Segments
As previously discussed in Note 2. Significant accounting policies—Accounting pronouncements recently adopted, the Company adopted the provisions of ASU 2023-07, which required enhanced disclosures concerning significant segment expenses that are provided to the CODM and included within each measure of segment profit or loss. The Company identifies a business as an operating segment if (i) it engages in business activities from which it may earn revenues and incur expenses; (ii) its operating results are regularly reviewed by the CODM and (iii) it has available discrete financial information. The Company’s CODM is its President and Chief Executive Officer, who uses Segment adjusted EBITDA to make decisions regarding the allocation of resources, assess performance and to develop annual budgets and forecasts.
The Company’s two operating segments are U.S. and International, which also represent its reportable segments. Both segments sell the Company’s portfolio of products to healthcare institutions, physicians, patients, distributors and dealers. The Company does not disclose segment information by asset, as the CODM does not review or use it to allocate resources or to assess the operating results and financial performance.
The following table presents segment adjusted EBITDA reconciled to loss before income taxes for the years ended December 31:
December 31, 2024
U.S.InternationalConsolidated
Revenue$506,809 $66,471 $573,280 
Adjusted cost of sales(a)
118,985 24,188 
Adjusted selling expense(b)
157,789 11,233 
Adjusted marketing expense(b)
24,235 3,004 
Adjusted general and administrative expense(b)
97,592 14,949 
Adjusted research and development expense(c)
13,139 41 
Adjusted other segment income(d)
(352)(405)
Adjusted EBITDA95,421 13,461 108,882 
Reconciliation to loss before income taxes
Interest expense, net(38,792)
Depreciation and amortization(49,555)
Acquisition and related costs(1,339)
Shareholder litigation costs(13,802)
Restructuring and succession charges57 
Equity-based compensation(10,058)
Financial restructuring costs(351)
Impairments of assets(36,357)
Loss on disposal of a business(292)
Other items(e)
(7,519)
Loss before income taxes$(49,126)
December 31, 2023
U.S.InternationalConsolidated
Revenue$449,860 $62,485 $512,345 
Adjusted cost of sales(a)
109,889 25,760 
Adjusted selling expense(b)
140,278 11,908 
Adjusted marketing expense(b)
24,401 2,655 
Adjusted general and administrative expense(b)
86,108 12,285 
Adjusted research and development expense(c)
11,458 31 
Adjusted other segment income(d)
(942)(348)
Adjusted EBITDA78,668 10,194 88,862 
Reconciliation to loss before income taxes
Interest expense, net(40,676)
Depreciation and amortization(57,365)
Acquisition and related costs(5,694)
Restructuring and succession charges(2,331)
Equity-based compensation(2,722)
Financial restructuring costs(7,291)
Impairments of assets(78,615)
Loss on disposal of a business(1,539)
Other items(e)
(13,740)
Loss before income taxes$(121,111)

December 31, 2022
U.S.InternationalConsolidated
Revenue$455,251 $56,866 $512,117 
Adjusted cost of sales(a)
109,961 19,847 
Adjusted selling expense(b)
147,772 11,291 
Adjusted marketing expense(b)
30,161 2,667 
Adjusted general and administrative expense(b)
93,565 10,397 
Adjusted research and development expense(c)
18,326 33 
Adjusted other segment (income) expense(d)
(1,047)534 
Adjusted EBITDA56,513 12,097 68,610 
Reconciliation to loss before income taxes
Interest expense, net(12,021)
Depreciation and amortization(55,398)
Acquisition and related costs(21,731)
Restructuring and succession charges(7,453)
Equity-based compensation(17,585)
Impairment of assets(10,285)
Impairment of goodwill(124,697)
Other items(e)
(8,465)
Loss before income taxes$(189,025)
(a)Adjusted cost of sales used in calculating segment Adjusted EBITDA excludes depreciation and amortization as well as the amortization of inventory step-up resulting from acquisitions.
(b)Adjusted selling, general and administrative expense used in the calculation of segment Adjusted EBITDA excludes certain acquisition and related costs, shareholder litigation costs, certain restructuring and succession charges, asset impairments, financial restructuring costs, equity-based compensation expense and other segment items—charges associated with strategic transactions, such as potential acquisitions or divestitures and transformative project to redesign systems and information processing projects.
(c)Adjusted research and development expense used in calculating segment Adjusted EBITDA excludes depreciation and amortization, equity-based compensation expense and other items—charges associated with the discontinuance of MOTYS and certain regulatory costs.
(d)Adjusted other segment (income) expense primarily consists of foreign currency transaction and remeasurement gains and losses and other certain nonrecurring items. Activity excluded for the year ended December 31, 2024 included previously unrealized foreign currency gains within the International segment resulting from the sale of the Advanced Rehabilitation Business. There were no excluded costs relating to other (income) expense during the year ended December 31, 2023. Costs excluded for the year ended December 31, 2022 included an impairment related to the investment in Trice Medical Inc. within the U.S. segment.
(e)Other items primarily include charges associated with strategic transactions, such as potential acquisitions or divestitures and a transformative project to redesign systems and information processing. During the year ended December 31, 2024, other items primarily consisted of divestiture costs related to the Company’s Advanced Rehabilitation Business, including transactional fees, transformative project costs and strategic transaction costs.
During the year ended December 31, 2023, other items mostly consisted of strategic transaction costs, transformative project costs, transition and severance costs and expenses related to the discontinuance of MOTYS.
During the year ended December 31, 2022, other items primarily consisted of costs related to the discontinuance of MOTYS, strategic transaction costs and public company preparation costs

About Segments Disclosures

Segment disclosures break a company into its reportable operating units, revealing revenue, profit, and asset allocation that consolidated financial statements obscure. Under ASC 280, segments must match how the chief operating decision maker views the business, providing a window into internal management structure and resource allocation priorities.

Key signals: compare segment margins to identify which units drive profitability and which destroy value. Watch for changes in the number of reportable segments — segment aggregation or disaggregation often coincides with strategic shifts or attempts to obscure declining performance. Intersegment elimination patterns reveal internal pricing practices. The reconciliation between segment totals and consolidated figures exposes corporate overhead allocation and unallocated items. Geographic revenue concentration highlights regulatory and currency exposure. Compare segment-level capital expenditure against segment revenue to assess where management is investing for future growth versus harvesting existing assets.