Thank you for standing by and welcome to Integra LifeSciences Fourth Quarter and Full Year 2022 Financial Results Call. At this time, all participants are in a listen-only mode. [Operator Instructions] I would now like to hand the call over to Chris Ward, Senior Director, Investor Relations. Please go ahead.

Thank you, Lateef. Good morning and thank you for joining the Integra LifeSciences fourth quarter and full year 2022 earnings conference call. Joining me on the call this morning are Jan De Witte, President and Chief Executive Officer; Jeff Mosebrook, Chief Accounting Officer; and Mathieu Aussermeier, Vice President, Corporate FP&A, Investor Relations & Treasurer. Earlier today, we issued a press release announcing our fourth quarter 2022 and full year 2022 financial results. The release and corresponding earnings presentation, which we will feature during the call, are available at integralife.com under Investors, Events & Presentations and the file named Fourth Quarter 2022 Earnings Call Presentation. Before we begin, I would like to remind you that many of the statements made during this call may be considered forward-looking statements. Factors that could cause actual results to differ materially are discussed in the Company's Exchange Act Report filed with the SEC and in the release. Also, in our prepared remarks, we will refer to both reported and organic revenue growth. Organic revenue growth excludes the effects of foreign currency; acquisitions, divestitures as well as discontinued products. Unless otherwise stated, all disaggregated and franchise-level revenue growth rates are based on organic performance. And lastly, our comments today will include certain non-GAAP financial measures. Reconciliations of any non-GAAP financial measures can be found in today's press release, which is an exhibit to Integra's current report on Form 8-K filed with the SEC. And with that, I will now turn the call over to Jan.

Thank you, Chris, and good morning to all of you joining us today. We will take you through our accomplishments and financial results for 2022 as well as our plans and financial guidance for 2023. Please turn to Slide 4. 2022 was a year of many challenges for all of us, especially from the macro environment. I'm proud of our colleagues for having demonstrated themselves to be responsible stewards of our business, and the challenging economic and supply environment. We remain focused on doing right by our customers and patients, while delivering on our financial commitments to our shareholders. We met our full year organic growth targets, exceeded our original adjusted EPS guidance, advanced our strategic initiatives and bolstered key capabilities. So let me start by highlighting several of these accomplishments in 2022, including key new product introductions, commercial optimization and strategic M&A that not only expanded our portfolio, but also strengthened our capabilities to capitalize for growth. In our Codman Specialty Surgical division, we added important line extensions to our CUSA portfolio with a recent launch laparoscopic tip, and with clearance of our bone tip in late Q4. Although it's a direct contribution to our revenues in 2003 from these products will be modest, they illustrate continued differentiation of our CUSA product line with new functionalities that enhance the utility of this technology platform. We also launched the Aurora Evacuator plus coagulation tip in the U.S as we continue to partner with surgeons to address their needs and expands the Aurora platform. In our Tissue Technologies division, we launched NeuraGen 3D, a unique mid cap nerve repair product. We also successfully completed the integration of the ACell portfolio through the expansion of our wound reconstruction sales team. As planned a year ago, we returned the ACell portfolio to growth…

Thank you. Lateef, we can open the line up for Q&A, please.

[Operator Instructions] Our first question comes from the line of Vik Chopra of Wells Fargo. Your question please, Vik.

Hey, good morning and thanks for taking the question. Just a couple for me. I guess the first one is can you provide an update on the CFO search? What's the criteria for the candidates and any time line, that will be helpful. And my second question is on margins. Jan, thanks for the comments, they were helpful. But how should we think about growth and EBITDA margins in 2023? Thank you.

Okay. So let me pick the first one, and I will ask Jeff to go a bit deeper into the margin question. So on the CFO search, we started late January with the search with an executive search company. Looking for the CFO who provides a good balance between on the one side, the operational capabilities. I mean Integra is a heavy operational business, many dimensions of operational excellence and, I would say, complexity. But also on the other end of the balance there, strong strategic capability and capability to engage in M&A. It's clear that at this point in time, we are an acquisitive firm company, and we will continue to be an acquisitive company. So we are looking for a CFO that has that balance. At this point in time, we are with the executive search company making a list of candidates. I expect that I'm going to be busy interviewing during the month of March. How that translates into a candidate being feet on the ground can take between 3 to 4 months. So that's on the CFO. I'll hand it to Jeff to give a bit of view on the margin evolution in 2023. As I've communicated during my prepared remarks, we definitely made a choice to reinvest some of our strong gross margin improvement in 2023 to reinvest in several investment areas that all of them support our growth capability. But I will let Jeff go a bit deeper on this.

Thanks, Jan. And Vik, to kind of walk through your question, maybe start first on the gross margin. So, Jan, in his prepared remarks, and the way he just highlighted a lot of positive things we see across gross margins. So when you start first on the revenue side, you see the benefits that we are going to drop through in 2023 with the product mix and the price capture. You couple that with the benefit that we will see for the full year for the TWC divestiture will drive benefits there along with what we are seeing with manufacturing efficiencies that we hope to gain in 2023. Some of them was mentioned around the closure of a high cost facility in France as well, too. So overall, when we look at gross margin, we see that improvement being around 100 bps mid of improvement there. So that's going to be the capture that we're expecting going into 2023. Now if you move to the operating expenses, as Jan had mentioned, we are really trying to apply that and make sure that we are redeploying and we are looking at our strategic investments. And we mentioned a couple of kind of key areas there, the SurgiMend and the doors PMAs, new products, R&D and clinical, international expansion along with some R&D along the digital pilot study. So what you're going to see from an EBITDA is really modest EBITDA margin expansion as the offset related to the gross margin expansion will be within the operating expense as we continue to invest into the growth drivers of our business.

Thank you. Our next question comes from the line of Robbie Marcus of JPMorgan. Your question please, Robbie.

Hi. This is Alan on for Robbie. I had a quick one on the quarter and then on 2023. So starting with the quarter. We were talking about gross margin, but from our perspective, it looks actually came in a little bit softer than expected, especially when you look at the kind of fact that it worsened year-over-year and also sequentially despite the fact that macro -- currency macro was generally full of pressure, but not as bad as expected. Can you just dive into what drove that relative softness and whether or not there's upside to that 100 basis points you just called out?

So let me maybe a quick answer on the -- I understood you talked about gross margin, right, for the fourth quarter, Robbie?

Yes, that's correct.

Yes. So if you look at -- there's an impact of the mix as a result of the supply shortages, specifically packaging materials, we felt shorter. We have higher backorders than we wanted on our dural access and repair, which is a higher profitability product. So yes, that mix pushed along the site. Then of course, still a bit impact from the CereLink recall, customer making during the quarter. And then third, impact from -- on a comparative basis, impact from inflation that was hitting us on the gross market side, inflation that came through our factories during the year. And those are the three main levers playing in the fourth quarter.

Yes. Jan, I just probably would add there. Again, you had mentioned about the FX. We still look at the FX in a year-over-year, it was significantly worse versus Q4 from the prior year. And as Jan mentioned, relative to some of our costs, what we see is some of the inefficiency with our manufacturing that happened in the earlier part of the year, those amounts get deferred and then expensed in Q4. So the gross margins came in lighter in Q4, but that was within our guidance and within our expectations.

Got it. And [technical difficulty] 2023, when we look at your organic growth range 4 to 5.2, at the top end, you're coming at the very low end of the LRP. I know there's still some puts and takes to the year. But with -- you have CereLink coming back in the first half, so you have difficult comps in the first half offset by easy comps in the back half, recognizing that it will take time to get that going. And also you'll be working on integrating SIA. I guess what gives you confidence that you can continue to kind of drive that reacceleration and back to growing sustainably within your LRP and hopefully getting closer to the high-end of the LRP? Thank you.

Yes, I would give you the short answer. And if you want to go a bit deeper, we can. But first, and as I communicated before, we have our two portfolios and the markets they're in. I think in Tissue Technology, clearly in 2022, yes, it proves to be that 7% to 9% growth business, definitely with ACell starting to pull heart but also the rest of the portfolio delivering well. Yes, we see a normalization of our private label. That definitely carried more than its weight in '22, yes, but it's going to normalize in '23. But overall, that portfolio is doing what we expect it to do. And then the neuro portfolio 3% to 5% markets, which if you look at the portfolio in '22, excluding CereLink, definitely delivered that. With CereLink coming back, yes, that will contribute to its rightful weight in the portfolio. So if you take those two together, we're a 5% plus business, and that's what we're working towards in 2023.And now a couple of the year-over-year comparisons make that a bit more difficult with different ups and downs in 2022. But overall, that gives me confidence in the portfolio that we’ve in the 5% to 7% range that we have set as our long-range plan. On top of that, there's a couple of NPIs that were launched in '22, which will start to deliver more -- increasingly more over 2023. I'm thinking about Aurora and NeuraGen, at 3D, two of the 2022 losses that will show up in '23.

It is important also to note that from a CereLink perspective, we are really counting on revenue in the second half as we are looking at our guidance range.

Question please.

Thank you. Our next question comes from the line of Steven Lichtman of Oppenheimer. Your line is open, Steven.

Great. Thank you. Good morning, guys. So I wanted to ask on a couple of topics. One on product pipeline over the medium term. Can you give us an update on both SurgiMend and Aurora? What are the key milestones that we should be looking for on both --both in terms of your discussions with SurgiMend and on the Aurora rollout? And then Jan, maybe the second question, could you just flesh out a little bit more on what you see as the international opportunity? And what should we be looking for from Integra in 2023 as you really continue to build that out? Thanks.

So first on a question on the product pipeline. One, SurgiMend, as we communicated on the last slide, we're well on track to do our submission in -- it's going to be August of this year. So that submission of further data that we've been working together with the FDA will be submitted. We are well on track to do that, and that should lead -- and we feel good about our prospects to get PMA somewhere over 2024. With Aurora, at this point in time, it's about putting further instruments in the field to drive utilization and drive experience with the surgeons. Last year, 2022, I mean, low revenues was not the target. We expect in 2023 to have the first, call it, material revenues also Aurora to show up on the top line. So that's on the product. In terms of international opportunity: one, the international historically has been able to continue to be high-single-digit growth driver, strong growth in Asia, Japan, China, for sure. But also if you look at our indirect markets in the Middle East, Latin America, Canada, good drivers. In parallel, we are working different investments into international. First, more feet on the street. There are still some regions where we are underrepresented versus what we -- with our current portfolio. And then second, we're building out our global portfolio in international. We just launched early in January the ACell portfolio in Europe. So that's existing products in new markets that will add to international growth. We're further exploring opportunities for tissue technologies in Europe, but also in select Asian countries. And then from a neuro surgery perspective there -- given we're well-positioned in Europe, looking for further opportunities in Asia, places like China to bring more of our new surgery products into the market. So two -- mix is one. It's a good market, and we are feeding the good markets with the products we have. And then second, we are introducing products that we have into both Europe and Asia. While in parallel, we are not excluding M&A opportunities to further build out our footprint in international.

That’s helpful. Thanks, Jan.

Thank you. Our next question comes from the line of Matt Taylor of Jefferies. Your line is open, Matt.

[Indiscernible] Matt Taylor, I don’t know [indiscernible]. Okay, great. So thanks guys. I just wanted to ask a question about some of the factors that are going to help you in the second half of the year. I guess, could you quantify the amount of contribution that you expect from CereLink and understanding that you'll be in the 6% range implied in the second half of the year, you're within your LRP targets. But -- do you think that's a good jumping off point to be able to consistently grow in that range as you move into 2024?

Yes. So Matt, this is Mathieu here. So again, when you look at our first half, second half and kind of the ramp from the 3% to 6%, CereLink, we are not banking on any revenue in the first half and coming back in the second half. If you look at what we have seen historically in terms of sales coming back from CereLink, we think we’re going to be gradually coming back to this in the second half and then entering 2024 with, again, a stronger base growth in that year. In general, in terms of trends into 2024, I think we will continue to make progress towards our long-term plan, which is really that 3% to 5% on the CSS side. It's that 7% to 9% on tissue tech, and we expect to make strides going forward, '23, '24 and onward to achieve those long-term targets.

Okay, great. And maybe just one follow-up. You talked about the private label normalization a few times. Can you be more specific about how you expect private label to grow in '23 because of the tough comps in the first half?

I will give this again to Mathieu.

Yes. So first half, when you look at private label, I mean, we definitely expect a year-over-year comp that's going to be down. First half 2022 was really our strong half, I would say, of 2022. And as you go into the second half, we expect it to be slightly down to flattish, bringing the year on a year-over-year comparison to down low single to mid-single-digit on the private label segment.

Great. Thank you very much.

But overall , Matt, private label is mid-single-digit growth business. And that's where we will be back at those levels. As of 2023, we will continue in the out years.

Okay, great. Thanks for the clarification there. Thank you.

Thank you. Our next question comes from the line of Ryan Zimmerman of BTIG. Please go ahead, Ryan.

Okay. Good morning. Thanks for taking my questions. I guess, I want a little more clarity on the margin line because as I think about the long-range plan, when do we get to kind of that low teens or double-digit EPS growth? The 100 margin -- the 100 basis points of margin expansion you're expecting, is that absolute for '23? Because I guess I'm curious if there's anything baked in, in terms of inflation headwinds or other FX that you're talking about? Or should we assume that you're going to get 100 bps of margin expansion in '23 on an absolute basis and all in? And just as a second to that, when do we get back to kind of that low double-digit EPS growth? Because if I look at kind of where margins are going coupled with some of the sales and marketing structure, it doesn't look like we're going to see a double-digit number in '24 as well, just looking at kind of where the margins are at today.

Okay. Let me -- I'm going to hand it back Ryan to Jeff, but also to clarify a couple of things more on the gross margin, which I think you fully captured. Jeff?

Yes, Ryan, so going back to that 100 bps, that was a discussion around the gross margin side. So where we see gross margin improving 100 bps mid relative to kind of those drivers we mentioned before. Now when we talk about kind of year-over-year and modest EBITDA improvement, keep in mind within our OpEx, the redeployment that Jan was speaking of, which is a reset kind of coming out of our expense management that we had in the second half of the year, you also have to couple that with the SIA acquisition we did at the end of December. So that acquisition brought within operating expense, and we mentioned within that deal that it would be dilutive. So it's adding the additional R&D and commercial with that business to make sure that we support it going forward, both from the PMA perspective and commercial execution there as well, too. So I think relative to 2023, you got to keep in mind, there's a lot of moving parts on the top line with timing, and that has created some noise in the first half and the second half and then also on the operating expense side the investments that we're making along with SIA as well, too, that is making our EBITDA growth more on the modest side. But again, gross margin growing at 100 mid basis points offset on the operating expense with those investments that we talked about.

So maybe, Ryan, just to add to that, because I mean Jeff used the term 100 bps mids, which it means well above100.

Correct, yes.

So that's one. Our -- yes, we definitely, for 2023, are driving strong gross margin accretion as a result of -- yes, on the one hand, yes, some of the mix portfolio changes we've done and focus on operational efficiencies, okay? So that's one. Second, in terms of what I flagged as we are investing in growth. If you look back at our OpEx pattern first half, second half last year, you'll see that second half were significantly lower on OpEx. At that point in time, I told our investors that -- this is preparing not just to compensate for CereLink, but also preparing to redeploy which we're doing. So you will see that OpEx come back and more, part is the SIA acquisition. But part is that we're reinvesting the money we redeployed last year. And I would say, in total, there's about $35 million of redeployed money that we're reinvesting in 2023, okay? So that brings our OpEx level back to a bit more normal level, we say, like the first half of '22 plus the SIA acquisition and some labor inflation, okay. So those two elements, that's essentially the re-step up of our OpEx that is keeping our EBITDA progress in 2023 at a [indiscernible].

Okay. Let me ask about market growth, and I'm going to ask a little bit away from the P&L for a second. As you think about the puts and takes of the business, and I know CereLink is coming back and so forth, what are you assuming for overall market growth, be it Neurosurgery or Tissue Tech? Are those markets at depressed levels right now, in your view? Because if they're not, then you are losing share, I guess, relative to your market in the first half of this year. And if they are at depressed levels, when are you assuming they come back? And is that in coordination with the product drivers you're talking about? And why not get more of a boost, I guess, in the back half of the year?

So we see the markets pretty much back at their normal [technical difficulty] we've seen Q4 except for a couple of countries, but yes, we are pretty much back to normal. The growth that you see, we don't think we're losing share. And then there's definitely with CereLink not in the market, growing that market. But the other parts of the portfolio are doing as we expect them to do. And even in several areas, when I look at our capital, when I look at our CSS, I mean, we are definitely capturing share. So I think the numbers you see I mean have several elements of year-over-year comparison that may make you think differently, but that's definitely not the case. We see the market sits back and good, we see our position strong in the markets.

Okay. Thank you.

Thank you. Our next question comes from the line of Rich Newitter of Truist. Your line is open, Rich.

Hi. Thank you for taking the questions. Just maybe sticking with the margin outlook. I think I heard you say earlier in the call, modest EBITDA margin expansion or operating margin expansion. I guess I'm just -- for the full year, I'm trying to figure out how you get there. Earnings growth is effectively in line more or less with the top line and you have a repo in there. So maybe help flesh out, are they below the line non-operating items and tax interest that are considerations there that would lead to modest expansion. I'm getting more to flat, maybe even slight deleveraging. And then secondly, on the cadence of margin improvement, it sounds like you you're going to step up the spending back to "normalized" level pretty immediately starting in the first half. That's where growth is on the top line a little bit lower between the first half and the second half. So should we be thinking about different margin delevering and levering profiles in the first half and second half? So any color you can provide on kind of the margin cadence moving through the year?

Yes. Thanks, Rich. So maybe just walking down the rest below EBITDA. So I think keep in mind, as you're kind of modeling through the EPS with the range that we gave, walking down kind of on the tax rate, that's an area to call out. We did have in 2022 a benefit from stock comp that we don't see will be reoccurring in 2023. So we are modeling our tax rate around 19% for the year. So that's year-over-year about 100 -- a little bit over 100 bps of increase in tax rate. You had mentioned the share count, but that is the key point as well, too, as we initiated in early Q1 a $150million share repurchase. So you have to factor that into an updated share count for the rest of the year. and that really kind of drives to our EPS guidance that you mentioned. And again, recall, on the operating expense as well, too, it's the deployment of those additional investments that Jan had mentioned, plus the addition of the SIA acquisition that was in December that's adding the additional expenses and contributing to the modest EBITDA improvement.

Okay. So …

On the cadence question -- on your cadence question, I think you had asked, so I think you're correct. You'll see a little bit of the drive and the profitability, matching the revenue. We had provided the guide of the walk of the first half of 3% versus the second half at 6%. So that will align with some of the profits as well, too, as the operating expense investments will be fairly evenly throughout the year, with maybe a slight uptick in the second half, but you'll see more profit driven more in the second half of the year.

Okay. Thank you. Maybe just one on CereLink. As we think of the products return to market, should we be thinking about the incremental revenue contribution at least in 2023 is more just getting supply back to existing customers? Or are you banking or is your guidance assuming actually opening new accounts and incremental revenue beyond some baseline level that you get back to?

We definitely count on opening new accounts. As I communicated before, our manufacturing capability is ready. We have a different parts yet ready to start manufacturing. So the capacity is not -- it's not really going to be a bottleneck. At this point in time, on CereLink, we are running the validation, verification of the new technical fix generating statistical significant data that we then take it to the FDA and get back into the market after submission.

Okay. Thank you.

Thank you. Our next question comes from the line of Jayson Bedford of Raymond James. Your line is open, Jayson.

Hi. Good morning. Just maybe a couple of quick ones. You mentioned price capture as part of the stronger margin profile. Can you just provide a little bit more detail as to price the discussions, any pushback you're getting? And what's the contribution to revenue growth in '23?

So thanks for the question, Jayson. In terms of price, we communicated last year that typically, we've always gotten some price in the range of 1 percentage. Last year, we aimed at four more, and we succeeded in getting more this year, given the realities of inflation that we saw last year and some of the inflation that is hanging. We are aiming a next step higher. And as far as we see customers understand we are not the only [indiscernible] company that is adding price to deal with inflationary prices. So we are on a path to get more than last year, which definitely is significantly more than what we would get in a typical year.

And Jan, that's on a net basis, meaning if I just look at kind of your $1.5 billion in revenue in '22, you expect to get north of 1% in price in '23 across the portfolio?

Yes.

Okay. Okay. And then just quickly, second one. The mid-single-digit decline in dural access repair, it sounds like much of it is supply chain-related. Are there any demand issues? Or are there any kind of competitive market share dynamics at play as well? Thanks.

No, no, this is all supply and then primarily packaging material, unpredictable availability, let's call it that way. So we are losing some manufacturing capacity, yes, as a result.

And when this expected to be alleviated, the supply chain dynamics?

We will definitely expect it to take all the first half to bid-by-bid improve. This is about the supply chain getting back to its capacity. We are developing and have developed parallel suppliers of some of these packaging materials. So we are alleviating some of the root cause. But for some, we will have to continue working with supplier a bit of a bit get back to the capacity of material supply that.

And Jason, this is Mathieu. This is also, I would say, kind of a good example of what we are going to see throughout 2023 in terms of gradual supply recovery, right? What you mentioned here from a dural access and repair perspective is really in line with how we kind of look at 2023 and the step up of supply recovery.

Got it. Thank you.

Thank you. Our next question comes from the line of Joanne Wuensch of Citi. Your question please, Joanne.

Hi. This is actually Anthony on for Joanne. Thank you for taking our questions. First comment in China grew mid single digits this quarter despite what we've seen with [indiscernible] with the reopening. Can you just talk about maybe what specifically driving the growth there? And then what your outlook is for growth in China this year? And then I'll ask my follow-up just that you could discuss what you're seeing in terms of hospital appetite for new capital? Thank you.

I got your second question. Well, the first one, not sure, Anthony. What -- could you repeat?

Yes. Sorry, just asking about the Codman growth in the quarter, I believe you said it was mid single digits in China. So just curious maybe what specifically you're seeing in China, what's driving the growth there and then your expectations for China growth in 2023?

Yes. So what we saw in China over the fourth quarter, still some impact of the rolling lockdowns. What we still saw in the fourth quarter mid-single-digit growth, but that's compared to what the double-digit growth we are expected to see from China. And so from China, we expect as of the second quarter this year to be back to that double-digit growth rhythm. The first quarter still going to be a bit of a mix with some of the Chinese New Year and some of the January COVID wave that passed to the country. We definitely saw impact. Although coming out of Chinese New Year, I think most people are pleasantly surprised on how the ripples flattened out quite quick. So yes, first quarter do not expect double-digit yet, but as of the second quarter, I see China back into a normal rhythm, which is driven by the further growth of health care in that country but also our drive to move from Tier 1 to Tier 2 and 3 hospitals. So we are spreading our geographic coverage in China, okay? And that's the second -- be on the market. That's the second big growth driver for our Codman portfolio there. The question on capital. Capital in the fourth quarter has been solid, remains solid. We ended the year with very healthy funnels. And we pretty much have seen this healthy cap all over 2023. And the only thing that we've seen a bit different over the years that decision timings have become longer, and that's primarily driven by just the administrative processes that seem to run or turn a bit slower. We do not expect that to accelerate quite rapidly. But we consider we are at the new steady state where decisions will take longer. But the pipeline is well filled, and we will get the deals out of that pipeline at a steady growth phase that we've seen last year.

Thank you. Our next question comes from the line of Dave Turkaly of JMP Securities. Your question please, Dave.

Yes. Great. Jan, I'd just like to get your thoughts on sort of valuations out there. It seems like a lot of the private companies are compressed. And if that's true, I'll just add the second part in here. And you're a little below the LRP on top line and you're under leveraged. Why do you think the $150 million buyback is the right allocation choice right now? Thank you.

So I think you know as a discipline with our balance sheet, when we initiated the $150 million buyback, there were two drivers. One, given what we have in our M&A objectives, what we also have on the balance sheet, we felt that we both could give the capital back and still not impact our M&A planning. And then second, from a timing perspective, when we did the SIA acquisition, we knew first year $0.06 dilutive. And with that buyback, we wanted to isolate our shareholders from that impact. So I see it more as a strength of our balance sheet that we can do both do M&As, but at the same time, also if we have excess capital to not let it linger on the balance sheet, but bring it back. What do you say on the depressed valuations, we are very aware of that. And, yes, we definitely know what are the targets that we want to master for this year and the next years.

Thank you.

Thank you. Our next question comes from the line of Matthew O'Brien of Piper Sandler. Your line is open, Matthew.

Okay. Thanks for taking my question. Just a follow-up on Dave's question there a little bit, Jan. You've got your gameboard, you're not that levered, but you're making a lot of investments in the organic business this year. And the inorganic acquisition from last year. So is it fair to think that the likelihood of a chunkier deal this year is lower just because of all you got going on right now and more -- we should like more technology or very smaller tuck-in acquisitions versus something bigger? And then I do have one quick follow-up.

So I would not make that translation to all these smaller deals yet. Definitely, on our gameboard, which is driven by strategy, there's deals that are more tuck-in, like there's also a more significant objectives. And our balance sheet is not keeping us from having to make a selection on which we can afford, okay. So the timing is mainly driven by whether on both sides of the table, there's the willingness to transact.

Okay. Thanks for that. And then ACell was an acquisition that was done that was challenging to start with, but based on the results here recently has been -- is really perking up. So can you just maybe deconstruct a little bit of some of where that growth is coming from? And then the confidence level and the durability that you're seeing there on the low double-digit growth side of things? Thanks.

Well, the simple story on ACell is that as part of the first moves on the acquisition, we essentially had to reduce that sales force. This was linked to SIA agreement that was on this business that we did not want to take over. So we essentially had to rebuild parts of that ACell sales force. And that took time and investing in bringing new people on board starting end of 2021. And as we communicated over the first quarter and the second quarter, where we said, look, we are bringing people on board. We are getting them up and running. It's going to take 6 months before they hit the street, I mean all of that pretty much played out as we projected, and we saw the results in the second half. This product today in the acute wound and reconstruction clearly has its place to fill or to care for deep wounds. We also see a bit of a combination effect where some of the ACell products pulls some of the other tissue technology products. So overall, when I look back, I think the strategy for this product was right. Its [indiscernible] that fits in our portfolio. I think the start up was a bit with a down and then back up as we had to rebuild that sales force, yes. But -- and clearly, also to me, our sales teams have proven that they understand how to build and run the sales organization.

Okay. Thank you.

Thank you. This concludes Integra LifeSciences fourth quarter and full year 2022 financial results call. Thank you for participating. You may now disconnect.

Thank you, Lateef.