Integra LifeSciences (NASDAQ:IART) reported fourth-quarter 2025 results that topped the midpoint of its guidance range, while management emphasized continued progress on quality and supply-chain initiatives and outlined a 2026 outlook that excludes potential changes tied to new tariff actions due to ongoing uncertainty.
Fourth-quarter results and operational progress
For the fourth quarter, Integra reported revenue of $435 million and adjusted earnings per share of $0.83. CEO Mojdeh Poul said both figures came in above the midpoint of the company’s guidance range, and described the quarter as part of a year of “meaningful operational and strategic progress” including strengthened quality systems, compliance work tied to FDA warning letter commitments, and supply-chain resiliency efforts.
On innovation and commercialization, management highlighted several developments during 2025, including the U.S. launch of MAYFIELD Ghost, an expanded indication for CUSA Clarity in cardiac surgery, and progress in clinical evidence programs. The company also pointed to supply improvements in Integra Skin and the early relaunch of PriMatrix and DuraRepair through a dual-sourcing strategy.
Full-year 2025 financial performance
CFO Lea Knight said full-year 2025 revenue was $1.635 billion, representing 1.5% reported growth and an organic decline of 0.7%. Knight attributed reported growth in part to the full-year contribution from the Acclarent acquisition, while noting organic performance was affected by quality remediation work and supply constraints during the year.
Profitability metrics declined year over year. Full-year gross margin was 61.9%, down 260 basis points, which Knight said reflected tariffs, supply pressures, and incremental costs associated with the compliance master plan. Adjusted EBITDA margin was 19.4%, down 60 basis points, and adjusted EPS was $2.23, compared to $2.56 in 2024. Knight said disciplined cost management helped mitigate some of the impact.
Cash flow from operations for the year was $50.4 million, with capital expenditures of $81.4 million. Knight said the company invested in manufacturing infrastructure to improve supply reliability and continued funding the Braintree facility construction and EU MDR compliance, which together accounted for about $97 million in cash outlays.
Business segment performance: CSS up slightly, Tissue Technologies down
In the fourth quarter, management said the Codman Specialty Surgical (CSS) segment delivered 1.4% organic growth in global neurosurgery, supported by international strength and broad demand across the portfolio. Growth was led by double-digit performance in CereLink, MAYFIELD Capital, and AURORA, with additional contributions from Bactiseal, DuraGen, and CUSA. The capital business grew in the low double digits, while instruments posted low single-digit growth. ENT revenue grew 2.2%, led by double-digit growth in Aera and TruDi navigated disposables and mid-single-digit gains in MicroFrance ENT Instruments, partially offset by continued reimbursement headwinds affecting sinuplasty balloons.
Tissue Technologies revenue was $111.6 million, down 12.8% on both a reported and organic basis. Knight said Wound Reconstruction sales declined 21.4%, reflecting remediation efforts for MediHoney and a difficult comparison against record Integra Skin revenue in the prior-year quarter, which benefited from backorder clearance. Private label sales rose 20.1% due in part to improved partner orders and timing.
During Q&A, management added that without MediHoney, the Tissue Technologies decline would have been about 6%, which they said was largely driven by the Integra Skin comparison. They also said they continued to see strong momentum in Integra Skin as the company exited the quarter.
Tariffs, guidance, and 2026 priorities
Poul opened the call by addressing the U.S. Supreme Court decision related to tariffs imposed under the International Emergency Economic Powers Act (IEEPA) and the administration’s announcement of new Section 122 tariffs. She said there is “substantial uncertainty” regarding implementation and timing, and as a result, the company’s 2026 guidance does not incorporate those tariff changes.
Knight provided additional context, stating the company paid approximately $20 million in tariffs in 2025, with an estimated $16 million imposed under IEEPA authority. She said Integra’s guidance continues to reflect tariff assumptions in place prior to the recent developments and does not contemplate recovery of amounts paid prior to the Supreme Court ruling.
For the first quarter of 2026, Integra guided revenue to $375 million to $390 million, implying reported growth of -2% to +1.9%, including an estimated 140 basis point foreign exchange tailwind. Organic growth is expected to range from -3.4% to +0.5%, with guidance reflecting an approximate $10 million headwind largely due to MediHoney and order timing. First-quarter adjusted EPS guidance is $0.37 to $0.45, including an estimated $0.07 impact from tariffs.
For full-year 2026, the company guided revenue to $1.66 billion to $1.7 billion, representing reported growth of 1.6% to 4.1% and organic growth of 0.8% to 3.3%, including an estimated 80 basis point foreign exchange tailwind. Full-year adjusted EPS is expected to be $2.30 to $2.40, reflecting an estimated $0.32 tariff impact, which management said is expected to be offset by margin improvement initiatives and operational improvements. The company expects gross margins to be approximately flat year over year and EBITDA margin improvement of about 40 basis points.
Cash flow and leverage expectations
In the fourth quarter, operating cash flow was $11.8 million and free cash flow was negative $5.4 million. Responding to analyst questions, Knight attributed roughly two-thirds of the weaker free cash flow to the timing of collections, with the remaining third tied to restructuring costs associated with the transformation and operating model changes.
Looking into 2026, Knight said Integra expects operating cash flow to be north of $200 million, about a $150 million improvement from 2025. She said about half of that improvement is expected to come from reduced cash outlays related to EU MDR compliance and the Braintree project, with the remainder driven by improved working capital, lower capital expenditures, and better EBITDA.
As of Dec. 31, net debt was $1.6 billion and the consolidated total leverage ratio was 4.5x, within the company’s maximum allowable leverage of 5x. Knight said Integra expects to remain within its allowable leverage through 2026 and expects “meaningful deleveraging” that would allow the company to approach the upper end of its target leverage range of 2.5x to 3.5x by the end of 2026. Total liquidity was about $516 million, including approximately $264 million in cash and short-term investments.
On product supply and key milestones, management reiterated it expects the new Braintree manufacturing facility to be online by the end of June, with remaining milestones focused on process validations. Poul said the facility is expected to support inventory build for the return of SurgiMend to the market in the fourth quarter of 2026. Management also said PriMatrix and DuraRepair were relaunched in the fourth quarter of 2025—about 12 months ahead of plan—with a positive early customer reception and a measured ramp expected in 2026.
On MediHoney, management said remediation work has continued into 2026 and that the company has not included any MediHoney revenue in its 2026 guidance.
About Integra LifeSciences (NASDAQ:IART)
Integra LifeSciences Corporation is a global medical technology company specializing in products and innovations for neurosurgery, regenerative medicine and reconstructive procedures. The company develops and markets surgical instruments, implants and advanced wound care solutions designed to support tissue repair and functional recovery. Its product portfolio includes collagen-based matrices, dural substitutes, hemostatic agents and specialized spinal and peripheral fixation devices.
Founded in 1989 and headquartered in Plainsboro, New Jersey, Integra has expanded its capabilities through targeted acquisitions and internal research efforts.
