トレース・メディカル（TMCI）2026年第3四半期決算説明会：EBITDA改善、ガイダンスレンジ縮小

主要ポイント

• トレース・メディカル・コンセプツが発表した2026年第3四半期の売上高は、低価格の低侵襲製品への売上構成比のシフトや外反母趾手術用キットの総販売数の減少により、前年同期比4%減の4,830万ドルとなった。
• 在庫保有代理店向け売上を除くと、外反母趾キットの販売数量は増加し、売上高は1桁台半ばの成長率を記録した。経営陣によると、手術件数は2桁の伸びを示した。
• 売上総利益率は79.1%から79.5%に上昇した一方、営業費用は10%減の4,990万ドルとなった。調整後EBITDAは260万ドルの赤字から30万ドルの黒字へと改善した。
• 同社は2026年通期の売上高見通しを2億600万ドル〜2億1,000万ドルへとレンジを縮小し、調整後EBITDAは100万ドル〜200万ドルの赤字を見込んでいる。
• 第3四半期時点で、Lapiplastyを使用する外科医の約45%が、Nanoplasty、Percuplasty、SpeedMTPのいずれかを1つ以上使用しており、第2四半期の40%から上昇した。
• 経営陣は、2026年の新製品投入によってトレース・メディカルの対応可能市場（TAM）が約7億ドル拡大すると試算している。

主要財務データ

事業および業績の動向

トレース・メディカルは、売上高減少の主な要因として、平均販売価格の低い製品構成へのシフトと、外反母趾手術用キットの総販売数の減少を挙げた。この製品構成のシフトは、低価格な低侵襲製品の普及拡大を反映している。同社は、前年の在庫保有代理店からの発注による影響が第3四半期以降に大幅に縮小すると見込んでいる。

拡充された外反母趾向け製品群の採用は拡大を続けた。Lapiplastyを使用する外科医の約45%がNanoplasty、Percuplasty、SpeedMTPのいずれかを1つ以上使用しており、第2四半期の40%から上昇した。また、これら新システムをきっかけに初めてトレースの顧客となった外科医の約30%が、その後にLapiplasty製品を採用した。

経営陣によると、2025年に投入された3つの外反母趾システムは、Lapiplastyのコアセグメント以外で推定75%を占める外反母趾手術件数に対応している。また、製品群の拡充により、顧客である外科医が手掛ける足部・足関節再建手術件数のうち少なくとも80%に対応できるようになると見込んでおり、LapiplastyとAdductoplastyのみを提供していた当時の約30%から大幅に拡大する見通しだ。

トレース・メディカルは第3四半期中に圧縮スクリューシステム「SuperBite」の本格展開を開始した。また、「HyperPlate XM」、「VitaFuse」、「CartiBlaster」も市場投入し、VitaFuseとCartiBlasterは第4四半期中に全面的な商業展開へ移行する見込みである。経営陣は、これら4製品によって同社の米国における対応可能市場（TAM）が合計で約4億ドル拡大すると試算している。

また、内反小趾（テーラーズバニオン）向けの低侵襲システムである「Tailorplasty」を用いた初期症例も完了した。2027年第1四半期中に本格的な商業展開が予定されている。さらに、「Lapiplasty Lightning」プラットフォームも2027年第1四半期に商業展開を開始する予定である。

業績見通し（ガイダンス）

経営陣は、季節的に最も需要が旺盛な第4四半期に増収へ転じると見込んでいる。この見通しは、手術件数の増加、2025年投入製品に伴う平均販売価格の構成比シフトによる圧力の緩和、そして2026年に投入された製品の貢献を前提としている。

同社は2027年の営業費用について大幅な変動を予想していない。小幅な増加にとどまる見込みであり、また販売費用の大部分が変動費であるため、販売報酬は売上高の成長に連動すると見込んでいる。

リスク要因と注視すべきポイント

• 低価格な低侵襲システムへのシフトが継続することで1症例当たりの平均売上高が押し下げられる可能性があるものの、経営陣はより高付加価値な中足部および後足部手術がその影響を一部相殺すると見込んでいる。
• 第4四半期の成長見通しは、同社にとって季節的な最盛期における手術件数の増加と、最近投入された製品の採用動向に左右される。
• 営業組織は複数の新技術を同時に統合している最中である。経営陣は、研修や競合の足部・足関節メーカーから採用した営業担当者の経験が、実行リスクの抑制に寄与するとしている。
• 経営陣は、足部・足関節市場が足元で過去実績である1桁台半ばの成長ペースを下回って推移していると指摘し、2027年の見通しを示す前に第4四半期の追加的な症例数データを確認したい意向を示した。

アナリスト質疑応答のハイライト

経営陣は、2025年の投入製品による価格設定および製品構成の影響を一巡しつつあることから、手術件数の伸びと売上高成長のギャップが縮小していると述べた。製品群の拡充により、低価格な低侵襲症例と、高付加価値で複雑な中足部・後足部手術が混ざり合う構成になると予想している。

顧客維持率（リテンション）について、経営陣は新たに導入されたシステムのリピート率は高いと説明し、トレース製品を2種類以上または3種類以上使用する外科医の数が増加していると述べた。ただし、具体的な再注文率は開示しなかった。

トレース・メディカルは直販部隊の拡大を小幅かつ段階的な規模にとどめる計画だ。経営陣は、既存の手術において追加製品を提案し、同一の顧客医師によるより多くの症例に関与することで、営業担当者の生産性を向上できると考えている。

海外展開は依然として潜在的な機会であるが、経営陣はスケジュールや期待される貢献度の数値化を示さなかった。同社は、最盛期の手術件数を精査し、2026年投入製品の実績をさらに積み上げた上で、第4四半期の決算説明会で2027年のガイダンスを発表する方針だ。

決算説明会の全編書き起こし

決算説明会の完全なトランスクリプト

経営陣による説明

Operator

[Operator Instructions]

Please be advised that today's conference is being recorded. Now it's my pleasure to turn the call to Tripp Taylor with Investor Relations. Please go ahead.

Unknown Speaker

Good morning, everyone, and welcome to our third quarter 2026 earnings conference call. Participating from the company today will be John Treace, Chief Executive Officer, and Mark Hair, Chief Financial Officer. John and Mark will discuss our third quarter financial results and 2026 outlook. We'll then host a question-and-answer session following our prepared remarks. Our press release can be found in the Investor Relations section of our website at investors.treace.com.

This call is being recorded and will be archived in the Investor Relations section of our website. Before we begin, we would like to remind you that it's our intent that all forward-looking statements made during today's call will be protected under the Private Securities Litigation Reform Act of 1995.

Any statements that relate to expectations or predictions of future events and market trends as well as our estimated results or performance are forward-looking statements. All forward-looking statements are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements.

All forward-looking statements are based upon currently available information and Treace Medical assumes no obligation to update these statements. Accordingly, you should not place undue reliance on these statements. Please refer to our SEC filings, including our 2025 Form 10-K and our Form 10-Q for the third quarter of 2026, filed before the market opens today, November 6, which can be found in the Investor Relations section of our website at investors.treace.com for a detailed presentation of risks. With that, I will now turn the call over to John.

John Treace

Thank you, Tripp. Good morning, everyone, and thank you for joining us on our third quarter 2026 earnings conference call. We're encouraged by our third quarter performance, driven by double-digit case volume growth and continued market share gains from increasing adoption of our comprehensive portfolio of best-in-class bunion systems and our expanding line of new technologies. During the quarter, we continued to advance our strategic priorities with investments in new products creating opportunities to build on the foundation that Lapiplasty has established as our surgeon customers adopt more of our new products into their practice.

And now we're expanding our presence across a broader range of foot and ankle procedures. We expect the new 2026 product introductions that I will discuss this morning to expand our total addressable market by approximately $700 million. This strategy has allowed us to leverage our commercial resources to pursue high-impact growth opportunities while maintaining disciplined expense management. We believe this approach positions us to enhance our growth trajectory while improving operating performance over time.

With that said, we're narrowing our full year 2026 revenue guidance to be in the range of $206 million to $210 million. This compares to the previous revenue guidance of $204 million to $212 million. Importantly, this outlook assumes a return to growth in the fourth quarter through continued procedure volume increases and as we begin to both lap the ASP mix shift dynamics related to our 2025 product launches and benefit from our 2026 product launches.

Now, taking a closer look at our growth strategy and the progress we're making across our portfolio, we continue to focus on 3 key initiatives. First, leverage our large existing customer base to drive adoption of the 3 new bunion systems that we launched in Q3 of 2025. Second, continue to build upon our leadership position with Lapiplasty by launching new technologies that can make Lapiplasty even more appealing and attract new surgeon users. And third, expand our product and procedure offerings to expand our TAM and grow wallet share.

Now, turning to our first initiative, leveraging our existing customer base to drive adoption of our new bunion systems, we continue to see a substantial opportunity to increase utilization of our newer bunion systems, namely Nanoplasty, Percuplasty, and SpeedMTP across our existing customer base. As we've discussed, Lapiplasty has established a strong position in the Lapidus fusion segment of the bunion market, but that represents only a portion of the overall bunion procedures performed by our surgeons.

Nanoplasty and Percuplasty systems give us differentiated 3D minimally invasive options in the large-volume osteotomy segment of the market, while our SpeedMTP system extends our reach into the attractive MTP fusion market. These technologies were developed to address different surgeon preferences and procedural approaches, allowing us to participate in a significantly larger portion of the overall bunion market than with Lapiplasty alone.

In fact, we estimate that the 3 new bunion systems we launched in 2025 address the remaining 75% of procedure volumes beyond Lapiplasty. Across our existing customer base, we see an opportunity to increase utilization with this broader portfolio, and the third quarter represented yet another validation that our strategies are working. Through the third quarter, approximately 45% of our Lapiplasty surgeons used at least 1 of these 3 new bunion systems in their practice, up from 40% in Q2.

We also continue to see approximately 30% of surgeons who initially became Treace customers through these new bunion systems now using Lapiplasty products, demonstrating the potential for these new systems to create synergies within our business and pull through additional Lapiplasty usage.

Shifting to our second initiative, advancing our Lapiplasty technology and expanding its appeal and adoption across a broader surgeon audience. Lapiplasty remains a core focal point of our strategy and what we believe to be the gold standard in the Lapidus fusion segment of the market, a segment that represents roughly 30% of the estimated U.S. bunion procedures. As such, we intend to keep innovating, training surgeons, and supporting Lapiplasty in this largest dollar segment of the bunion market.

We also continue to believe in the importance of supporting our technologies with clinical evidence. At the American Orthopaedic Foot & Ankle Society's annual meeting in September, we announced results from 3 clinical studies that further strengthened our growing body of clinical evidence across our portfolio. Most notably, our 5-year Align3D prospective multicenter study demonstrated positive long-term patient outcomes following the Lapiplasty procedure, including very low radiographic recurrence rates, significant reduction in pain, and significant improvements in key validated patient-reported outcome scores.

Our 5-year Align3D data represents a first-in-industry milestone for a commercial bunion system. We also shared positive results from our multicenter Adductoplasty and SpeedPlate studies, adding to the evidence supporting our broader technology portfolio. Together, these findings continue to build our differentiated clinical library, providing additional proofs around the durability of our procedures, our patient outcomes, and the performance of our technologies.

Turning now to our Lapiplasty product strategy. Our Lapiplasty Lightning platform is designed to allow for a faster Lapiplasty procedure and to give surgeons even greater control and accuracy in dialing in their 3D correction. We are in final preparations for the anticipated commercial launch of our Lightning system in Q1 2027. We're also focused on expanding the capabilities and utilization of the IntelliGuide PSI platform. This is our patient-specific planning and cut guide system for Lapiplasty bunion and Adductoplasty midfoot corrections.

IntelliGuide brings a personalized surgery experience for patients and is designed to provide surgeons greater confidence and control in managing complex deformities and revisional cases while also reducing valuable OR time. We believe the combination of our Lapiplasty Lightning and IntelliGuide PSI platforms can continue to differentiate Treace as the trusted partner for our surgeons and extend our market leadership position in the Lapidus bunion and midfoot deformity segments of the market.

And now turning to our third initiative, expanding into adjacent foot and ankle procedures. Today, we are growing wallet share and becoming a more comprehensive technology partner for our foot and ankle surgeons. If you look back a year or so ago, when we offered the Lapiplasty and Adductoplasty systems alone, we estimate these market-leading solutions addressed around 30% of our average customers' overall reconstructive foot and ankle surgery volumes.

With the expanded bunion offerings we launched in Q3 of 2025, plus the additional 2026 product launches I'll discuss next, we believe we now have the opportunity to serve an estimated 80% or more of our average surgeon's reconstructive surgery volumes. Given this, this fourth quarter will be our first opportunity to tap into a broader range of elective foot and ankle procedures outside of bunions, while also benefiting from seasonally high bunion case volumes with our expanded bunion portfolio.

I'd now like to elaborate on the new 2026 product introductions that represent the $700 million TAM expansion and the value they bring to our customers. In the third quarter, we fully launched our SuperBite compression screw system. As a reminder, compression screws are core fixation technology used throughout the foot and ankle. SuperBite was designed to make screw fixation more efficient by eliminating the step of drilling before placing the screw, a common and time-consuming step performed with conventional screw systems.

SuperBite has quickly allowed Treace to participate in a wide range of new procedure opportunities, from incremental reconstructive surgeries in the front of the foot, to the back of the foot, and to the ankle. Early in its launch, we're pleased with the adoption we're seeing with SuperBite from our existing surgeon customer base. And in many of these SuperBite cases, the surgeon is also utilizing other Treace products, creating additional pull-through opportunities with our expanded portfolio.

With SuperBite screws as an entry point into the mid and hind foot segments of the market, we've built upon this with a new fixation plate offering, namely our HyperPlate XM Dynamic Compression Locking Implant. Fusions of the mid and hind foot bones are generally known for higher nonunion rates. We designed HyperPlate XM implants to provide a highly stable fixation construct through the use of a robust titanium compressing plate with integrated locking screws with the goal of improving outcomes for these challenging larger bone fusions.

Additionally, in Q3, we introduced our VitaFuse Bioactive Glass Graft, a synthetic bone grafting technology that complements our tissue-based CordaFuse Graft and our Allograft wedges. These biologic offerings are highly complementary and allow Treace to more fully service our surgeons' broader bone grafting needs throughout the foot and ankle.

Adding to our differentiated suite of mid and hind foot solutions, we also recently introduced our CartiBlaster line of powered joint preparation rasps. These are single-use sterile instruments which connect to a powered surgical saw and are designed to facilitate rapid and thorough removal of the cartilage on these larger bone surfaces to prepare them for fusion. We are seeing that CartiBlaster rasps speed up what historically has been a tedious and time-consuming manual process, thus improving the surgeon's overall experience and saving valuable OR time.

We believe these 4 products, SuperBite, HyperPlate XM, VitaFuse, and CartiBlaster, the latter two, which we expect to fully commercialize within the fourth quarter, collectively expand our U.S. TAM by an estimated $400 million.

Rounding out our 2026 portfolio expansion, earlier today we announced successful initial cases with our new Tailorplasty system. Tailorplasty is Treace's new minimally invasive instrumented solution for tailor's bunions or bunionettes. Bunionettes are painful deformities of the fifth metatarsal bone and affect an estimated 5% to 10% of the U.S. adult population. When surgical intervention is needed, bunionette surgery is performed either concurrent with a bunion correction or as an isolated procedure. We anticipate full commercialization of this new system within Q1 of 2027.

In closing, leveraging our anchor position as the market leader in bunion correction, we are actively executing our strategy to commercialize an ongoing, steady cadence of new product and procedural innovations for 2027 and beyond. And delivering these to our growing base of surgeon customers through our direct focused sales force to expand our share and presence across the broader foot and ankle surgical market.

We appreciate the dedication of our employees delivering this rapid pace of innovation along with the continued support of our surgeon customers and our shareholders. We remain focused on executing our commercial strategy, improving operating performance, and building a business that can deliver sustainable growth and long-term value. With that, let me now turn the call over to Mark to review our financial performance. Mark?

Mark Hair

Thank you, John. Good morning, everyone. Revenue in the third quarter was $48.3 million, a decrease of 4% compared to the prior-year period. The decline was mainly driven by the shift in revenue mix towards lower-priced, minimally invasive products and a lower volume of bunion procedure kits sold. Excluding sales to stocking distributors, bunion kit sales volume increased and revenue grew mid-single digits compared to the third quarter of 2025. We anticipate the revenue impact from stocking distributor orders will significantly decrease after the third quarter.

Gross margin was 79.5% in the third quarter of 2026 compared to 79.1% in the third quarter of 2025. Total operating expenses decreased $5.5 million or 10% to $49.9 million in the third quarter of 2026 compared to total operating expenses of $55.4 million in the third quarter of 2025. Third quarter net loss decreased by $3.7 million or 23% to $12.6 million, or $0.19 per share, compared to a net loss of $16.3 million, or $0.26 per share, in the third quarter of 2025.

Adjusted EBITDA for the third quarter was a positive $0.3 million compared to a loss of $2.6 million in the third quarter of 2025. Year-to-date cash usage was reduced by 53%, or $9.7 million when compared to the same period in 2025. Cash, cash equivalents, and marketable securities totaled $39.8 million as of September 30, 2026.

Turning to our outlook for full year 2026, we are narrowing our full year guidance and expect full year 2026 revenue to be in the range of $206 million to $210 million, representing a decline of 3% to 1% compared to full year 2025. We expect to return to revenue growth in our seasonally strongest fourth quarter through procedure volume increases as we begin to lap the ASP mix shift dynamics related to our 2025 product launches and benefit from our 2026 product launches.

In addition, we are updating our expectation of a loss in Adjusted EBITDA to be in the range of $1 million to $2 million for the full year 2026, as compared to a loss of $3.9 million in full year 2025. We are reiterating our expectation of a reduction in cash usage of approximately 50% for full year 2026 as compared with full year 2025. Supported by a strong and flexible balance sheet, we believe we are well positioned to continue executing our strategic and growth initiatives for the foreseeable future. With that, I'll turn the call over to the operator to open the line for questions.

Operator

[Operator Instructions]

Our first question comes from the line of Ryan Zimmerman with BTIG. Please proceed.

質疑応答

Ryan Zimmerman

Hey, guys, can you hear me okay?

John Treace

We can. Hey, Ryan.

Ryan Zimmerman

I guess I want to start, you know, we've been through this period of, you know, ASP dynamics versus volume. And, you know, it's encouraging to hear about the double-digit volume growth that you're seeing. I guess if you could reflect, John, on kind of, you know, how you think about that dynamic going forward, you know, particularly as it relates to ASP. You know, as you capture more wallet share and you introduce new products, you know, help us think through maybe kind of the ASP dynamics that you think you'll see as we look ahead to next year, appreciating that, you know, you're not going to give us specific guidance.

John Treace

Hi, Ryan. Good morning. Yeah, thanks for the question. You know, we're seeing the gap trend in the right direction here, this ASP mix gap, getting closer to where both volume growth and revenue growth as we get into this fourth quarter, our seasonally strongest, you know, get tighter. On top of that, we're really pleased with the reception and the adoption rate of all these new products that we're beginning to bring to the market. We think the next wave of intros is going to increase our TAM by about $700 million, and exciting for us to be in a position to bring those into our customer base on top of this great bunion portfolio.

So we're going to continue to broaden the portfolio, not only in bunions, but other adjacencies. So there's going to be some of that dynamic that overall ASPs or revenue per case may come down a bit from where they've historically been. We've talked about in the past how the newer MIS products, some of the new additional products we bring out are going to carry lower ASPs than ASPs in Lapiplasty, but on the counter side of that, we've got a robust portfolio now of multiple technologies that are going into some high-reimbursed complex cases in the midfoot and rearfoot.

So we have some very high ASP cases that are getting into the mix as well that we're seeing. But we think this overall strategy, the broad portfolio, the way the ASP and volume is going to play out is going to benefit us well for the long term.

Ryan Zimmerman

Okay, very helpful, John. And then, you know, if you think about, we're going into the busy bunion season in the fourth quarter. You've got a lot of new products to introduce. How do you think about the phasing of those products, you know, just to kind of manage through the busy season and into the next year, you know, and minimize the execution risk? You know, I think, you know, as you move into some of these other areas, you know, how do you kind of keep that focus still on, say, Lapiplasty or the MIS segment of the bunion market while also pursuing, you know, foot and ankle?

John Treace

Yes. Yes, I understand your question. Our strategy here is to build a large, diversified foot and ankle business off of our anchor as the leader in the bunion space. And that leadership position is something we're highly committed to and we're constantly working on, you know, not just the products we launched in Q3 of last year, but next generations of Lapiplasty with LapiTome, more IntelliGuide, which serves that Lapiplasty and Adductoplasty midfoot segment. So we're highly committed to that.

The reps keep focused on that, along with MTP fusion. These are the highest growth volume procedures that surgeons do day in, day out. So we got to be best in class in that, and we're highly committed to keeping that focus. These new technologies and new procedures we're getting into are coming from the same customers that our reps are serving on that bunion anchor.

They're happening in the same day or the same week. So it's very convenient and it works very seamless for them to integrate these new technologies that they have in their bag into the daily surgery approach of their surgeons. So we think it's going to be pretty straightforward, but there are a lot of new technologies coming into the reps' hands, and they're having a great time. We're spending a lot of time training them. We've hired a lot of reps that have competitive company foot and ankle experience that are now into the mix. They know how to sell the broad portfolio, so that's benefiting us as well.

Ryan Zimmerman

Got it. Thank you for taking the questions.

John Treace

Sure. Thanks, Ryan.

Operator

Our next question comes from Ben Haynor with Lake Street Capital Markets.

Benjamin Haynor

First off for me, just on – it seems like every quarter you're marching at about 5% – more adoption of the new bunion systems by the existing Lapiplasty surgeons. I guess, do you just see that tracking at kind of 5% a quarter until we get to 100? Does that max out at some point? How should we think about that?

John Treace

Yes. Hey, Ben, thanks for the question. It's John. You know, we're pleased with the progress we're seeing there. Last week we mentioned our customer base, 3,300 surgeon customers. That's grown through this year, I can tell you that. And to be at a point where nearly half of that large surgeon group has used 1 or more of the 3 new bunion systems we launched in Q3 of 2025, that's great progress. We're very happy with it, but we're not done. We've got a long way to go.

We want to drive that as deep into that procedure, the surgeon count as we can. We'd love to have 100% of these surgeons using 1 or more, but it goes beyond that. We want them using 2, 3, 4, 5. We want to create a full Treace portfolio of surgeons and have our reps become a much greater resource for these surgeons that love our bunion products to serve the world that they are operating in outside of bunions comprehensively. So that's what we're going after and that's what we're tracking to.

Benjamin Haynor

Great. Makes sense. And then just kind of a bigger picture question, now that you have this broad portfolio of products, at what point does it start to make sense to go internationally?

John Treace

Yes, international is something we understand is a real opportunity for the business. We've been working hard to get to a point where we have a broader portfolio that can engage some international markets. We go to the national meetings for the surgeons, and we see international surgeons that want these products, so we know there's a demand there.

That said, it takes a while to get into a lot of these international markets. We've got the big portfolio now. If and when we get to a point where there's something material, we'll let you know. But we're eyeing it. We know it's an opportunity, but we'll update you as things get more material there.

Benjamin Haynor

Fair enough. And then lastly for me, on CartiBlaster, is there any truth to the rumors that you've secured Cardi B to endorse that product?

John Treace

I can neither confirm nor deny what our marketing people may be doing to try to broadly protect trademarks or derivations thereof that might try to infringe on them.

Benjamin Haynor

Fair enough. That's a smart maneuver there. Thanks for taking the questions, guys, and congrats on the quarter and the progress.

John Treace

Thanks, Ben.

Operator

Our next question comes from Rick Wise with Stifel. Please proceed.

Frederick Wise

Perhaps turning back to the quarter, you posted a rough $0.5 million in the sales beat but kept the midpoint of the guide range. I like it, of course, when you raise low ends. Help us think about why you brought the upper end down. You're a month and a half or so into the fourth quarter. Talk as well, if you would, about just what you're seeing out there on the customer side or just given all the economic concerns, how's the consumer health, if you will, and interest in getting their feet fixed as you head toward year-end.

Mark Hair

Yes, good morning, Rick. This is Mark. Let me take a shot at your questions. There's a few questions there, so let's make sure that we unpack all those and get them all answered. Our views on Q4 are really unchanged. The magnitude of the Q3 beat, as you mentioned, is relatively modest and doesn't necessarily warrant a change for our full-year outlook at this stage. But that said, the double-digit procedure growth is real validation that we're executing our strategies. And just wanted to comment a little bit as a reminder in some of the prepared remarks I mentioned, excluding stocking distributor headwinds that we had in Q3.

We had significant sales in Q3 of last year for those initial stocking orders that we didn't have this year. So, excluding kind of that group of stocking distributor sales, revenue growth was mid-single digits in Q3, and those headwinds related to stocking distributors will decrease significantly in Q4. So, understanding the underlying strength of the business gives us confidence in the Q4 expected trends. We remain confident in the seasonally strong Q4, the underlying opportunity of our base and our new products. John talked a lot about all these new products, not only those that were launched last year, but those that have come out this year as well that will also benefit us in the fourth quarter. So we're confident that we're getting back to growth in Q4, and that is a huge win. We've been talking about this for the last several quarters, so we're really pleased with what we've been able to do.

And think about the decline in Q3 and to jump to a very respectable growth rate in Q4. That's a meaningful change. So we still want to ensure that our expectations are set, very achievable and appropriately reflect the visibility that we have today. I think there's some other questions more broadly about the overall market.

John Treace

Right. Yes, Rick, we know there have been some commentaries on slowing procedure volumes from some other companies. We were in a little different situation because of the expansion of our bunion portfolio along with the expansion of things like getting into SuperBite, which brings us into new incremental procedures. So Q3, we not only benefited from, you know, an early, a little bit of start of bunion season that we typically see at the tail end of Q3, but elective foot season, you know, where SuperBite was bringing us into more procedures, and that definitely helped our procedure volumes.

And we expect that's going to continue through Q4 here. So that high procedure volume growth we believe is going to be the driver and deliver the Q4 that we're expecting. But we are in a little different situation where procedure volume growth for us has been climbing as we've gone through the last 3 quarters. And we expect it to continue to climb in Q4.

Frederick Wise

Understandable given all the exciting new products. John, you've several times referred to the, and it's been impressive to watch, the increasing percentage of your growing physician base trying, you know, some of these new systems once, you're at 45% this quarter, but can you give us some color on whatever metric, however you want to frame it, but reorders after that initial trying? Or do you have a metric that says they tried 1 of the products once and a third of them, 10% of them, 50% have gone on to try another one? Just any other metrics that would help us better appreciate the sort of sustainability of this interest or the expansion of the interest, if you see what I'm getting at? Thank you.

John Treace

Yeah, no, I think I know where you're going there. You know, the reorder rate or the repeat customer rate when they adopt 1 of these new systems is, I can tell you, pretty high. You know, we always wish for 100% and multiple 100%, but we're very pleased with the stickiness we're seeing. We're also seeing more growth in the 2-plus category and the 3-plus category. So those are metrics we're watching internally and tracking and just monitoring how well we're becoming that full 1-stop shop or full-service provider for our surgeons' bunion needs, and now we're watching how are we capturing new segments like midfoot and rearfoot cases and procedure volumes. So we're tracking and monitoring all this, and what we see is very healthy.

Frederick Wise

That sounds good. And just 1 last one from me for Mark. Mark, you've alluded to and mentioned the sales performance ex the comp of the stocking distribution purchases. So if you're at a mid-single-digit rate now, if adoption of all these products you've launched and some to come are launching, shouldn't we be thinking about the next year potential, especially against the, I'll call it relatively easier comps that didn't have all these exciting innovative products? Shouldn't we imagine that next year on a preliminary basis, sales could grow in the sort of, I'm just framing it just randomly, but 5% plus, 5% to 10% kind of range, for starters? I know it's not a perfect question, but I had to ask. Thank you.

Mark Hair

No, Rick. Rick, I know exactly where you're going. And our minds are on the same thing. The foot and ankle market has historically grown mid-single digits, but more recently last year and this year, they have been lower than historical rates. Our goal is to take share, and we're watching the market in these trends, but we absolutely want to return to market trends and then do better with all these additional product lines and products that we have. So before we really dive deep into 2027, and we plan to give our guidance on our Q4 call like in previous years, but we continue to launch these new products and know that they are important to our ability to grow faster than the market. So before providing views on 2027, we really want to better understand these case volumes in our seasonally strongest quarter. This is an important quarter for us.

It always is, and it sets kind of the stage for what we believe can happen next year. So we want to get through this fourth quarter. And then we also want a handful of months with our new products. So I know that the conversation over the last several quarters have been about the 2025 product launches, but we've got some really compelling and interesting 2026 launches. So we really want to have a little bit more experience with those new product launches. We think they can really be a driver to case volume growth. And some of them are just additive to existing cases.

And we think that's important too, because that means incremental revenue per case by using these sterile instruments or these other additive items that surgeons are asking for, and then we can get incremental case volume. So I know exactly where you're going for, Rick, with the question. We are aligned. We believe that the first step is to get to where the market is, and then we fully plan to drive above where the market is as well. But give us a little bit more time and we'll talk about 2027 on our Q4 call.

Frederick Wise

Thanks for all the color, gentlemen.

Mark Hair

Thank you, Rick.

Operator

Our last question comes from Richard Newitter with Truist Securities. Please proceed.

Unknown Speaker

This is Kunal on for Rich. With you guys adding so much to the portfolio, I realize that some of these are sold into existing cases already, but to ensure continuing rep productivity, are you going to continue to add headcount? Do you need dedicated reps? And then, kind of with that in mind, how does that play into the cost controls you guys have in place? Any qualitative or directional guidance on how you're thinking about OpEx moving forward?

John Treace

Hey, Kunal, thanks for the question. I can maybe talk about the reps and then Mark can talk about OpEx if that's okay. We do have the bigger bag and there's a lot of synergy with the products that we're bringing into our established direct sales force. You know, instead of being in X number of cases per week, they're in 1.5x cases. And this is great. This is healthy. It's easy for them to leverage, you know, throughout the day in serving more of their surgeons' cases, or to hand them more technologies into their existing case that they're in today.

Right? We talked about how we have these new disposable CartiBlasters, we talk about how we have a synthetic biologics line now. These are products that are very easy in the same case for the sales rep to offer and just displace whatever other company the surgeon's been using for those technologies, SuperBite as well. So it works really efficiently.

That said, we will continue to modestly build our sales channel and strengthen our sales channel over time. But we're not talking about investments of big magnitude there. I'd say they'd be more incremental. That's our plan on the rep side, and in terms of how it's impacting OpEx going forward, I'll turn that over to Mark.

Mark Hair

I'll just, I think John hit it right on. A lot of those sales costs, a lot of those are variable costs. With a commission compensation program, it will align with the revenue growth, those costs. We're not giving 2027 guidance right now, but we're not anticipating dramatic changes to our OpEx. You know, we'll have some incremental increases for a variety of reasons, but yes, I think that the important point to take away here is we're really pleased with the leverage that we've shown this year. We've had a decline in revenue year over year. However, at the same time, we've dramatically reduced our cash usage.

We're improving our bottom line Adjusted EBITDA. If you look at the guidance range that we gave today, that would imply perhaps a 60% plus improvement on the bottom line in Adjusted EBITDA. So we think there's more improvement in leverage and profitability to come, and we're excited about getting through this really busy season for us and giving more specifics on our Q4 call.

Unknown Speaker

Awesome. Thanks, guys. I'll leave it to that.

Operator

Thank you. And this will conclude our Q&A session and conference for today. We want to thank everyone for participating. You may now disconnect.

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