Paragon 28 Inc (FNA) 2023 Q4 法說會逐字稿

Good afternoon, and welcome to Paragon 28 fourth quarter 2023 earnings conference call. (Operator Instructions) As a reminder, this call is being recorded for replay purposes.

下午好，歡迎參加 Paragon 28 2023 年第四季財報電話會議。（操作員說明）謹此提醒，此通話正在錄音以供重播之用。

I would now like to hand the conference over to your host today, Mr. Matt Brinckman, SVP of Strategy and Investor Relations. Mr. Brinckman, please go ahead when you're ready.

現在我想將會議交給今天的東道主，戰略和投資者關係高級副總裁 Matt Brinckman 先生。布林克曼先生，準備好後請繼續。

Good afternoon, and thank you for joining Paragon 28 fourth quarter 2023 financial results and earnings call. Presenting on today's call are Albert DaCosta, Chairman and Chief Executive Officer, and Steve Deitsch Chief Financial Officer.

下午好，感謝您參加 Paragon 28 2023 年第四季財務業績和收益電話會議。出席今天電話會議的有董事長兼執行長 Albert DaCosta 和財務長 Steve Deitsch。

Before we begin, I would like to remind you that management will make statements during this call that include forward-looking statements within the meaning of federal securities laws, which are made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995.

在我們開始之前，我想提醒您，管理層將在本次電話會議期間發表聲明，其中包括聯邦證券法含義內的前瞻性聲明，這些聲明是根據1995 年《私人證券訴訟改革法案》的安全港條款制定的。

Forward-looking statements include statements made as to the company's or management's intentions, hopes beliefs, expectations or predictions of future events, results, or performance. These forward-looking statements are subject to a number of risks, uncertainties, estimates, and assumptions that may cause actual results to differ materially from these forward-looking statements.

前瞻性陳述包括有關公司或管理階層的意圖、希望信念、對未來事件、結果或績效的期望或預測的陳述。這些前瞻性陳述受到許多風險、不確定性、估計和假設的影響，可能導致實際結果與這些前瞻性陳述有重大差異。

All forward-looking statements are based upon currently available information and Paragon 28 assumes no obligation, except as required by law to update those statements. Additional information concerning certain risks and uncertainties that may impact these forward-looking statements is contained from time to time in the company's SEC filings and in the press release that was issued earlier today.

所有前瞻性陳述均基於目前可獲得的信息，Paragon 28 不承擔任何義務，除非法律要求更新這些陳述。有關可能影響這些前瞻性陳述的某些風險和不確定性的更多信息，不時包含在該公司向 SEC 提交的文件和今天早些時候發布的新聞稿中。

During this presentation, we will refer to the non-GAAP financial measure of adjusted EBITDA and constant currency net revenue growth. A reconciliation to the most comparable GAAP financial measure, net income, and reporting net revenue growth is contained in our press release issued earlier today.

在本示範中，我們將參考調整後 EBITDA 和恆定貨幣淨收入成長的非 GAAP 財務指標。我們今天稍早發布的新聞稿中包含了與最具可比性的公認會計準則財務指標、淨利潤和報告淨收入成長的對帳。

And with that, I will now turn the call over to Albert.

現在，我將把電話轉給艾伯特。

Thanks, Matt. Good afternoon, and thank you for joining us for our fourth quarter 2023 earnings call. I will start things off with a review of our recent performance, followed by highlights from the quarter, and I'll pass it over to Steve to provide further details on our fourth quarter and full year financial results and an overview of our 2024 revenue guidance.

謝謝，馬特。下午好，感謝您參加我們的 2023 年第四季財報電話會議。我將首先回顧我們最近的業績，然後是本季度的亮點，然後我將把它交給史蒂夫，以提供有關我們第四季度和全年財務業績的更多詳細信息以及我們2024 年收入指導的概述。

Before diving into the results, I wanted to acknowledge our team's amazing work throughout 2023. This was a transformative year for Paragon 28, and we made significant progress in our transition into a more scalable organization for our next phase of growth. I want to thank this team for their unwavering resilience and teamwork to get us where we are today and for advancing our mission to improve foot and ankle patient outcomes.

在深入研究結果之前，我想對我們團隊在 2023 年所做的出色工作表示認可。對於 Paragon 28 來說，這是變革的一年，我們在轉型為更具可擴展性的組織以實現下一階段的成長方面取得了重大進展。我要感謝這個團隊堅定不移的韌性和團隊合作，使我們取得了今天的成就，並推進了我們改善足部和腳踝患者治療效果的使命。

Now turning to results. Global revenue for the full year 2023 with $216.4 million, representing 19.3% reported growth and 19.7% constant currency growth, in line with the top end of our preliminary revenue results provided on January 8. Once again, we saw balanced growth across all the five foot and ankle subsegments growing the entire business at nearly three times our overall market growth rate 7%.

現在轉向結果。2023 年全年全球收入為 2.164 億美元，報告成長率為 19.3%，以固定匯率計算成長率為 19.7%，與我們 1 月 8 日提供的初步收入結果的上限一致。我們再次看到所有五足和腳踝細分市場的均衡成長，整個業務的成長速度幾乎是我們整體市場成長率 7% 的三倍。

Fourth quarter '23 global revenue was $60.6 million, representing 17.6% reported growth and 17.3% constant currency growth compared to the fourth quarter of '22. We saw a nice 14.7% step-up compared to the third quarter of '23, reflective of the normalized seasonality we expected this year. This compares favorably to the 11% third to fourth quarter net revenue step-up we saw in '22 and reflects the improving supply chain environment.

23 年第四季全球營收為 6,060 萬美元，與 22 年第四季相比，報告成長 17.6%，以固定匯率計算成長 17.3%。與 2023 年第三季相比，我們看到了 14.7% 的成長，這反映了我們今年預期的正常化季節性。這與我們在 2022 年第三季至第四季淨收入成長 11% 相比毫不遜色，反映了供應鏈環境的改善。

Looking at the US business performance, I am pleased to say that our growth accelerated nicely compared to the third quarter. We have a lot to be positive about beyond the fourth quarter top line performance. In the fourth quarter of '23, we increased our US producing sales roster by almost 14% to 266 reps compared to the fourth quarter of '22 and grew our surgeon customer base by 9% to a record 2,215 surgeons. Both our rep roster and surgeon base are larger than ever, and these metrics are strongly indicative of our future growth potential as we expect to continue driving productivity increases on legacy products and new product launches.

看看美國的業務表現，我很高興地說，與第三季相比，我們的成長加快了。除了第四季的營收表現之外，我們還有很多值得樂觀的地方。與 22 年第四季相比，23 年第四季度，我們的美國生產銷售名冊增加了近 14%，達到 266 名代表，外科醫生客戶群增加了 9%，達到創紀錄的 2,215 名外科醫生。我們的代表名冊和外科醫生基礎都比以往任何時候都更大，這些指標強烈表明我們未來的成長潛力，因為我們預計將繼續推動傳統產品和新產品發布的生產力提高。

We've done a lot to bolster our medical education program, including the launch of a second mobile lab late in '23. Specifically designed for more metro markets. With this new mobile lab, we're able to cover more ground in the US, meeting our surgeons and reps at their respective sites of care for highly focused and efficient training.

我們做了很多事情來支持我們的醫學教育計劃，包括在 23 年末推出第二個行動實驗室。專為更多地鐵市場設計。有了這個新的行動實驗室，我們能夠涵蓋美國的更多地區，在各自的護理地點與我們的外科醫生和代表會面，進行高度集中和高效的培訓。

Our international business continues to do very well. We've invested heavily in our core markets and have established a direct or directly managed commercial model in 13 of our 22 international markets. We still have positive runway for P28 internationally as we continue to drive regional investments in our teams and infrastructure as well as regulatory initiatives like EU MDR to clear and launch more new products. In short, we continue to build momentum, and I'm excited for what the future holds for FNA and the surgeon community internationally.

我們的國際業務持續表現出色。我們在核心市場投入巨資，並在 22 個國際市場中的 13 個建立了直接或直接管理的商業模式。隨著我們繼續推動對團隊和基礎設施的區域投資以及歐盟 MDR 等監管舉措，以清理和推出更多新產品，P28 在國際上仍然有積極的發展空間。簡而言之，我們繼續積聚動力，我對 FNA 和國際外科醫生界的未來感到興奮。

Now, I want to shine a light on our innovation, which is critical to our growth and our mission to improve foot and ankle outcomes. In the fourth quarter of '23, we launched two new solutions with the Jaws Great White Nitinol Staple System and BEAST Cortical Fiber Bone Graft, which were both great additions to our portfolio. And now we are off to the races to start '24, but five meaningful product launches and one limited market release announced already in the first quarter.

現在，我想介紹我們的創新，這對於我們的成長以及我們改善足部和腳踝效果的使命至關重要。在 2023 年第四季度，我們推出了兩種新的解決方案：Jaws Great White 鎳鈦合金釘系統和 BEAST 皮質纖維骨移植物，它們都是我們產品組合的重要補充。現在，我們即將開始 24 年的競爭，但第一季已經宣布了五種有意義的產品發布和一項有限的市場發布。

It's important to note that these products launched so far in '24 are in high-growth foot and ankle segments like bunion, soft tissue, and minimally invasive surgery. In soft tissue, we have launched three solutions with the Grappler Knotless Anchor, Bridgeline Tape, and Mister Tendon Harvester, all of which will typically be used in conjunction with other procedures in our highly complementary to our existing plating and screw system.

值得注意的是，2024 年迄今推出的這些產品適用於高生長的足部和腳踝部位，如拇囊炎、軟組織和微創手術。在軟組織方面，我們推出了三種解決方案，包括 Grappler 無結錨、Bridgeline Tape 和 Mister Tendon Harvester，所有這些解決方案通常都會與其他程序結合使用，與我們現有的鋼板和螺絲系統高度互補。

Another solution is FJ2000 Power Console and Burr System designed specifically for the extremities and optimized for MIS surgery. This system features disposable handpieces and instruments that help streamline workflow and minimize the need for sterilization between cases, which allows surgeons to turn more cases in a day.

另一個解決方案是專為四肢設計並針對 MIS 手術進行最佳化的 FJ2000 電源控制台和毛邊系統。該系統採用一次性手機和器械，有助於簡化工作流程並最大限度地減少病例之間的滅菌需求，從而使外科醫生能夠在一天內處理更多病例。

Lastly, we launched the PRECISION MIS Bunion System and have our new Lapidus clamp, the Bun-Yo-Matic, unlimited market release. With these two solutions, P28 boasts a substantial range of offerings for treating bunions. Ultimately, our goal as a leader in foot and ankle and a real partner to our surgeons is to give surgeons multiple options to treat each patient's unique condition. We expect that these early 2024 product launches will generally start having a nice impact on top line in the second half of the year and substantially contribute in 2025.

最後，我們推出了 PRECISION MIS Bunion 系統，並推出了新的 Lapidus 夾具 Bun-Yo-Matic，無限市場發布。憑藉這兩種解決方案，P28 擁有大量治療拇囊炎的產品。最終，作為足部和腳踝領域的領導者和外科醫生的真正合作夥伴，我們的目標是為外科醫生提供多種選擇來治療每位患者的獨特病症。我們預計 2024 年初推出的這些產品通常會在下半年開始對營收產生良好影響，並在 2025 年做出重大貢獻。

I'm so proud of the design teams and engineers that brought these truly innovative solutions to life. And we are excited to see them all hit the market. Of course, it's only February, and we have a lot more to look forward to in 2024 on the product front, with over 25 active projects, including our first reveal of the SMART28 platform expected midyear.

我為將這些真正創新的解決方案變為現實的設計團隊和工程師感到非常自豪。我們很高興看到它們全部投放市場。當然，現在只是 2 月份，2024 年我們在產品方面還有很多值得期待的事情，有超過 25 個活躍項目，包括預計在年中首次發布的 SMART28 平台。

Smart28 software has already been incredibly beneficial for our internal development, and we are excited to share it once ready. Our balanced and innovative portfolio galvanizes P28 as a strong partner to the surgeon community and an ideal home for the most passionate foot and ankle salespeople.

Smart28 軟體已經對我們的內部開發非常有益，我們很高興在準備好後分享它。我們平衡和創新的產品組合使 P28 成為外科醫生界的強大合作夥伴，也是最熱情的足部和腳踝銷售人員的理想家園。

In closing, I am pleased with the progress we made in 2023, but even more excited about 2024 and beyond. We made significant investments in '23 to enhance our infrastructure, teams, and processes to enable P28 to realize its full potential.

最後，我對我們在 2023 年的進展感到高興，但對 2024 年及以後的發展更加興奮。我們在 '23 進行了大量投資，以增強我們的基礎設施、團隊和流程，使 P28 能夠充分發揮其潛力。

We also fortified our balance sheet and combined with our focus on profitability and cash flow improvements, we have plenty of liquidity to get us to cash flow breakeven. Underlying demand in foot and ankle continues to be very strong, and we are in a great position to execute on our mission to improve foot and ankle patient outcomes across the globe.

我們也強化了資產負債表，再加上我們對獲利能力和現金流改善的關注，我們擁有充足的流動性，可以使我們實現現金流收支平衡。足部和腳踝的潛在需求仍然非常強勁，我們處於有利地位，可以履行我們的使命，改善全球足部和腳踝患者的治療效果。

With that, I will now turn it over to Steve.

有了這個，我現在將把它交給史蒂夫。

Thank you, Albert. Paragon 28s fourth quarter 2023 revenue was $60.6 million, representing 17.6% and 17.3% reported in constant currency year-over-year growth, respectively. Our US revenue was $51.7 million, representing 14.1% growth over the prior year quarter. Our international revenue was $8.9 million, representing 43.1% and 40.7% reported and constant currency year-over-year growth. Importantly, we continue to see solid balanced growth from each of our foot and ankle segments.

謝謝你，艾伯特。Paragon 28 2023 年第四季的營收為 6,060 萬美元，以固定匯率計算，年成長分別為 17.6% 和 17.3%。我們在美國的營收為 5,170 萬美元，比去年同期成長 14.1%。我們的國際收入為 890 萬美元，分別佔報告和固定貨幣年增率的 43.1% 和 40.7%。重要的是，我們繼續看到我們的腳和腳踝各個部分都保持穩定、平衡的成長。

Supply chain headwinds continued into the fourth quarter, but we're in line with our expectations, and we're far less significant than the impacts we experienced during the second and third quarters of 2023. Importantly, our supply chain environment continues to improve.

供應鏈逆風持續到第四季度，但符合我們的預期，而且遠不如 2023 年第二季和第三季所經歷的影響嚴重。重要的是，我們的供應鏈環境持續改善。

Gross profit margin for the quarter was 74.5% compared to 81.5% in the fourth quarter of '22. For the full year '23, gross profit margin was 79.9% compared to 82.1% for the full year '22. Related to the recent inventory stockpiling, the company recorded non-cash inventory write-downs totalling $4 million during the fourth quarter of '23, which reduced fourth quarter and full year '23 gross profit margin by 6.6-percentage-points and 1.8-percentage-points, respectively.

該季度的毛利率為 74.5%，而 2020 年第四季的毛利率為 81.5%。23 年全年的毛利率為 79.9%，而 22 年全年的毛利率為 82.1%。與最近的庫存庫存相關，該公司在 23 年第四季記錄了總計 400 萬美元的非現金庫存減記，這使 23 年第四季和全年毛利率分別下降了 6.6 個百分點和 1.8 個百分點- 點，分別。

This adjustment had no impact on our operations during the fourth quarter, and we expect our annual gross profit margin to continue to be approximately 80% going forward. We've also continued to drive significant operating leverage. Fourth Quarter 2023, SG&A and R&D expenses combined for $56.4 million, a 10.5% increase compared to the fourth quarter of '22. And importantly, the increase from the prior year was driven by increases in R&D and sales and marketing initiatives.

此次調整對我們第四季的營運沒有影響，我們預計未來全年毛利率將持續維持在80%左右。我們也持續提高營運槓桿率。2023 年第四季度，SG&A 和研發費用合計為 5,640 萬美元，比 2022 年第四季成長 10.5%。重要的是，與前一年相比的成長是由研發以及銷售和行銷活動的增加所推動的。

Adjusted EBITDA for the fourth quarter of 2023 was a $4.4 million loss compared to a $1.5 million loss in the prior year period. For the full year 2023, adjusted EBITDA was $9.7 million loss, an improvement of $1 million compared to the prior year period. Both fourth quarter and full year 2023 adjusted EBITDA included the $4 million inventory write-down. We expect operating leverage to continue to improve in 2024, and we are committed to driving positive adjusted EBITDA on an annual basis beginning this year.

2023 年第四季調整後 EBITDA 虧損 440 萬美元，而去年同期虧損 150 萬美元。2023 年全年，調整後 EBITDA 虧損 970 萬美元，比去年同期減少 100 萬美元。2023 年第四季和全年調整後 EBITDA 均包括 400 萬美元的庫存減記。我們預計營運槓桿率將在 2024 年繼續改善，並且我們致力於從今年開始每年推動調整後的 EBITDA 為正值。

Now turning to cash flow and liquidity. Our operating cash use for '22 and '23 combined totalled approximately $113 million compared to approximately breakeven operating cash flow in both '20 and' 21.

現在轉向現金流和流動性。我們 22 年和 23 年的營運現金使用總額約為 1.13 億美元，而 20 年和 21 年的營運現金流量均約為損益兩平。

On our last earnings call, we noted three specific items contributing to most of the operating cash use during '22 and '23, including inventory stockpiling, a nonrecurring legal settlement ,and negative adjusted EBITDA. We believe the cash flow headwinds associated with each of these items will become a tailwind throughout 2024 and beyond.

在我們上次的財報電話會議上，我們注意到三個具體項目在 22 年和 23 年期間貢獻了大部分營運現金使用，包括庫存庫存、非經常性法律和解和負調整 EBITDA。我們相信，與這些項目相關的現金流逆風將在 2024 年及以後成為順風。

We have approximately $125 million of total liquidity, consisting of $75 million of cash on the balance sheet and $50 million available through our credit facilities. As we continue to lever our growth investments made in '22 and '23 and continue to execute on our plans to improve inventory efficiency. We expect our liquidity will allow us to reach cash flow breakeven.

我們擁有約 1.25 億美元的總流動資金，其中包括資產負債表上的 7,500 萬美元現金和透過我們的信貸額度提供的 5,000 萬美元。我們將繼續利用 22 年和 23 年的成長投資，並繼續執行我們提高庫存效率的計畫。我們預計我們的流動性將使我們能夠實現現金流收支平衡。

Now turning to our 2024 revenue guidance. We feel great about our start to '24. In the first quarter in developing in line with our expectations among other things, our revenue guidance takes into consideration the improving supply chain environment and an expanded sales channel armed with several exciting and high impact new product launches.

現在轉向我們的 2024 年收入指引。我們對 24 週年的開局感覺很好。在第一季的發展符合我們的預期等方面，我們的收入指引考慮到供應鏈環境的改善和銷售管道的擴大，以及幾項令人興奮和高影響力的新產品的發布。

Further, that assumes the foot and ankle market continues to outpace broader orthopedic market growth, which is consistent with the demand we have seen to start the year. And of course, our view is also balanced with respect to what we can control, including the macro-economic environment. For the full year of 2024, we estimate net revenue to be between $249 million to $259 million, representing a range of 15% to 20% growth.

此外，假設足部和腳踝市場的成長繼續超過更廣泛的骨科市場的成長，這與我們年初看到的需求一致。當然，對於我們能夠控制的因素，包括宏觀經濟環境，我們的看法也是平衡的。我們預計 2024 年全年淨收入將在 2.49 億美元至 2.59 億美元之間，成長 15% 至 20%。

P28 grew net revenue, 25.8% reported and 27.1% constant currency in the first quarter of 2023, making the first quarter of '24 our toughest growth comparison of the year. Additionally, we have one less billing day in the first quarter of '24, which creates a 100 to 200 basis point headwind.

2023 年第一季度，P28 的淨收入成長了 25.8%，以固定匯率計算成長了 27.1%，這使得 24 年第一季度成為我們今年最艱難的成長比較。此外，我們在 2024 年第一季減少了一個計費日，這造成了 100 到 200 個基點的逆風。

Beyond the first quarter, we anticipate seasonality will continue to be more normal. We also expect quarterly growth rates for the rest of the year are likely to be higher than in the first quarter of '24 given dynamics of the year-over-year growth rate comparisons and the timing of our new product launches. Lastly, our net revenue guidance also assumes foreign currency translation rates remain consistent with current translation rates. That is the end of our prepared remarks.

在第一季之後，我們預計季節性將繼續更加正常。考慮到同比成長率比較的動態以及我們新產品發布的時間，我們也預期今年剩餘時間的季度成長率可能會高於 2024 年第一季。最後，我們的淨收入指引也假設外幣換算率與目前換算率一致。我們準備好的演講到此結束。

(Operator Instructions) Matthew O'Brien, Piper Sandler.

（操作員說明）Matthew O'Brien、Piper Sandler。

Hey. Thanks for taking the questions. Maybe just talk a little bit about for starters Q4 and especially domestically, I know was a nice step up sequentially from Q3, but we have been flatlining a little bit in terms of two-year stacked growth. So what are you seeing in the marketplace domestically? How big of a headwind was the supply chain issue still in Q4? And is that behind you now at this point as we head into 2024?

嘿。感謝您提出問題。也許只是先談談第四季度，尤其是在國內，我知道與第三季度相比，這是一個很好的進步，但就兩年的疊加增長而言，我們一直在持平。那麼您在國內市場上看到了什麼？第四季供應鏈問題的阻力有多大？當我們邁入 2024 年時，您現在是否已經忘記了這一點？

Hey, Matt, it's Steve. Thanks for the question. And we continue to see our US business strengthen. And importantly, we continue to see the supply chain headwinds lessen. And as we begin the year, we're largely through the headwinds, and we're really pleased to see that we still have a few select SKUs, but by and large, we are in really good shape and really pleased to see that US business improved so much sequentially compared to the third quarter.

嘿，馬特，我是史蒂夫。謝謝你的提問。我們的美國業務繼續增強。重要的是，我們繼續看到供應鏈的阻力正在減少。當我們開始今年的時候，我們基本上已經度過了逆風，我們很高興看到我們仍然有一些精選的 SKU，但總的來說，我們的狀態非常好，並且很高興看到美國與第三季相比，業務連續改善了許多。

And it was, I think, a record sequential improvement into the fourth quarter for us at 14%. So really, really happy about that. And also our supply chain team has done a really nice job of rectifying the challenges that really impacted us heavily in the second and third quarters of last year.

我認為，第四季度我們的連續改善達到了創紀錄的 14%。對此真的非常非常高興。我們的供應鏈團隊在糾正去年第二季和第三季對我們產生重大影響的挑戰方面也做得非常出色。

Got it. And then on the guidance side, you know, nice to see that's the high end of the range, still touching 20 off of a pretty difficult comparison here. So maybe just talk a little bit about the range here that we're seeing low end to high end. What's embedded in there as far as market growth?

知道了。然後在指導方面，你知道，很高興看到這是範圍的高端，仍然比這裡相當困難的比較低 20。所以也許只是談談我們所看到的從低端到高端的範圍。就市場成長而言，其中蘊藏著什麼？

And then, Steve, I didn't hear you talk about adjusted EBITDA this year. I thought we were expecting breakeven this year, is that right? Thank you.

然後，史蒂夫，我沒有聽到你談論今年調整後的 EBITDA。我以為我們今年有望達到收支平衡，對嗎？謝謝。

Yeah. Happy to answer both of those. So I would start with and then Albert will come in here on the -- on our guide for this year. We're incredibly confident in this business. We've really gotten off to a strong start this year. And we've consistently said this is a 20% better top line growth business. So the top end of our guidance reflects that and what drives that the tip of the spear, as we've said before, is our innovative and broad product portfolio. And we also have some really exciting new launches to add to that broad portfolio that we've just put in place and are just getting going.

是的。很高興回答這兩個問題。所以我首先要介紹的是，然後阿爾伯特將在我們今年的指南中加入。我們對這項業務充滿信心。今年我們確實有了一個好的開始。我們一直表示，這是一項營收成長 20% 的業務。因此，我們的指導方針的頂端反映了這一點，正如我們之前所說，推動矛尖的是我們創新和廣泛的產品組合。我們還推出了一些非常令人興奮的新產品，以添加到我們剛剛推出並即將開始的廣泛產品組合中。

So the products and then also our growth is enabled by our incredible commercial team, which grows in size and quality every quarter. So it's exciting to have this terrific portfolio and an expanding portfolio. And that gets us to the high end of the range, which is consistent with what we've talked about in the past. When you think about the low end, we've typically said we can't controls certain things like the macro-economic environment. So consistent with the way we've done this before, the 15% takes into account certain things that are outside of our control. So 15% to 20%, it's two to three times the market growth rate of 7%. So pretty pleased with that kind of a guide going into this year as we start the year.

因此，產品以及我們的成長都是由我們令人難以置信的商業團隊推動的，他們每季的規模和品質都在成長。因此，擁有這個出色的產品組合和不斷擴大的產品組合是令人興奮的。這使我們達到了該範圍的高端，這與我們過去討論的內容是一致的。當你考慮低端時，我們通常會說我們無法控制某些事情，例如宏觀經濟環境。與我們之前的做法一致，15% 考慮了某些我們無法控制的事情。所以15%到20%，是市場成長率7%的兩到三倍。我們對今年開始時的這種指南非常滿意。

And then Albert, I know had some comments on the tech.

然後阿爾伯特，我知道對這項技術有一些評論。

Yeah, no, absolutely. And hey, Matt, how are you doing? You know, it's interesting just coming off a conference season. We got to showcase some of the new products there. The energy was pretty amazing surrounding that. I think it's just kicking this year off with a wonderful push. We launched several new products in the Bunion space.

是的，不，絕對是。嘿，馬特，你好嗎？你知道，剛結束會議季很有趣。我們必須在那裡展示一些新產品。周圍的能量非常驚人。我認為這只是今年一個精彩的推動力。我們在拇囊炎領域推出了幾款新產品。

We had a couple of soft tissue introductions, a couple of things on beta launch. But while we had a really, really good reception on that. The products are kind of jazzing up our internal teams as well. So we've got a lot of positivity and good momentum going into the year.

我們有一些軟組織介紹，以及測試版發佈時的一些內容。但儘管我們對此的反應非常非常好。這些產品也讓我們的內部團隊充滿活力。因此，今年我們有很多積極的態度和良好的勢頭。

And I didn't answer your second question, Matt. So positive EBITDA, absolutely. We will have positive EBITDA on an annual basis this year.

我沒有回答你的第二個問題，馬特。EBITDA 絕對是正值。今年我們的年度 EBITDA 將為正值。

Great. Thanks. I appreciate that.

偉大的。謝謝。我很感激。

You got to. Thank you.

你必須這樣做。謝謝。

(Operator Instructions) Craig Bijou, Bank of America.

（操作員說明）Craig Bijou，美國銀行。

Good afternoon. Thanks for taking the questions. Maybe to follow up on some of the products, Albert, or Steve, how to think about the contribution from especially the Bunion products you guys mentioned, how well that market is growing. And then you also mentioned Smart28. So we've been hearing a lot about it. I think there's a lot of excitement around it. Would love to understand kind of how you're monetizing that and what exactly you do we are going to bring to the market this year?

午安.感謝您提出問題。也許是為了跟進一些產品，阿爾伯特或史蒂夫，如何思考你們提到的拇囊炎產品的貢獻，以及該市場的成長情況。然後你還提到了Smart28。所以我們已經聽到很多關於它的消息。我認為周圍有很多令人興奮的事情。很想了解你們如何將其貨幣化以及今年我們將向市場推出什麼產品？

You got it. Hey Craig, good to hear from you. It is great to see a lot of you at the AAOS Conference as well. I know I talked a lot of your peers off just getting into some of the technology that we're so excited about. On the bunion space. You know, there's I think I'll start off by saying we've always been a company that respects that there's easily four, maybe five different pathologies that relate to bunions. And each one of those pathologies really have different considerations for surgeons.

你說對了。嘿克雷格，很高興收到你的來信。很高興在 AAOS 會議上見到你們。我知道，我剛接觸了一些我們非常興奮的技術，就讓很多同行望而卻步。在拇囊炎空間上。你知道，我想我首先要說的是，我們一直是一家尊重與拇囊炎相關的四種、也許五種不同病症的公司。每種病理學對於外科醫生來說都有不同的考慮因素。

And so we've been the company that's trying to give surgeons meaningful opportunities to address the unique aspects of each of those different pathologies. And you could see that with some of the products we launched during this conference season, right. We -- the Bun-Yo-Matic to start is addressing more severe type cases where we tend to go further back into the tote to correct it.

因此，我們一直致力於為外科醫生提供有意義的機會來解決每種不同病理的獨特方面。您可以從我們在本次會議期間推出的一些產品中看到這一點，對吧。我們——Bun-Yo-Matic 首先是解決更嚴重的類型情況，我們傾向於進一步回到手提包來糾正它。

The guide gives surgeons a sense of comfort that even though the patients not in a weight-bearing position, we can replicate some of those important aspects, so that our correction is giving surgeons the correction that is really important when the patient is going to bear weight. So that system -- the ability for surgeons to create such reproducibility with that has been pretty exciting. And I think when surgeons get their hands on it. They immediately understand that aspect and they're pretty excited.

該指南為外科醫生提供了一種舒適感，即使患者沒有處於負重位置，我們也可以複製其中一些重要方面，以便我們的校正為外科醫生提供當患者要承受重量時非常重要的校正重量。因此，外科醫生能夠利用該系統創造如此可重複性的能力非常令人興奮。我認為當外科醫生接觸到它時。他們立即明白了這一點，並且非常興奮。

The other part we just introduced minimally invasive surgery for bunions. It's the PRECISION MIS Bunion product. That product is pretty exciting as well. In Europe, they really started doing this probably 10-plus years ago. So the US is a little bit late to the game there, but it didn't give us a chance to really learn about the complexities of that procedure, the benefits, how to perfectly address it.

另一部分我們剛介紹了拇囊炎的微創手術。這是 PRECISION MIS Bunion 產品。該產品也非常令人興奮。在歐洲，他們真正開始這樣做可能是十多年前。因此，美國在這方面的行動有點晚了，但它並沒有給我們機會真正了解該程序的複雜性、好處以及如何完美解決它。

And so we've got the PRECISION MIS system that has a really unique guide that gives surgeons the ability to kind of dial in the correction in every single plane. That's really nice when you're going through a small incision and you don't have the visibility that you're used to in the operating room. This guide can give you a good sense of comfort and the single surgeon can do that by him or herself.

因此，我們擁有了 PRECISION MIS 系統，該系統具有真正獨特的導向裝置，使外科醫生能夠在每個平面上進行校正。當您經歷一個小切口並且您沒有在手術室中習慣的可見度時，這真的很好。本指南可以給您帶來良好的舒適感，並且單一外科醫生可以自己完成。

The other thing, the drawback to some of these MIS surgeries is we tend to use burrs and not saw blades. So we've launched the first ever completely disposable handpiece that has the perfect combination of torque and speed to allow surgeons to comfortably burr the joint and prepare that for not the joint -- sorry, their osteotomy and prepare that for fusion with the comfort that we’re not overdoing it on the speed and we’re not going to burn and char the bone, which compromised some of the healing characteristics there. So just a really amazing compliment.

另一方面，一些 MIS 手術的缺點是我們傾向於使用毛邊而不是鋸片。因此，我們推出了首款完全一次性的手機，它具有扭矩和速度的完美結合，使外科醫生能夠舒適地對關節進行毛刺，並為非關節做好準備——對不起，他們的截骨術並為融合做好準備，舒適度很高。我們不會在速度上做得太過分，我們也不會燒傷和燒焦骨頭，這會損害那裡的一些癒合特性。這是一個非常了不起的讚美。

We also launched the product and I won't go too deep into the rest of these. But you know, this is my sweet spot. We also launched a first of its kind. It's a Tendon Harvester for flat foot reconstruction or PCFD. That product is really, really unique and it allows the surgeons to not have to do such a dramatic incision and to access the real bottom side of the flight to get that Tendon Harvested.

我們也推出了該產品，我不會太深入地討論其餘的內容。但你知道，這是我的甜蜜點。我們也推出了同類產品中的第一個。這是一款用於扁平足重建或 PCFD 的肌腱收割機。該產品確實非常獨特，它使外科醫生不必進行如此戲劇性的切口，並且可以進入飛行器的真正底部來收穫肌腱。

It really is the first of its kind, and I'll tell you every surgeon that's put their hands on that product so far has been pretty excited to use it. So we're optimistic about all of that. And I'll leave the soft tissue stuff, maybe for another conversation, but we've got some really exciting things on the soft tissue side as well. So thank you for the question. Really excited about that.

這確實是同類產品中的第一個，我會告訴你，到目前為止，每位接觸過該產品的外科醫生都非常興奮地使用它。所以我們對這一切都持樂觀態度。我將留下軟組織的內容，也許是為了另一次談話，但我們在軟組織方面也有一些非常令人興奮的事情。謝謝你的提問。對此真的很興奮。

You did ask a question about Smart28. We still expect to launch our first module of Smart28 near about the mid-market the year. That product is the -- you know, how excited I am about that. Our general theme around a lot of these procedures is how important the millimeters of correction are. And we're really working on systems that are going to give surgeons the sense of confidence that they're going to have those millimeters addressed in every single procedure they do.

您確實問過有關 Smart28 的問題。我們仍然預計今年將在中階市場推出我們的第一個 Smart28 模組。該產品是——你知道，我對此感到多麼興奮。我們圍繞著許多此類程序的總體主題是修正毫米數的重要性。我們真正致力於開發一個系統，讓外科醫生有信心在他們所做的每一個手術中都能解決這些毫米問題。

So when we see that system that module, I think it's going to create an aha moment for a lot of the market there that might not totally understand what Smart28 means. But when we introduce that, we're pretty excited that it's going to make a lot of sense to you all. That's coming about the mid-market. We've got a bunch of products slated for the end of the year. I will tell you this year, in particular, has a lot of big key product launches that makes this a pretty exciting time for us.

因此，當我們看到該系統該模組時，我認為這將為許多可能不完全理解 Smart28 含義的市場創造一個頓悟時刻。但當我們介紹這一點時，我們非常興奮，因為它會對你們所有人產生很大的意義。這即將發生在中端市場。我們計劃在今年底推出一系列產品。我要告訴你的是，今年有很多重大的關鍵產品發布，這對我們來說是一個非常令人興奮的時刻。

Great. Thanks. And maybe to follow up on one of Matt's questions earlier on US and OUS and really how to think about those growth rates going forward? And if you had a 20% growth target, or would you guys consider your revenue growth longer term or just how to think about the growth of the company? So what's the split in the US and OUS? In '23, we saw it a little bit lower in the US. So should we assume that the US growth is slightly below that 20% level or would be less than the overall company. Just maybe a little bit of color on how to think about that in '24 and maybe beyond.

偉大的。謝謝。也許是為了跟進馬特早些時候關於美國和海外的問題之一，以及如何真正考慮未來的成長率？如果你們有 20% 的成長目標，或者你們會考慮長期的營收成長，還是只是如何考慮公司的成長？那麼美國和海外的分歧是什麼呢？23 年，我們看到美國的數字略低一些。因此，我們是否應該假設美國的成長率略低於 20% 的水平，或低於整個公司的成長率。也許只是關於如何在 24 年甚至更遠的時間思考這個問題的一些色彩。

Yeah, happy to help with that. I think it's clear to us that our '23 growth rate in the US was impacted by the supply chain issues that we have managed largely through at this point. And we posted a 16% growth rate. Into the fourth quarter, we accelerated 300 basis points from the third quarter. So we are pleased to see that. We expect this business in the US to be a 20% grower.

是的，很高興能提供協助。我認為我們很清楚，我們 23 年在美國的成長率受到了供應鏈問題的影響，而我們目前基本上已經解決了這些問題。我們公佈了 16% 的成長率。進入第四季度，我們比第三季度加快了300個基點。所以我們很高興看到這一點。我們預計美國的這項業務將成長 20%。

And we talk about the overall business is 20% or greater. But this US business is that type of performance. And it's a very, very large market. We still have a very large or small market share, and we think we have the most innovative portfolio in the marketplace and an expanding portfolio. So we're going to continue to grow this things at multiples of markets, and we're excited to get the supply chain challenges behind us.

我們談論的整體業務是20%或更高。但這家美國企業就是這樣的表現。這是一個非常非常大的市場。我們仍然擁有很大或很小的市場份額，我們認為我們擁有市場上最具創新性的產品組合和不斷擴大的產品組合。因此，我們將繼續在多個市場上發展這種產品，我們很高興能夠克服供應鏈挑戰。

(Operator Instructions) George Sellers, Stephens Inc.

（操作員說明）George Sellers，Stephens Inc.

Hey, good afternoon and thanks for taking the questions. Maybe looking at the international piece of the business, I'm just curious if you could help parse out a little bit some of the growth drivers there. How much of that growth is related to increasing your direct sales exposure versus adding new surgeons or know getting your existing surgeons to use more of your device portfolio. What are some of the puts and takes that are really driving that 40%-plus growth that we've seen.

嘿，下午好，感謝您提出問題。也許看看該業務的國際部分，我只是好奇您是否可以幫助解析其中的一些成長動力。這種增長有多少與增加您的直接銷售曝光率有關，而不是增加新的外科醫生或知道讓您現有的外科醫生更多地使用您的設備組合。哪些看跌期權和看跌期權真正推動了我們所看到的 40% 以上的成長。

Hey, George, it's Steve. I'll start and Albert will talk about this. This has been a really exciting year in time for our international business, and we expect that momentum to continue. A 44% constant currency growth rate in '23 is on a pretty good-sized number as that business has scaled. We've invested there George. So we've invested in teams, systems, medical education, and a lot of areas post-IPO to really give us some firepower there to take advantage of the market.

嘿，喬治，我是史蒂夫。我先開始，艾伯特會談論這個。對於我們的國際業務來說，今年是非常令人興奮的一年，我們預計這種勢頭將繼續下去。隨著業務規模的擴大，23 年 44% 的恆定貨幣成長率是一個相當不錯的數字。我們在那裡投資了喬治。因此，我們在團隊、系統、醫學教育和首次公開募股後的許多領域進行了投資，真正為我們提供了一些火力來利用市場。

We talk about our US market share being small, but it's even smaller internationally. So this is an area of focus for us and specifically where the growth came from in '23 was a lot of different places. Our big three markets of the UK, Australia, and South Africa had amazing years and maybe specifically, I'll call out the UK. They were awarded our Country of the Year at the recent international sales meeting, and they've just done an amazing job. It's a big market. We've got a big business developing there and we've got great leadership and a great sales team. So a lot of good things going on there.

我們說我們的美國市場份額很小，但在國際上更小。所以這是我們關注的一個領域，特別是 23 年的成長來自許多不同的地方。我們的三大市場英國、澳洲和南非經歷了令人驚嘆的幾年，也許我會特別提到英國。他們在最近的國際銷售會議上被授予我們的年度國家獎，他們的工作非常出色。這是一個很大的市場。我們在那裡發展了一項大業務，我們擁有出色的領導力和出色的銷售團隊。所以那裡發生了很多好事。

And then we also have markets that aren't new to us, but markets that we've invested more in and we put new teams in place and more folks on the ground in places like Germany, Italy, new relationships in Spain, Canada, we're looking at later in this year, Japan, maybe early '25. So a lot of exciting things on tap outside the US.

然後，我們也有一些對我們來說並不陌生的市場，但我們在這些市場上投入了更多資金，我們在德國、義大利等地建立了新的團隊，並在當地部署了更多的人員，在西班牙、加拿大建立了新的關係，我們正在關註今年稍後的日本，也許是 25 年初。因此，在美國境外有很多令人興奮的事情。

And one thing in, hey, by the way, great to hear from you, George, but one other thing I'll add to that. As you know, there's a regulatory delay that we experience in the international market. So it's a little bit different than what we have here in the US. So what you tend to see is that when we launch a product here, you can take one, two years plus before we might have access to some of those products internationally. So it really is a combination one. We're very selective when we look at new countries and opportunities there. We want to make sure we're a very clinically oriented organization, our product development strategy is typically very clinically oriented, and we want to make sure we find partners and territories that match that very academic type countries. So we're very selective about where we go. But so far, the reception everywhere we have gone has been overwhelmingly positive.

還有一件事，嘿，順便說一句，很高興收到你的來信，喬治，但我還要補充另一件事。如您所知，我們在國際市場上遇到了監管延遲。所以這與我們在美國的情況有點不同。所以你往往會看到，當我們在這裡推出一款產品時，你可能需要一兩年多的時間，我們才能在國際上獲得其中一些產品。所以它確實是一個組合。當我們尋找新的國家和那裡的機會時，我們非常有選擇性。我們希望確保我們是一個非常以臨床為導向的組織，我們的產品開發策略通常非常以臨床為導向，並且我們希望確保我們找到與非常學術型國家相匹配的合作夥伴和地區。所以我們對去哪裡非常有選擇性。但到目前為止，我們所到之處的反應都是極為正面的。

The second piece of that is, like I mentioned, you tend to see some of the legacy products go into these territories and then you see a staggered introduction of subsequent products. And so that for us is pretty exciting because we continue to have opportunities to grow even those more established territories that we've been in really since 2017, 2018, which was when we started focusing on some of the international opportunities.

第二點是，就像我提到的，您往往會看到一些遺留產品進入這些領域，然後您會看到後續產品的交錯引入。因此，這對我們來說非常令人興奮，因為我們繼續有機會發展那些更成熟的領域，甚至是我們自 2017 年、2018 年以來一直在的領域，當時我們開始關註一些國際機會。

So it's just a really good combination of all of those things together, like Steve mentioned, the investments that we're making there are really paying off. We're getting quality people representing our product the best way that we would envision and it's a real partnership.

因此，這只是所有這些事情的完美結合，就像史蒂夫提到的那樣，我們在那裡所做的投資確實得到了回報。我們正在聘請高素質人才以我們設想的最佳方式代表我們的產品，這是真正的合作關係。

And then the last piece that I always tell our team is if we're going to be in a country, we want to be there. We don't want to just sell products into these countries. We really want to participate. We want to meet the key opinion leaders. We want to hear what they're saying on the podium when they're having discussions about technology and approaches to different procedures. We want to actually be present there.

我總是告訴我們團隊的最後一點是，如果我們要去一個國家，我們就想在那裡。我們不想只向這些國家銷售產品。我們真的很想參與。我們希望與關鍵意見領袖會面。我們想聽聽他們在討論不同程序的技術和方法時在講台上所說的內容。我們希望真正出現在那裡。

And so that means a lot to us that we're having the successes we're having in this international market because some we can't be have a meaningful change to the foot and ankle market unless we're a global company. And this is our chance to do it.

因此，這對我們來說意義重大，我們在這個國際市場上的成功，因為除非我們是一家全球性公司，否則我們無法對腳和腳踝市場進行有意義的改變。這是我們這樣做的機會。

Okay. Thanks. Really appreciate all that color. And then on the product side of things, obviously some exciting things here that have been talked about in the first quarter so far. We think about the remainder of the year, how real how should we think about the sort of what percent, I guess, of the new devices or how significant of the new devices you're expecting throughout the remainder of the year will be more of the sort of single use type devices like the Mister Tendon Harvester versus the CapEx spend type devices?

好的。謝謝。真的很欣賞所有這些顏色。然後在產品方面，顯然到目前為止第一季已經討論過一些令人興奮的事情。我們會考慮今年剩下的時間，我們應該如何真正考慮新設備的百分比，我猜，或者您預計在今年剩餘時間里新設備的重要性有多大。像肌腱收割機先生這樣的一次性設備與資本支出支出型設備有何不同？

Yeah. And that's a great question, George. And we've got a few products throughout the year. By the way this year, one of the things that's most exciting is I think it's really last line extensions type introductions this year and some real new introductions in areas we haven't really participated in yet absent some of the bunion areas, but a lot of really exciting areas, and it's balanced across all the subsegments of foot and ankle.

是的。這是一個很好的問題，喬治。我們全年都會推出一些產品。順便說一句，今年最令人興奮的事情之一是我認為這確實是今年最後的產品線擴展類型介紹，以及我們尚未真正參與的領域的一些真正的新介紹，但缺少一些拇囊炎領域，但很多真正令人興奮的區域，並且它在腳和腳踝的所有子部分之間保持平衡。

So you're going to see some things in the trauma arena. You're going to see some things in the Charcot arena. You're going to see some things scattered throughout all the five subsegments, which has always been our strategy. I will highlight that we still have 25-plus projects still being developed. And we anticipate, at least for the next three years, a cadence of 5 to 10 new products hitting the market. I'd probably say that when we think about some of the soft tissue products, those tend to be more of the sterile pack type products that you're asking about.

所以你會在創傷領域看到一些事情。您將在夏科競技場看到一些東西。你會看到一些東西分散在所有五個子細分市場中，這一直是我們的策略。我要強調的是，我們仍有 25 多個專案仍在開發中。我們預計，至少在未來三年內，將會有 5 到 10 種新產品推出市場。我可能會說，當我們考慮一些軟組織產品時，這些往往更多是您所詢問的無菌包裝類型產品。

We have a few pretty big launches later this year that are going to be hardware, but maybe not as dramatic on the CapEx side, as you would expect from like a large joints like an ankle replacement or some of our counterparts in orthopedics. Some modest CapEx associated with those products. But generally speaking, I think we've got really good products hit the market this year, which is going to drive a lot of momentum even starting the year, but ending the year as well.

今年晚些時候，我們將推出一些相當大的硬體產品，但在資本支出方面可能不會那麼引人注目，正如您對腳踝置換等大型關節或骨科領域的一些同類產品所期望的那樣。與這些產品相關的一些適度的資本支出。但總的來說，我認為今年我們有非常好的產品進入市場，這將在今年年初和年底推動很大的動力。

We expect to start to see a real contribution to the growth of this company. Second half of the year and even into '25 from some of the products we're launching now and even launched in Q4 of last year. So a lot of good stuff there.

我們期望開始看到對該公司發展的真正貢獻。從我們現在推出的一些產品，甚至是去年第四季推出的產品來看，我們已經進入了下半年，甚至進入了 25 年。所以那裡有很多好東西。

Okay, great. Thanks again for taking the questions.

好的，太好了。再次感謝您提出問題。

You got it.

你說對了。

Dave Turkaly, Citizens Bank.

戴夫·圖爾卡利，公民銀行。

Hey, good evening, guys. How are you? Hey, can you hear me, right?

嘿，晚上好，夥計們。你好嗎？嘿，你聽得到我說話嗎？

Yeah.

是的。

Okay, thanks. Maybe Albert, I was wondering if you might share with us, you know, sort of embedded in your guidance, what kind of rep adds you think you might have this year and maybe for like a target doc turning into something like that you would like share with us in terms of how you get into those numbers, it would be helpful if you could.

好的謝謝。也許阿爾伯特，我想知道你是否可以與我們分享，你知道，在你的指導中，你認為你今年可能會有什麼樣的代表，也許像目標文檔變成你想要的東西與我們分享您如何獲得這些數字，如果可以的話將會很有幫助。

You got it. Maybe I'll start this question at a by the way, great to hear from you, Dave. Maybe I'll start this question and then I'll turn it over to Steve for some metrics there as well. But you know, our balanced approach to growth. One of the nice things about the products that we're introducing to the market. It does generate a lot of interest on the sales side of things.

你說對了。順便說一下，也許我會開始這個問題，戴夫，很高興收到你的來信。也許我會開始這個問題，然後我會將其交給史蒂夫以獲得一些指標。但你知道，我們的平衡成長方式。我們向市場推出的產品的優點之一。它確實引起了銷售方面的許多興趣。

So we get a lot of activity either from surgeons or from sales reps who are really looking at these products and wanting to be a part of this mission to improve foot and ankle outcome. So that's always an exciting time for us. I feel like right now, the visibility as a public company with some of these big launches that could be really meaningful to surgeons are generating a lot more interest in than even in the past.

因此，我們從外科醫生或銷售代表那裡得到了大量的活動，他們真正關注這些產品，並希望成為改善足部和腳踝結果這一使命的一部分。所以這對我們來說總是一個令人興奮的時刻。我覺得現在，作為一家上市公司的知名度，其中一些對外科醫生來說可能真正有意義的重大發布引起了比過去更多的興趣。

And so I continue to expect to see a lot more rep type improvements, but we're also really careful. We want to make sure that the sales folks that come on Board with us have the same culture and feel about wanting to be a true service to our surgeon partners. And that means that they want to learn everything they can about foot and ankle Surgery.

因此，我仍然期望看到更多代表類型的改進，但我們也非常小心。我們希望確保加入我們的銷售人員具有相同的文化，並希望為我們的外科醫生合作夥伴提供真正的服務。這意味著他們想要學習有關足部和腳踝手術的一切。

They want to really sympathize with what's going on in the operating room so they can be the best service. So we're in a wonderful place now. We've got an amazing portfolio. It's pretty comprehensive, If not one of the most comprehensive and still growing the way it's growing. I think we could take our choices here and really find the right partners and continue to expand our sales representation. Anything to add to that, Steve?

他們想要真正同情手術室裡發生的事情，這樣他們才能提供最好的服務。所以我們現在處於一個很棒的地方。我們擁有令人驚嘆的產品組合。它非常全面，即使不是最全面的之一，並且仍在以這種方式增長。我認為我們可以在這裡做出選擇，真正找到合適的合作夥伴，並繼續擴大我們的銷售代表。史蒂夫，還有什麼要補充的嗎？

Yeah, I would just tell you Turk, that the -- we had an outsized contribution from the growth in the number of producing reps during '23 in the US I mean, we had it almost 40 producing reps or 14% growth. We expected that to be more balanced in terms of the numbers being added as well as the productivity dollars per. We expect a lot of revenue from these producing reps that recently have joined us and are just getting going.

是的，我只想告訴你特克，23 世紀美國生產代表數量的增長對我們做出了巨大的貢獻，我的意思是，我們有近 40 名生產代表，增長了 14%。我們預計在增加的數量以及每單位的生產力美元方面會更加平衡。我們預計這些最近加入我們並剛開始工作的生產代表會帶來大量收入。

So some really exciting adds to the team both last year and in the first part of this year, even some really exciting adds. And so we expect some more balance, though in terms of the overall math on what's driving the US business, the split between numbers of reps and actual dollars per rep.

因此，去年和今年上半年，團隊中都增加了一些非常令人興奮的成員，甚至還有一些非常令人興奮的成員。因此，我們預計會出現更多的平衡，儘管從推動美國業務的整體數學角度來看，代表人數與每個代表的實際美元之間的差距。

Thank you for that. And you had mentioned last quarter you had a step-up in inventory that you expect in obviously closing at around $100 million that -- I think that’s kind of what you anticipated. I want to make sure that’s sort of in line? And then also that you think the write-down are essentially over at this point?

謝謝你。您在上個季度提到，您的庫存有所增加，預計最終將達到 1 億美元左右，我認為這正是您的預期。我想確保這符合要求？然後您還認為此時減記基本上已經結束了嗎？

Yeah. No, I think that's a great question. And our inventory levels ended up exactly where we had anticipated, they would. And as we go into this year, as we've said, we expect significant improvements in operating cash flow and free cash flow. And we believe that and we have great visibility to that. And it's going to be driven by positive EBITDA. It's going to be driven by leveraging the existing inventory investments we've made. So we don't expect and are planning for and we will not have the kind of inventory increases that we saw last year. So that's all going to bode very well from a cash flow perspective improvement in '24.

是的。不，我認為這是一個很好的問題。我們的庫存水準最終達到了我們的預期，他們會的。正如我們所說，進入今年，我們預計營運現金流和自由現金流將顯著改善。我們相信這一點，我們對此非常清楚。這將由正的 EBITDA 驅動。它將透過利用我們現有的庫存投資來推動。因此，我們預計並正在計劃，並且不會出現去年那樣的庫存增加。因此，從 24 年現金流改善的角度來看，這一切都是好兆頭。

And to your point, the adjustments that we made in the fourth quarter was a non-cash charge, increasing the level of reserves on just a much higher level of inventory. So we don't expect adjustments of that order of magnitude at any time in the future. Those kinds of adjustments, you always have inventory adjustments, but not to the size and scale we saw in the fourth quarter.

就您而言，我們在第四季度所做的調整是非現金費用，只是在更高的庫存水準上增加了儲備水準。因此，我們預計未來任何時候都不會出現如此數量級的調整。在這些調整中，庫存總是會調整，但不會達到我們在第四季看到的規模和規模。

But given that it's onetime to I think most people will back it out. But thank you for all that detail.

但鑑於這是一次性的，我認為大多數人都會支持它。但謝謝你提供的所有細節。

Yeah, thank you, [bud]. Appreciate that.

是的，謝謝你，[芽]。感謝。

One comment just to add to that is we still respond to my mom, you know, as one of the first investors it's really important that we keep good records and account. Everybody is accountable for what we spend and how we invest those dollars. And that's not changed since we've become public. We take a lot of pride in building an amazing business there.

補充一點，我們仍然回應我媽媽，你知道，作為第一批投資者之一，我們保持良好的記錄和帳戶非常重要。每個人都對我們的支出以及如何投資這些資金負責。自從我們公開以來，這一點就沒有改變。我們為在那裡建立令人驚嘆的業務感到非常自豪。

(Operator Instructions) Michael Matson, Needham & Company.

（操作員說明）Michael Matson，Needham & Company。

Yeah, thanks. I appreciate the detail on the bunion products you provided and getting to see them at AAOS. But I guess I wanted to ask one just about kind of the market opportunity there in bunions. Can you just remind us, I don’t know if you have numbers in terms of the number of bunion procedures, but -- then, to what degree do you think these products will drive market share gains, conversions from competitive products versus just expanding the overall market?

是的，謝謝。我很欣賞您提供的拇囊炎產品的詳細信息，並在 AAOS 上看到它們。但我想我想問的是拇囊炎的市場機會。您能否提醒我們一下，我不知道您是否有拇囊炎手術數量方面的數字，但是，您認為這些產品將在多大程度上推動市場份額的增長、競爭產品與普通產品的轉化擴大整體市場？

Yeah. Thanks for the question. Maybe I'll start here. The first part of your question. You know, the bunion market today, there's about 400 according to our estimates. I'll preface it by saying that, but there's about 450,000 bunions done annually in the United States. And we do think that that's growing pretty nicely. There's a lot of patients waiting for better technology to get their bunions treated.

是的。謝謝你的提問。也許我會從這裡開始。你問題的第一部分。你知道，今天的拇囊炎市場，根據我們的估計，大約有 400 個。我首先要說的是，美國每年約有 45 萬例拇囊炎手術。我們確實認為這種成長非常好。有很多患者正在等待更好的技術來治療他們的拇囊炎。

We've had and continue to have a really strong presence there. We've got some of the best technology in our opinions to treat bunions, again, addressing a pretty wide optionality there to make sure that we can address specific considerations for each patient. And we're definitely not a one size fits all organization there, and we've got some amazing products to treat that.

我們已經並將繼續在那裡擁有非常強大的影響力。我們認為，我們擁有一些最好的技術來治療拇囊炎，再次解決了相當廣泛的選擇，以確保我們能夠解決每個患者的特定考慮因素。我們絕對不是一個適合所有組織的組織，我們有一些令人驚嘆的產品來解決這個問題。

And that being said, I think these products are going to be really complementary and put a spotlight on some of the technology that we have and expand our presence or continue to expand our presence in the bunion space, which is a fast-growing large part of the foot and ankle market as a whole. It is a wonderful balance for us.

話雖這麼說，我認為這些產品將真正互補，並重點關注我們擁有的一些技術，並擴大我們的業務或繼續擴大我們在拇囊炎領域的業務，這是一個快速增長的重要領域足部和腳踝市場作為一個整體。這對我們來說是一種美妙的平衡。

So it's I wouldn't say it's more important than fracture fixation or ankle or Charcot or forefoot or any of the other procedures. But it is exciting for us to continue to build a really good balanced portfolio, create reproducibility with every surgery that we can, and impact patients in a positive way.

所以我不會說它比骨折固定或腳踝或夏科或前腳或任何其他手術更重要。但令我們興奮的是，我們能夠繼續建立一個真正良好平衡的產品組合，盡我們所能為每一次手術創造可重複性，並以積極的方式影響患者。

Okay. Thanks. And then you've got to given the credit facility increase, we haven't seen you do a lot of M&A or wanted to take a temperature there in terms of outlook to know, is that something you're still looking at? Or do you feel like you've certainly got quite the engine there internally for developing their own products.

好的。謝謝。然後你必須考慮到信貸額度的增加，我們還沒有看到你進行了大量的併購，或者想要了解你的前景，這是你仍在關注的事情嗎？或者您是否覺得您內部肯定有足夠的引擎來開發自己的產品。

Yeah, maybe I'll hit this one. I'll tell you, we are 100% committed to creating an environment for foot and ankle surgery that improves outcomes. I can't think of a better way to say. And we're also very I think we are very passionate and excited about what we can build in foot and ankle. We're aware of areas where maybe we don't have the expertise and the technology in house to do things that are dramatically going to improve those outcomes. So we're always looking for that.

是的，也許我會打這個。我告訴您，我們 100% 致力於為足部和腳踝手術創造一個改善結果的環境。我想不出更好的說法。我認為我們對腳部和腳踝的發展充滿熱情和興奮。我們意識到在某些領域我們可能沒有內部專業知識和技術來做那些能夠顯著改善這些結果的事情。所以我們一直在尋找那個。

And we're very careful about what we consider and how we consider it. But technology that influences better outcomes for foot and ankle patients is always going to be top of mind for us. As we're on this mission, right? And this mission is pretty exciting. It's very few times in life that you get a chance to do something so powerful in a market and influence the market the way we hope to. And so that for us, we're going to keep an open mind to it. I wouldn't say that there's things right now on the burner, but we are always looking for opportunities to continue to expand that technology.

我們對我們的考慮內容和考慮方式非常謹慎。但為足部和腳踝患者帶來更好結果的技術始終是我們的首要考慮因素。當我們執行這個任務時，對嗎？這個任務非常令人興奮。一生中很少有機會在市場上做如此有影響力的事情並以我們希望的方式影響市場。因此，對我們來說，我們將對此保持開放的態度。我不會說現在有一些東西正在燃燒，但我們一直在尋找機會來繼續擴展該技術。

Okay, great. Thank you.

好的，太好了。謝謝。

You've got it, Mike.

你做到了，麥克。

Caitlin Cronin, Canaccord Genuity.

凱特琳·克羅寧，Canaccord Genuity。

Hi. Thanks for taking the questions. Just to start off thoughts on Stryker's new footprint technology and Smart28 is eventually going to compete with this product?

你好。感謝您提出問題。剛開始思考 Stryker 的新足跡技術，Smart28 最終會與該產品競爭嗎？

Yeah. Thanks for the question, Caitlin. I'll hit it. I'm -- I believe the footprint product is surrounding the total ankle piece. I think any kind of preoperative planning is a great way for us to be thinking about the future of foot and ankle surgery. I think it connects a lot to what our aspirations are around Smart28.

是的。謝謝你的提問，凱特琳。我會擊中它。我－我相信足跡產品圍繞著整個腳踝部分。我認為任何形式的術前計劃都是我們思考足部和腳踝手術未來的好方法。我認為這與我們對 Smart28 的期望有很大關係。

I think we need to do and have better tools to help diagnose to health plans and predict what the output of that is going to be. And so to the extent that it can influence better outcomes for foot, for the ankle replacement, I think it's a positive move for the market.

我認為我們需要做並擁有更好的工具來幫助診斷健康計劃並預測其結果。因此，就其可以影響足部、腳踝置換的更好結果而言，我認為這對市場來說是一個積極的舉措。

Okay. And any color on adjusted EBITDA cadence through 2024 as you hit breakeven on an annual basis?

好的。當您每年達到損益平衡時，到 2024 年調整後的 EBITDA 節奏有什麼顏色嗎？

Hey, Caitlin, it's Steve. I think you can think about it sort of scaling with the revenue build. And we did see, I think the best leverage of our operating expenses that we've seen as a public company during the fourth quarter with 10% growth on a of much higher top line growth.

嘿，凱特琳，我是史蒂夫。我認為你可以考慮隨著收入的成長而擴大規模。我們確實看到了，我認為我們作為一家上市公司在第四季度看到的營運費用的最佳槓桿，在更高的收入成長的基礎上實現了 10% 的成長。

So as we go into this year, you can expect that our operating expenses are going to continue to scale at a much less lower rate than overall revenue growth and that our EBITDA will trend in line as the revenue builds and grows. So that's maybe the simplest way to think about it. But it's some it's the way we're running the business and we don't get in front of ourselves in terms of investments in really anywhere up and down the P&L.

因此，當我們進入今年時，您可以預期我們的營運支出將繼續以遠低於整體收入成長的速度成長，並且我們的 EBITDA 將隨著收入的增加和成長而變化。所以這可能是最簡單的思考方式。但這是我們經營業務的方式，我們在損益表上下任何地方的投資方面都沒有超前。

Got it. Thanks so much.

知道了。非常感謝。

You're welcome. Thank you.

不客氣。謝謝。

Justin Lin, William Blair.

林毅夫、威廉‧布萊爾。

Hey guys. Thanks for taking my questions here. I guess to start off kind of high-level comments about the strength of the end markets kind of going into 2024, what's kind of the state of the patient backlog, which maybe is less important for your business now, but just curious how are all these dynamics are trending?

大家好。感謝您在這裡提出我的問題。我想先對進入 2024 年的終端市場的實力進行一些高層評論，患者積壓的情況如何，這可能對您現在的業務不太重要，但只是好奇一切都怎麼樣這些動態是趨勢嗎？

Yeah. Maybe I'll start and then Albert will talk a little bit about what he's hearing from surgeons every day. I'd tell you that we were very, very busy to begin the year through today. We've had a strong start to the year and markets are buoyant, and we're participating well in those buoyant markets. The fourth quarter was strong.

是的。也許我會開始，然後阿爾伯特會談談他每天從外科醫生那裡聽到的事情。我想告訴你，從年初到今天，我們都非常非常忙碌。我們今年開局良好，市場活躍，我們很好地參與了這些活躍的市場。第四季表現強勁。

And I would tell you that the fourth quarter was stronger for us at the first half and then December was good, but not quite as good as the earlier months. And then we saw a really strong February. So it feels like we've got buoyant markets and setting us up nicely going into this year and to take advantage of our commercial team's capabilities in this product portfolio and our new products. So we're excited about the setup for '24.

我想告訴你，上半年第四季對我們來說比較強勁，然後 12 月也不錯，但不如前幾個月那麼好。然後我們看到了一個非常強勁的二月。因此，感覺我們擁有活躍的市場，並為我們進入今年做好了良好的準備，並利用我們的商業團隊在該產品組合和新產品方面的能力。所以我們對 24 週年的安排感到很興奮。

I'll maybe just add one comment to that. Just to note that I've mentioned before, I don't think we see too much of a backlog [bolus] type thing for the foot and ankle space. I think we capture a long time where we can. I think maybe some of our counterparts in orthopedics see a little bit more of the bolus stuff. I kind of like that because that for us having a pent-up energy just -- it's spreads that over a longer period of time, it's a more predictable business piece, right?

我可能會對此添加一條評論。請注意，我之前提到過，我認為我們不會看到腳和腳踝空間有太多積壓[推注]類型的事情。我認為我們會盡可能地捕捉很長的時間。我想也許我們骨科領域的一些同行看到的更多的是推注的東西。我有點喜歡這樣，因為對我們來說，被壓抑的能量會在更長的時間內傳播，這是一個更可預測的業務，對吧？

But all that to say, I don't think we were seeing as much of a backlog bolus type thing as we are just seeing pent-up demand for foot and ankle surgery more on the elective side, obviously.

但話雖如此，我認為我們並沒有看到那麼多積壓的推注類型的事情，因為我們顯然只是在選擇性方面看到了對腳和腳踝手術的被壓抑的需求。

I mean, maybe I'll just add one more thing this is maybe somewhat anecdotal, but I think it's important as the hips and knees, I know that they really did have more of a bolus impact in '23 and the commentary that I read is that that bolus isn't as strong going into '24, that bodes well for foot and ankle surgeons because there's more operating room availability because of that.

我的意思是，也許我會再補充一件事，這可能有點軼事，但我認為這與臀部和膝蓋一樣重要，我知道它們確實在23 年以及我讀到的評論中確實產生了更多的推注影響進入 24 年，推注不再那麼強勁，這對足部和腳踝外科醫生來說是個好兆頭，因為因此有更多的手術室可用。

So I don't know if that will develop into a potential tailwind for these markets that we're in. But I know that when there's less large joint orthopedic procedures taken place, it allows our smaller joint folks time to get in there and take advantage of the our space.

所以我不知道這是否會成為我們所在市場的潛在動力。但我知道，當進行的大型關節矯形手術較少時，我們較小的關節人員就有時間進入那裡並利用我們的空間。

Got it. Super helpful color here. Just first question, kind of on your commercial strategy. When you hire new reps, are you kind of going after new territories or are they kind of going deeper into accounts? And also kind of the second part of that question is like what are the main geographies you're not in today that you'd like to kind of expand into? I know you had talked about the UK, Australia, and the South Africa a lot, but just curious.

知道了。這裡超有用的顏色。第一個問題，關於您的商業策略。當你僱用新的銷售代表時，你是在追求新的領域還是深入客戶？這個問題的第二部分是，你今天不在的主要地區是什麼，但你想擴展到哪些地區？我知道你經常談論英國、澳洲和南非，但只是好奇。

Yeah. So look, the international market is about 45% of the global foot and ankle market. So very, very large. And we've got low single digits market share outside the US and we have better than that market share in those three big markets, but well below the rate that we expect to be in in the next three to five years. So our more established markets, we expect to continue to aggregate market share there. And then some of the other large markets that we're really not participating in meaningfully today like Germany, Italy, Canada, Spain will continue to grow in those markets.

是的。所以看，國際市場約佔全球腳踝市場的45%。非常非常大。我們在美國以外的市佔率較低，只有個位數，在這三個大市場中，我們的市佔率比這個市場份額好，但遠低於我們預期未來三到五年的市佔率。因此，我們希望在更成熟的市場中繼續擴大市場份額。然後，我們今天實際上沒有真正參與的一些其他大型市場，例如德國、義大利、加拿大、西班牙，將繼續在這些市場中成長。

We've got in Spain and -- it excuse me, in Italy and Germany for example, we've got teams on the put on the ground and facilities and systems in place to take advantage and get our products going there in a more meaningful way. And then we're going to be doing the same in Japan, which is the second largest overall orthopedic market.

我們在西班牙和——對不起，在義大利和德國，我們有實地團隊、設施和系統，可以充分利用這一優勢，讓我們的產品以更有意義的方式進入那裡。方式。然後我們將在日本做同樣的事情，日本是第二大整體骨科市場。

We're going to get in there early '25, perhaps a little bit late this year, but probably more so into '25. So there's a lot of opportunity. And then you look at South America and there's some select opportunities we're looking at there in a very disciplined way. But we want to like Albert said, if we're going to go into a market, we want to go into it in a meaningful way and get focused and not be too spread them across a lot of different locations. We want to win in the markets we're in.

我們將在 25 年初進入該領域，今年可能會晚一些，但進入 25 年後可能會更多。所以有很多機會。然後你看看南美洲，我們正在以非常嚴格的方式尋找一些精選的機會。但我們希望像阿爾伯特所說的那樣，如果我們要進入一個市場，我們希望以一種有意義的方式進入它並集中精力，而不是將它們過於分散在許多不同的地點。我們希望在我們所處的市場中獲勝。

Got it. Thank you.

知道了。謝謝。

Thank you. You got it.

謝謝。你說對了。

And this will conclude today's question and answer session. So I would like to hand back to the Paragon 28 team for closing remark.

今天的問答環節到此結束。所以我想請Paragon 28 團隊做結束語。

Thank you again for your time today. If you have any further questions, please reach out. Otherwise, we look forward to seeing many of you at our Future Investor and Industry Conferences. This concludes our call. Have a great day.

再次感謝您今天抽出時間。如果您還有任何疑問，請與我們聯絡。除此之外，我們期待在我們的未來投資者和行業會議上見到你們中的許多人。我們的通話到此結束。祝你有美好的一天。

This concludes today's conference call. Thank you all for joining. You may now disconnect your lines.

今天的電話會議到此結束。感謝大家的加入。現在您可以斷開線路。