Total Leverage Ratio Table (Details) - Senior Credit Facility	Jul. 14, 2020
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, 2022 USD ($)
Debt Disclosure [Abstract]
Remainder of 2022	$ 22,500
2023	61,875
2024	67,500
2025	669,375
Principal Repayment	$ 821,250

DERIVATIVE INSTRUMENTS - Schedu

DERIVATIVE INSTRUMENTS - Schedule of Derivatives (Details) - Cash Flow Hedges - Designated as Hedging Instrument - USD ($)	Jun. 30, 2022	Dec. 31, 2021
Derivative [Line Items]
Estimated Fair Value, Asset (Liability)	$ 26,939,000	$ (43,957,000)
1-Month USD LIBOR
Derivative [Line Items]
Notional amount	1,775,000,000	1,775,000,000
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)	$ 681,000	(5,268,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 13, 2017 Tranche 2
Derivative [Line Items]
Notional amount	$ 150,000,000	150,000,000
Fixed Interest Rate	2.423%
Estimated Fair Value, Asset (Liability)	$ 1,937,000	(5,520,000)
1-Month USD LIBOR | Interest Rate Swap Designated December 13, 2017 Tranche 3
Derivative [Line Items]
Notional amount	$ 200,000,000	200,000,000
Fixed Interest Rate	2.313%
Estimated Fair Value, Asset (Liability)	$ 3,322,000	(7,421,000)
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)	$ (660,000)	(5,512,000)
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)	$ (361,000)	(5,464,000)
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)	$ (485,000)	(5,494,000)
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)	$ 253,000	(6,886,000)
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)	$ 19,000	(6,764,000)
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)	$ 17,938,000	3,552,000
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)	$ 4,295,000	$ 821,000

DERIVATIVE INSTRUMENTS - Narrat

DERIVATIVE INSTRUMENTS - Narrative (Details) € in Millions, SFr in Millions		3 Months Ended		6 Months Ended
	Sep. 30, 2021 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2021 USD ($)	Jun. 30, 2022 USD ($)	Jun. 30, 2022 CHF (SFr)	Jun. 30, 2021 USD ($)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Oct. 04, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Dec. 31, 2020 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value	$ 100,000
Designated as Hedging Instrument
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value		$ 52,068,000	$ (25,894,000)	$ 95,367,000		$ 62,391,000
Total derivatives designated as hedges — Assets		57,343,000		57,343,000					$ 16,497,000
Foreign Exchange Forward | Not Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount		4,200,000		4,200,000								$ 4,200,000
Gain (loss) reclassified into other income				(100,000)		(300,000)
Total derivatives designated as hedges — Assets		100,000		100,000					$ 200,000
Cross-currency swap
Derivative [Line Items]
Current notional amount		6,400,000	7,300,000	6,400,000		7,300,000							$ 471,600,000	SFr 420.1
Gain (loss) recorded in AOCL, change in fair value		21,100,000	(11,000,000)	21,500,000		29,200,000
Gain (loss) reclassified into other income		2,000,000	1,300,000	3,800,000		2,500,000
Gain expected to be reclassified to earnings in the next twelve months		3,600,000		3,600,000
Intercompany loan quarterly payments | SFr					SFr 5.8
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Current notional amount										$ 50,000,000
Gain (loss) reclassified into other income		19,300,000	(12,900,000)	25,800,000		30,000,000
Cross-currency swap | Net Investment Hedges
Derivative [Line Items]
Current notional amount	$ 52,000,000										€ 44.9
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument
Derivative [Line Items]
Settled notional amount				250,000,000	SFr 222.3
Gain (loss) recorded in AOCL				4,900,000
Current notional amount							$ 300,000,000	SFr 288.2
Gain (loss) recorded, net investment hedge, change in fair value		10,800,000	100,000	12,100,000		13,700,000
Gain (loss) reclassified into other income		1,000,000	$ 1,700,000	2,300,000		$ 3,400,000
Gain expected to be reclassified to earnings in the next twelve months		$ 8,500,000		8,500,000
Cross-currency swap | Long | Codman
Derivative [Line Items]
Current notional amount | SFr																SFr 291.2
Cross-currency swap | Short | Codman
Derivative [Line Items]
Current notional amount															$ 300,000,000
Currency Swap
Derivative [Line Items]
Gain (loss) recorded in AOCL, change in fair value				$ 1,600,000

DERIVATIVE INSTRUMENTS - Sche_2

DERIVATIVE INSTRUMENTS - Schedule of Cross Currency Swap Derivatives (Details)	Jun. 30, 2022 USD ($)	Jun. 30, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Dec. 31, 2021 CHF (SFr)	Oct. 04, 2021 USD ($)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)	Oct. 02, 2017 USD ($)	Oct. 02, 2017 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount	$ 6,400,000					$ 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)	26,939,000		$ (43,957,000)
Cash Flow Hedges | Designated as Hedging Instrument | Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount					$ 50,000,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross-currency swap
Derivative [Line Items]
Fair Value Asset (Liability)	9,362,000		(8,242,000)
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ (2,557,000)		(8,283,000)
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One | Long
Derivative [Line Items]
Fixed Rate	1.95%	1.95%
Aggregate Notional Amount | SFr		SFr 145,598,000		SFr 145,598,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap One | Short
Derivative [Line Items]
Fixed Rate	4.52%	4.52%
Aggregate Notional Amount	$ 150,000,000		150,000,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 11,919,000		41,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two | Long
Derivative [Line Items]
Fixed Rate	3%	3%
Aggregate Notional Amount | SFr		SFr 385,637,000		SFr 397,137,000
Cash Flow Hedges | Designated as Hedging Instrument | Codman | Cross Currency Interest Rate Swap Two | Short
Derivative [Line Items]
Fixed Rate	3.98%	3.98%
Aggregate Notional Amount	$ 432,911,000		$ 445,821,000

DERIVATIVE INSTRUMENTS - Sche_3

DERIVATIVE INSTRUMENTS - Schedule of Net Investment Hedges Derivatives (Details) € in Thousands, SFr in Thousands	Jun. 30, 2022 USD ($)	Jun. 30, 2022 CHF (SFr)	Jun. 30, 2022 EUR (€)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount	$ 6,400,000								$ 7,300,000	$ 471,600,000	SFr 420,100
Net Investment Hedges | Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount							$ 52,000,000	€ 44,900
Designated as Hedging Instrument | Net Investment Hedges | Cross-currency swap
Derivative [Line Items]
Aggregate Notional Amount				$ 300,000,000	SFr 288,200
Fair Value Asset (Liability)	8,700,000					$ 3,858,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One
Derivative [Line Items]
Fair Value Asset (Liability)	$ 5,740,000					2,503,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One | Long
Derivative [Line Items]
Fixed Rate	0%	0%	0%
Aggregate Notional Amount | €			€ 51,760
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap One | 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 Two
Derivative [Line Items]
Fair Value Asset (Liability)	$ 4,784,000					2,147,000
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Two | Long
Derivative [Line Items]
Fixed Rate	0%	0%	0%
Aggregate Notional Amount | €			€ 38,820
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Two | 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 Three
Derivative [Line Items]
Fair Value Asset (Liability)	$ 0					(792,000)
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Three | Long
Derivative [Line Items]
Fixed Rate	0%	0%	0%
Aggregate Notional Amount | SFr		SFr 222,300
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Swap Three | 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 Interest Rate Contract Four
Derivative [Line Items]
Fair Value Asset (Liability)	$ (1,824,000)					$ 0
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Contract Four | Long
Derivative [Line Items]
Fixed Rate	0%	0%	0%
Aggregate Notional Amount | SFr		SFr 288,210
Designated as Hedging Instrument | Net Investment Hedges | Cross Currency Interest Rate Contract Four | Short
Derivative [Line Items]
Fixed Rate	1.94%	1.94%	1.94%
Aggregate Notional Amount	$ 300,000,000

DERIVATIVE INSTRUMENTS - Fair V

DERIVATIVE INSTRUMENTS - Fair Value of Derivative Instruments By Balance Sheet Location (Details) € in Millions, SFr in Millions	Jun. 30, 2022 USD ($)	May 26, 2022 USD ($)	May 26, 2022 CHF (SFr)	Dec. 31, 2021 USD ($)	Oct. 04, 2021 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2021 EUR (€)	Jun. 30, 2021 USD ($)	Dec. 21, 2020 USD ($)	Dec. 21, 2020 CHF (SFr)
Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	$ 57,343,000			$ 16,497,000
Total derivatives designated as hedges — Liabilities	12,343,000			64,838,000
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount	1,800,000,000			1,800,000,000
Interest rate 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	4,369,000			0
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	24,619,000			4,373,000
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	62,000			18,187,000
Interest rate swap | Cash Flow Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	1,987,000			30,143,000
Cross-currency swap
Derivatives, Fair Value [Line Items]
Current notional amount	6,400,000							$ 7,300,000	$ 471,600,000	SFr 420.1
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount					$ 50,000,000
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	6,122,000			4,900,000
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	5,797,000			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	2,558,000			8,283,000
Cross-currency swap | Cash Flow Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	0			4,859,000
Cross-currency swap | Net Investment Hedges
Derivatives, Fair Value [Line Items]
Current notional amount						$ 52,000,000	€ 44.9
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument
Derivatives, Fair Value [Line Items]
Current notional amount		$ 300,000,000	SFr 288.2
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	8,472,000			5,120,000
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Other assets
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Assets	7,964,000			2,104,000
Cross-currency swap | Net Investment Hedges | Designated as Hedging Instrument | Other liabilities
Derivatives, Fair Value [Line Items]
Total derivatives designated as hedges — Liabilities	$ 7,736,000			$ 3,366,000

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
	Sep. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		$ 1,615,197	$ 1,529,331	$ 1,684,804	$ 1,514,867
Amount of Gain (Loss) Recognized in AOCL	$ 100
Balance, End of Period		1,660,917	1,574,981	1,660,917	1,574,981
Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(21,025)	(43,627)	(45,155)	(74,059)
Balance, End of Period		(13,215)	(49,963)	(13,215)	(49,963)
Cross-currency swap
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL		21,100	(11,000)	21,500	29,200
Designated as Hedging Instrument
Derivative Instruments, Gain (Loss) [Roll Forward]
Amount of Gain (Loss) Recognized in AOCL		52,068	(25,894)	95,367	62,391
Amount of Gain (Loss) Reclassified from AOCL into Earnings		18,355	(15,721)	22,792	24,435
Designated as Hedging Instrument | Accumulated Other Comprehensive Loss
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(17,103)	(59,004)	(55,965)	(107,133)
Balance, End of Period		16,610	(69,177)	16,610	(69,177)
Designated as Hedging Instrument | Interest rate swap | Cash Flow Hedges | Interest expense
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		2,932	(53,546)	(43,956)	(93,769)
Amount of Gain (Loss) Recognized in AOCL		20,116	(15,013)	61,790	19,505
Amount of Gain (Loss) Reclassified from AOCL into Earnings		(3,891)	(5,823)	(9,105)	(11,528)
Balance, End of Period		26,939	(62,736)	26,939	(62,736)
Designated as Hedging Instrument | Cross-currency swap | Cash Flow Hedges | Other income, net
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(17,703)	(5,029)	(9,688)	(1,073)
Amount of Gain (Loss) Recognized in AOCL		21,136	(10,969)	21,452	29,225
Amount of Gain (Loss) Reclassified from AOCL into Earnings		21,268	(11,635)	29,599	32,515
Balance, End of Period		(17,835)	(4,363)	(17,835)	(4,363)
Designated as Hedging Instrument | Cross-currency swap | Net Investment Hedges | Interest income
Derivative Instruments, Gain (Loss) [Roll Forward]
Balance, Beginning of Period		(2,332)	(429)	(2,321)	(12,291)
Amount of Gain (Loss) Recognized in AOCL		10,816	88	12,125	13,661
Amount of Gain (Loss) Reclassified from AOCL into Earnings		978	1,737	2,298	3,448
Balance, End of Period		$ 7,506	$ (2,078)	$ 7,506	$ (2,078)

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) $ / shares in Units, $ in Millions	6 Months Ended
	Jun. 30, 2022 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Grants in period, net of forfeitures (in shares) | shares	145,565
Options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 23.15
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation costs | $	$ 5.3
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 | $	$ 40.2
Weighted-average period for cost recognition	2 years
Awards granted during the period (in shares) | shares	363,326
Other than options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 64.65
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	130,753
Other than options, weighted average grant date fair value (in dollars per share) | $ / shares	$ 65.11
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	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Retirement Benefits [Abstract]
Net periodic benefit costs	$ 0.3	$ 0.6	$ 0.5	$ 1.2
Service cost component	0.6	$ 0.8	1.3	$ 1.7
Estimated fair value of plan assets	34.4		$ 34.4		$ 39.9
Defer payment and taxation, base salary, percentage (up to)			75%
Defer payment and taxation, bonus and other eligible cash compensation, percentage (up to)			100%
Deferred compensation plan, fair value of assets	$ 4.3		$ 4.3		$ 3.8

LEASES AND RELATED PARTY LEAS_3

LEASES AND RELATED PARTY LEASES - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2022 USD ($) renewal_option	Jun. 30, 2021 USD ($)
Operating Leased Assets [Line Items]
Number of renewal options (or more) | renewal_option	1
Operating lease expense	$ 10.2	$ 10.6
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%
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, 2022	Dec. 31, 2021
Lessee, Lease, Description [Line Items]
ROU assets	$ 145,135	$ 84,543
Current lease liabilities	12,743	14,775
Non-current lease liabilities	154,029	90,329
Total lease liabilities	$ 166,772	$ 105,104
Leased facilities
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	17 years 10 months 24 days	10 years 4 months 24 days
Weighted average discount rate	5.20%	5.10%
Leased vehicles
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term (in years)	2 years 1 month 6 days	2 years 1 month 6 days
Weighted average discount rate	2.70%	2.60%

LEASES AND RELATED PARTY LEAS_5

LEASES AND RELATED PARTY LEASES - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 8,798	$ 7,019
ROU assets obtained in exchange for lease liabilities:
Operating leases	$ 69,489	$ 10,528

LEASES AND RELATED PARTY LEAS_6

LEASES AND RELATED PARTY LEASES - Future Minimum Lease Payment Under Operating Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Operating Leased Assets [Line Items]
Remainder of 2022	$ 7,972
2023	18,318
2024	18,304
2025	16,801
2026	15,277
2027	14,876
Thereafter	165,163
Total minimum lease payments	256,711
Less: Imputed interest	89,939
Total lease liabilities	166,772	$ 105,104
Less: Current lease liabilities	12,743	14,775
Long-term lease liabilities	154,029	$ 90,329
Related Parties
Operating Leased Assets [Line Items]
Remainder of 2022	148
2023	296
2024	296
2025	296
2026	296
2027	296
Thereafter	246
Total minimum lease payments	1,874
Third Parties
Operating Leased Assets [Line Items]
Remainder of 2022	7,824
2023	18,022
2024	18,008
2025	16,505
2026	14,981
2027	14,580
Thereafter	164,917
Total minimum lease payments	$ 254,837

TREASURY STOCK - Narrative (Det

TREASURY STOCK - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	Jun. 30, 2022	Jan. 12, 2022	Dec. 31, 2021	Apr. 26, 2022	Mar. 24, 2022
Equity [Abstract]
Stock repurchase program, authorized amount (up to)				$ 225,000
Remaining amount under share repurchase				$ 100,000
Treasury stock (in shares)	6,823,000		4,899,000
Treasury stock	$ 362,900		$ 234,400
Treasury stock, average cost per share (in dollars per share)	$ 53.18		$ 47.86
Accelerated share repurchase program, receipt (payment)		$ 125,000
Accelerated share repurchases, shares received at inception		1,480,000
Accelerated share repurchases, percentage of expected total repurchased		80%
Accelerated share repurchases, additional shares received					460,000

INCOME TAXES - Summary of Effec

INCOME TAXES - Summary of Effective Tax Rate (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Reported tax rate	13.20%	21.80%	14.50%	28.20%

INCOME TAXES - Narrative (Detai

INCOME TAXES - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Effective income tax rate	13.20%	21.80%	14.50%	28.20%
Benefit related to excess tax benefits from stock compensation	$ 4,800		$ 5,700
Provision for income taxes	$ 6,787	$ 9,756	$ 13,201	$ 31,640

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, 2022	Mar. 31, 2022	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2022	Jun. 30, 2021
Basic net income per share:
Net income	$ 44,788	$ 32,901	$ 35,068	$ 45,394	$ 77,689	$ 80,462
Weighted average common shares outstanding - Basic (in shares)	83,168		84,687		83,400	84,593
Basic net income per common share (in dollars per share)	$ 0.54		$ 0.41		$ 0.93	$ 0.95
Diluted net income per share:
Net income	$ 44,788	$ 32,901	$ 35,068	$ 45,394	$ 77,689	$ 80,462
Weighted average common shares outstanding - Basic (in shares)	83,168		84,687		83,400	84,593
Effect of dilutive securities:
Stock options and restricted stock (in shares)	454		653		579	731
Weighted average common shares for diluted earnings per share (in shares)	83,622		85,340		83,979	85,324
Diluted net income per common share (in dollars per share)	$ 0.54		$ 0.41		$ 0.93	$ 0.94

NET INCOME PER SHARE - Narrativ

NET INCOME PER SHARE - Narrative (Details) - shares shares in Millions	Jun. 30, 2022	Jun. 30, 2021
Earnings Per Share [Abstract]
Shares excluded from computation as their effect would be antidilutive (in shares)	0.2	0.1

ACCUMULATED OTHER COMPREHENSI_3

ACCUMULATED OTHER COMPREHENSIVE LOSS - Schedule of Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2022	Jun. 30, 2021
Equity [Abstract]
Net income	$ 44,788	$ 32,901	$ 35,068	$ 45,394	$ 77,689	$ 80,462
Foreign currency translation adjustment	(18,067)		1,558		(23,749)	(5,243)
Change in unrealized gain (loss) on derivatives, net of tax	25,922		(7,804)		55,744	29,111
Pension liability adjustment, net of tax	(45)		(91)		(54)	228
Comprehensive income, net	$ 52,598		$ 28,731		$ 109,630	$ 104,558

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, 2022	Mar. 31, 2022	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2022
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	$ 1,615,197	$ 1,684,804	$ 1,529,331	$ 1,514,867	$ 1,684,804
Other comprehensive gain (loss)					48,695
Less: Amounts reclassified from accumulated other comprehensive income, net					16,755
Net current-period other comprehensive gain (loss)	7,810	24,130	(6,336)	30,432	31,940
Balance, End of Period	1,660,917	1,615,197	1,574,981	1,529,331	1,660,917
Total
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period	(21,025)	(45,155)	(43,627)	(74,059)	(45,155)
Net current-period other comprehensive gain (loss)	7,810	24,130	(6,336)	30,432
Balance, End of Period	(13,215)	(21,025)	$ (49,963)	$ (43,627)	(13,215)
Gains and Losses on Derivatives
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		(42,981)			(42,981)
Other comprehensive gain (loss)					72,499
Less: Amounts reclassified from accumulated other comprehensive income, net					16,755
Net current-period other comprehensive gain (loss)					55,744
Balance, End of Period	12,763				12,763
Defined Benefit Pension Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		1,893			1,893
Other comprehensive gain (loss)					(54)
Less: Amounts reclassified from accumulated other comprehensive income, net					0
Net current-period other comprehensive gain (loss)					(54)
Balance, End of Period	1,839				1,839
Foreign Currency Items
Accumulated Other Comprehensive Income (Loss) [Roll Forward]
Balance, Beginning of Period		$ (4,067)			(4,067)
Other comprehensive gain (loss)					(23,750)
Less: Amounts reclassified from accumulated other comprehensive income, net					0
Net current-period other comprehensive gain (loss)					(23,750)
Balance, End of Period	$ (27,817)				$ (27,817)

ACCUMULATED OTHER COMPREHENSI_5

ACCUMULATED OTHER COMPREHENSIVE LOSS - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Accumulated Other Comprehensive Income (Loss) [Line Items]
Other income, net	$ 1,979	$ 5,034	$ 5,408	$ 9,903
Investment Income, Interest	$ (1,965)	$ (1,764)	(3,342)	$ (3,512)
Gains and Losses on Derivatives | Reclassification out of Accumulated Other Comprehensive Income
Accumulated Other Comprehensive Income (Loss) [Line Items]
Other income, net			22,800
Investment Income, Interest			$ 5,200

SEGMENT AND GEOGRAPHIC INFORM_3

SEGMENT AND GEOGRAPHIC INFORMATION - Narrative (Details) product in Thousands	6 Months Ended
	Jun. 30, 2022 Segment product
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, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Segment Net Sales
Total Revenues	$ 397,815	$ 389,992	$ 774,453	$ 750,063
Segment Profit
Operating income	59,867	51,854	106,031	82,568
Amortization	(3,304)	(4,198)	(7,198)	(8,725)
Operating Segments
Segment Profit
Operating income	153,822	178,409	317,875	335,198
Corporate and other
Segment Profit
Operating income	(90,651)	(122,357)	(204,646)	(243,905)
Codman Specialty Surgical
Segment Net Sales
Total Revenues	257,863	256,837	505,171	498,078
Codman Specialty Surgical | Operating Segments
Segment Profit
Operating income	92,196	113,996	202,356	220,774
Tissue Technologies
Segment Net Sales
Total Revenues	139,952	133,155	269,282	251,985
Tissue Technologies | Operating Segments
Segment Profit
Operating income	$ 61,626	$ 64,413	$ 115,519	$ 114,424

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, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Segment Reporting Information [Line Items]
Total Revenues	$ 397,815	$ 389,992	$ 774,453	$ 750,063
United States
Segment Reporting Information [Line Items]
Total Revenues	287,347	278,186	550,698	525,979
Europe
Segment Reporting Information [Line Items]
Total Revenues	46,862	48,437	90,606	94,256
Asia Pacific
Segment Reporting Information [Line Items]
Total Revenues	43,365	44,306	91,082	91,601
Rest of World
Segment Reporting Information [Line Items]
Total Revenues	$ 20,241	$ 19,063	$ 42,067	$ 38,227

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, 2022	Jun. 30, 2021
Arkis
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, End of Period	$ 13,000	$ 14,800
Arkis | Short-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	3,691	3,415
Additions from acquisition of ACell		0
Transfers		(3,432)
Change in fair value of contingent consideration liabilities	(155)	17
Balance, End of Period	3,536	0
Arkis | Long-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	11,408	11,746
Additions from acquisition of ACell		0
Transfers		3,432
Change in fair value of contingent consideration liabilities	(1,978)	(402)
Balance, End of Period	9,430	14,776
Derma Sciences | Long-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	230	230
Additions from acquisition of ACell		0
Transfers	0	0
Change in fair value of contingent consideration liabilities	0	0
Balance, End of Period	230	230
ACell | Short-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	0
Transfers	4,885
Change in fair value of contingent consideration liabilities	(4,885)
Balance, End of Period	0
ACell | Long-term
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance, Beginning of Period	21,800	0
Additions from acquisition of ACell		23,900
Transfers	(4,885)	0
Change in fair value of contingent consideration liabilities	1,219	(400)
Balance, End of Period	$ 18,134	$ 23,500

COMMITMENTS AND CONTINGENCIES_2

COMMITMENTS AND CONTINGENCIES - Narrative (Details)		6 Months Ended
	Jul. 29, 2019 USD ($)	Jun. 30, 2022 USD ($) liability	Dec. 31, 2021 USD ($)	Jun. 30, 2021 USD ($)	Dec. 31, 2020 USD ($)
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
Arkis | Fair Value, Inputs, Level 3 | Contingent Consideration Liability
Loss Contingencies [Line Items]
Fair value		$ 13,000,000		$ 14,800,000
Arkis | Long-term | Fair Value, Inputs, Level 3 | Contingent Consideration Liability
Loss Contingencies [Line Items]
Fair value		9,430,000	$ 11,408,000	14,776,000	$ 11,746,000
Arkis | Accrued expenses and other current liabilities | Fair Value, Inputs, Level 3 | Contingent Consideration Liability
Loss Contingencies [Line Items]
Fair value		$ 3,500,000
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]
Number of contingent liabilities remaining | liability		1
Contingent consideration, maximum undiscounted payment amount		$ 3,000,000
Derma Sciences | Fair Value, Inputs, Level 3
Loss Contingencies [Line Items]
Contingent consideration, estimated fair value		200,000		200,000
Derma Sciences | Long-term | Fair Value, Inputs, Level 3 | Contingent Consideration Liability
Loss Contingencies [Line Items]
Fair value		230,000	$ 230,000	$ 230,000	$ 230,000
Derma Sciences | BioD Earnout Payments and Medihoney Earnout Payments
Loss Contingencies [Line Items]
Payment for contingent consideration		$ 33,300,000

Uncategorized Items - iart-2022

Label	Element	Value
Accounting Standards Update [Extensible Enumeration]	us-gaap_AccountingStandardsUpdateExtensibleList	Accounting Standards Update 2020-06 [Member]