Below the Knee exists to separate signal from noise across wound care, limb salvage, and foot & ankle — tracking the deals, policy shifts, capital flows, and clinical inflection points that actually move this market. Inside, you'll find market-relevant developments, a clear-eyed interpretation of where reimbursement and regulation are heading, and a look at what February revealed about the durability of the industry's most important storylines. This isn't a news roundup; it's a working brief for investors, commercial leaders, and clinicians shaping adoption.
If this sharpened your view, forward it to one person who should be in the room. The best growth in this industry still travels by referral.
February Confirmed What January Started
If January set the tone, February delivered the proof.
Earnings season arrived. Reimbursement pressure became real numbers. And the market made clear what it already suspected: the CAMPs reset is not a blip — it's a structural renegotiation between payers, providers, and manufacturers that will define the competitive landscape for the next two to three years.
But underneath the headlines, a different story was also developing.
Vascular names outperformed. Wound care services compounded quietly. AI-enabled platforms continued to build commercial credibility. Foot & ankle innovation accelerated at ACFAS.
February reinforced a simple truth: Disruption and opportunity are the same event, viewed from different positions.
💲 Finance — WoundCareFund Market Pulse
February was a month of contrast — early-month weakness giving way to a strong finish, with the WoundCare Fund demonstrating consistent resilience against broader market volatility throughout.
Where Strength Showed Up
LeMaitre Vascular (+23.76%) — A move of this magnitude reflects strong earnings momentum and durable demand in peripheral vascular and limb salvage procedures. Pricing discipline and focused product strategy in vascular continues to reward shareholders.
Covalon Technologies (+18.77%) — Improving revenue visibility and margin trajectory in advanced wound dressings and infection control. When operating leverage begins to show up in smaller-cap wound names, re-ratings happen fast.
Avita Medical (+16.67%) — Investor confidence stabilizing around procedural growth and expanded RECELL utilization. Six of seven MACs now publishing payment rates — the reimbursement infrastructure is firming up.
InfuSystem Holdings (+16.33%) — Often overlooked in wound care circles, InfuSystem's wound therapy revenue surged over 160% in Q4 2025. Services-based healthcare models attract capital in stable growth environments, and this one is executing.
Bioventus (+15.38%) — Outperformance tied to strong Q3 2025 financial results, including organic revenue growth and improved profitability.
Where Pressure Remained
Spectral AI (−17.13%) — Shares pulled back despite ongoing DeepView® validation progress and regulatory preparations. A reminder that pre-revenue AI platforms trade on narrative timing, not just technology merit.
TELA Bio (−17.53%) — Mixed sentiment around its soft-tissue reconstruction business and recent analyst target cuts weighed on the stock.
Treace Medical Concepts (−11.30%) — Profit taking and lingering caution following preliminary revenue results that showed modest growth.
Market Takeaway
February's fund performance told a nuanced story. Capital rotated into names with vascular exposure, services revenue, and reimbursement clarity — and away from pre-revenue platforms and biologics companies facing the CAMPs reset. The outperformance wasn't defensive; it was selective.
The tolerance for ambiguity continues to shrink. Evidence, execution, and reimbursement durability are the only currencies that matter right now.
📊 Earnings — February Scorecard
February's earnings season was the most consequential since the CMS reimbursement changes took effect January 1. Here's what the numbers actually said:
MDXG — MiMedx Group [BEAT] Record 2025, reset 2026
Q4 revenue: $118.1M (+27% YoY) | FY2025: $419M (+20%) | Adj. EPS: $0.14 (beat $0.09 est) 2026 Guidance: $340–$360M revenue; adj. EBITDA mid-to-high teens. Below prior consensus of ~$375M.
Record year on the books — but the CAMPs reimbursement reset is biting. Q1 2026 is expected to be the trough, with management guiding for sequential quarterly recovery. The surgical franchise (+25% growth) is the real narrative bridge. MiMedx's $148M net cash position and $100M share repurchase authorization signals management conviction in the long thesis. Watch adoption of EpiExpress, Emerge, and the new RegenKit-Wound Gel distribution partnership with RegenLab.
ORGO — Organogenesis Holdings [BEAT] Record Q4, brutal 2026 setup
Q4 revenue: $225.1M (+78% YoY, beat by 30%) | Adj. EPS: $0.24 (beat $0.22 est) 2026 Guidance: FY 25–38% revenue decline YoY. Q1 2026: ~50% decline YoY.
CMS's December 30 discarded-product commentary was the detonator. Management believes the guidance was targeted at competitors exploiting large-size product loopholes — but it disrupted the entire market. Q1 is the trough. ReNu BLA (rolling submission underway) is the long-term thesis. BTIG maintains $9.00 price target on a stock trading at $4.11.
RCEL — AVITA Medical [BEAT] Stabilization complete. 2026 is about execution.
Q4: $17.6M (−4% YoY) | FY2025: $71.6M (+11%) | Q4 EPS loss: $0.38 2026 Guidance: $80–$85M revenue (+12–19%). Execution-led, not event-driven.
Six of seven MACs publishing RECELL payment rates removes a critical friction point. Commercial focus narrowed to ~200 core burn and trauma centers representing 90% of revenue. The $60M Perceptive Advisors credit facility removes covenant overhang. Multi-product platform (RECELL + CoHiliX + PermeaDerm) is developing. 2026 is about proving the model.
IART — Integra LifeSciences [BEAT] Wound Reconstruction was the drag
Q4: $434.9M (−1.7% reported) | FY2025: $1,635.2M (+1.5%) | Adj. EPS: $0.83 (beat $0.80 est) 2026 Guidance: $1,662–$1,702M revenue; adj. EPS $2.30–$2.40. $25–30M transformation savings expected.
The Wound Reconstruction segment declined 21.4% in Q4. MediHoney remediation is the culprit; Integra Skin showed improving supply reliability. Net leverage at 4.5x is a constraint. The 2026 transformation plan is the thesis reset. Tissue Technologies needs to stabilize before the wound care narrative reconnects.
INFU — InfuSystem Holdings [BEAT] Wound care was the standout
Q4: $36.2M (+7%) | FY2025: $143.4M (+6%) | Q4 EPS: $0.10 (+150% YoY) | Adj. EBITDA: $31.5M (+24%, record) 2026 Guidance: 6–8% pro-forma revenue growth; adj. EBITDA mid-to-low 20s.
Wound care revenue up 160%+ in Q4. Record EBITDA margins despite revenue noise from a contract restructuring. New RCM platform for wound care nearing completion — watch for efficiency gains in H2 2026. Small-cap, easily overlooked, performing well.
SNN — Smith & Nephew [BEAT] Wound growth lagged broader portfolio
Q4: ~$1,702M (~+6% underlying) | FY2025: ~$6,164M (~+5% underlying) | Trading Profit: ~$1,211M (+15%) | Trading Margin: ~19.7% (+160bps)
Free Cash Flow: ~$840M (+52%) | Dividend: +4% | 2026 Guidance: ~6% organic growth; trading profit ~8%; FCF ~ $800M.
Advanced Wound Management grew ~3% — positive, but below company average. U.S. skin substitute and bioactive categories showed softness ahead of reimbursement pressure. Tariffs (~$60M impact) and U.S. wound reimbursement changes expected to weigh $20–40M in 2026.
Orthopaedics and Sports Med carried the quarter. Cash flow improved materially, leverage stable. The RISE plan is working operationally — but wound needs acceleration to re-rate the narrative.
Coming Up:
MediWound (MDWD) — Wednesday, March 5 — NexoBrid commercial trajectory and pipeline update.
📢 Market, M&A & Company Signals
February delivered a dense mix of distribution expansion, product innovation, corporate activity, and clinical evidence:
Distribution & Market Access
MiMedx entered an exclusive distribution agreement with Summit Products Group to expand access to its advanced wound care portfolio — a push to scale through channel partnerships at exactly the right moment.
XLTA Woundcare SA announced a distributor partnership with Total Ancillary and its hydrocapillary wound care technology.
Kane Biotech signed multiple U.S. distribution and sales agreements for its FDA-cleared revyve® Antimicrobial Wound Gel, expanding commercial presence in advanced wound care channels. Anti-biofilm positioning is strategically distinct — and underserved.
McKesson accelerated its push into wound care distribution — not just a portfolio expansion, but a play to control the entire post-acute care pathway. More on this below.
Royal Biologics announced a U.S. distribution partnership for Jellagen's Collagen Type Zero — a non-mammalian collagen derived from jellyfish. Non-mammalian sourcing eliminates zoonotic contamination risk. An early commercial play worth watching for where it targets first.
Capital & M&A
BioLab Holdings announced an investment in Imbed Biosciences to accelerate commercialization of its fully synthetic SAM antimicrobial wound care platform, targeted for physician office settings.
Imbed Biosciences secured a separate strategic investment to support expansion of its wound care device platform — underscoring sustained investor interest in antimicrobial and bioengineered wound technologies.
BioStem Technologies (OTC: BSEM) closed its $15M acquisition of the BioTissue surgical and wound portfolio, adding sales force reach and meaningful product breadth in placental-derived biologics.
Product Innovation
Dynarex launched a next-generation portable NPWT pump designed for enhanced mobility across post-acute and home care settings. The market for ambulatory NPWT is real and growing.
MiRus received FDA 510(k) clearance for the IO Expandable Wedge Osteotomy System — built on its proprietary MoRe Superalloy — and launched immediately. The ability to assess and lock correction intraoperatively represents a genuine clinical advance for adult-acquired flatfoot and complex multiplanar deformities.
Stryker launched Synchfix EVT at ACFAS 2026 — the first flexible syndesmotic device with an adolescent indication. A defined, previously off-label population now has a cleared, labeled option. That's a reimbursement and liability inflection point.
Smith+Nephew signed an exclusive U.S. distribution deal with RMR Ortho for the A'TOMIC Nitinol Fixation System — using established channel access to bolt on differentiated fixation technology without building from scratch. Their second extremity distribution deal in as many months.
Treace Medical, Zimmer Biomet, and Medline were active at ACFAS 2026: Treace highlighted new lapidus fusion innovations and updated clinical data; Zimmer Biomet previewed upcoming data at AAOS; Medline debuted expanded ankle fracture and foot reconstruction plating systems.
DARCO introduced the Body Armor® PFA Walker, a new off-loading and immobilization solution tailored to partial foot amputation recovery — a niche but high-impact segment in limb salvage rehab.
Regulatory & Legal
MolecuLight disclosed that the U.S. International Trade Commission initiated an investigation following a prior complaint — introducing competitive and commercial implications for wound imaging market dynamics.
Polaroid Therapeutics received CE Mark in Europe for its photodynamic therapy wound platform — a meaningful step toward FDA and a source of real-world adoption data for the U.S. submission pathway.
Surmodics (GTCR take-private, $627M) is generating follow-on commentary around its implications: PE underwriting medtech at 41% premiums, FDA-cleared devices as acquisition accelerants, and a critical hydrophilic coatings supply chain now in private hands. Track the downstream implications for device manufacturers who depend on Surmodics coating technology.
AI & Market Trends
A new market forecast projects the AI-driven wound care market growing at a 35%+ CAGR — expanding from roughly $0.6B to nearly $13B by 2034 — driven by adoption of AI-enabled imaging, automated measurement, clinical decision support, and workflow optimization across chronic and complex wound settings. The imaging, automation, and documentation efficiency story is no longer theoretical.
⚠️ Regulatory & Risk Watch
The CAMPs Reimbursement Reset Is Still Playing Out
Both MiMedx and Organogenesis entered 2026 under identical pressure: the January 1 implementation of the $127/cm² Medicare price cap on skin substitutes, combined with WISeR prior authorization requirements in participating states. The market is adjusting — but the adjustment is not clean.
What management teams call "transition year" dynamics include slowed claims processing in WISeR states, increased audits and callbacks, and some providers exiting the market entirely. MiMedx described outright price-dumping by weaker competitors. These are the visible disruptions.
The less visible dynamic is structural: the CAMPs market is being culled. Providers without strong documentation infrastructure, clinical differentiation, and reimbursement expertise are being squeezed out. The companies that survive this adjustment — with RCTs, workflow integration, and payer relationships — will command higher market share in a smaller, but more defensible, addressable market.
This is consolidation via reimbursement, not M&A. The two produce similar outcomes over time.
CAMPs Wound Care Summit — West Palm Beach, FL — March 6–7 This is the next critical read on how the market responds. 350+ attendees including KOLs, regulatory experts, and commercial leadership from Organogenesis, MiMedx, and other CAMP manufacturers. If you're tracking biologics, this is non-negotiable attendance.
📊 Special Feature — 2026 Innovation Index: The CAMPs Category Under the Microscope
The CAMPs and skin substitutes category is the most commercially volatile segment in wound care right now — and the 2026 Innovation Index captures exactly why.
Market Size: $9.50B | CAGR: 7.0% | Category Innovation Score: 5.93
On paper, the fundamentals look solid. A $9.5B market growing at 7% annually. 32 companies evaluated. Consistent clinical demand for products that address wounds other interventions can't close.
In practice, this is the most disrupted segment in the Index.
The $127/cm² Medicare price cap and WISeR prior authorization requirements didn't create the underlying tension — they exposed it. The CAMPs category was already crowded, fragmented, and over-reliant on a reimbursement environment that CMS was always going to tighten. What's happening now is a forced reckoning with a market structure that rewarded distribution muscle and billing access over clinical differentiation and evidence quality.
What the Innovation Index Scores Reveal
The category average of 5.93 is instructive — it's not low, but it reflects the reality that regulatory parity and clinical redundancy are widespread. Many products occupy the same coverage pathways, target the same patient populations, and carry similar — or indistinguishable — clinical evidence packages. When CMS removes the reimbursement advantage, the middle of the market has no floor.
The companies that score at the top of the CAMPs segment share a consistent profile:
Technology differentiation that can't be easily replicated — novel sourcing (fish-derived collagen, proprietary ECM processing), distinct mechanisms, or platform architectures that support multiple indications
Clinical evidence that stands alone — RCTs, registry data, or real-world outcomes tied to cost reduction, not just wound closure rates
Reimbursement posture built for scrutiny — documentation infrastructure, payer relationships, and coding clarity that holds up under audit
Strategic activity that signals durability — partnerships, pipeline expansion, and capital structures that suggest long-term commitment, not opportunistic positioning
Top-scoring companies in the segment include Avita Medical (8.2), Coloplast/Kerecis (8.05), Organogenesis (7.45), and Integra LifeSciences (7.45). What separates them from the mid-tier isn't marketing spend or distribution reach — it's the quality and defensibility of their clinical and regulatory foundations.
The CAMPs Market Is Contracting Before It Matures
The reimbursement reset is functioning as a market filter. Providers without documentation infrastructure are exiting. Products without differentiated clinical evidence are losing shelf space. Companies with thin margins and no pipeline depth are running out of runway.
That's not a collapse — it's a correction. The category will be smaller on the other side of this transition, but it will also be more defensible, more evidence-driven, and more aligned with how payers and providers actually evaluate value.
The Innovation Index scores the CAMPs segment as "Moderate" in sensitivity to innovation-driven multiple expansion. That assessment holds — but with a nuance the current environment makes explicit: in a tightening reimbursement landscape, innovation score becomes a survival variable, not just a valuation driver.
The companies scoring 7.0 and above are not just better positioned for multiple expansion. They're the ones most likely to still be competing for market share when the reset fully plays out.
What the Full Report Covers
The 2026 Innovation Index evaluates all 32 companies in the Skin Substitutes / CAMPs segment across five weighted dimensions — technology differentiation, clinical evidence, regulatory and reimbursement posture, strategic activity, and brand presence — with full ranked company tables, segment maps, and analysis of where the category is likely to consolidate.
It's the clearest structured view available of who is positioned to win in CAMPs over the next 12–36 months — and who is not.
👉 Access the full 2026 Innovation Index Market Report —> belowtheknee.co/innovation-market-report
💡 Strategic Insight: McKesson's Wound Care Expansion Isn't About Products — It's About Control
McKesson's accelerated push into wound care distribution signals something more strategic than portfolio expansion: it's about capturing the entire post-acute care pathway.
Medicare's push toward lower-cost care settings — home health, SNF, outpatient — is reshaping wound care economics. McKesson isn't just adding wound products to its catalog. It's positioning to control fulfillment, compliance, and reimbursement optimization across fragmented channels.
Why this matters:
Reimbursement complexity favors scale. Navigating LCD requirements, prior authorizations, and CAMPs documentation requires infrastructure small distributors can't replicate.
Site-of-care arbitrage is real. The same NPWT device reimbursed at $3,000 in a hospital gets $800 in home health. McKesson's model thrives on volume efficiency in lower-margin, higher-volume settings.
Manufacturers lose pricing power. When distribution consolidates, suppliers negotiate from weakness. That dynamic is accelerating.
What to watch: Private label expansion in commoditized categories. Data monetization from utilization and prescriber behavior. Competitive response from Cardinal Health, Medline, and Owens & Minor — expect more distributor M&A in wound care services.
The strategic read: Distribution consolidation is deflationary for commodity wound products but accelerates adoption of differentiated, clinically validated technologies that can't be easily substituted.
Winners: Platforms with strong clinical data, workflow integration, and reimbursement clarity — NPWT innovators, AI-enabled wound imaging, advanced biologics with RCT evidence. Losers: Commodity dressings, me-too CAMPs without differentiation, small distributors without vertical integration.
McKesson's move is less about wound care growth and more about margin capture in a fragmenting market. Capital will favor companies that own clinical differentiation — not just SKU proliferation.
🎯 Innovation Index Spotlight: NPWT — The Mature Category Having a New Moment
Negative pressure wound therapy doesn't generate headlines like AI imaging or regenerative skin, but it remains the most clinically validated intervention in limb salvage — and it's entering a new competitive cycle.
NPWT is mature but not saturated. Penetration in diabetic foot ulcers is high (~70% of appropriate cases), but three trends are reopening growth:
Portability & Ambulatory Use — Dynarex's new pump reflects real market demand for mobility. Ambulatory NPWT enables earlier discharge, reducing hospital length-of-stay and cost per episode.
Home Health & Post-Acute Shift — As care migrates out of hospitals, NPWT utilization in home settings accelerates. Reimbursement complexity (rental vs. purchase, formulary restrictions) creates friction. Companies solving for compliance and ease-of-use win.
Instillation & Adjuvants — NPWT with instillation (NPWTi) is gaining traction for biofilm management. Combination approaches — NPWT + antimicrobial gels + biofilm-disrupting solutions — are gaining clinical adoption and represent the next differentiation axis.
The consolidation read: Large strategics (Smith+Nephew, Solventum, Convatec) control hospitals. Opportunity exists in fragmented post-acute, where innovation in portability, connectivity, and ease-of-use commands premium pricing.
Full NPWT competitive analysis and company scores available in the 2026 Innovation Index —> belowtheknee.co/innovation-market-report
📅 Upcoming Events
March 6–7 🔥 MAJOR EVENT CAMPs Wound Care Summit — West Palm Beach, FL Premier biologics and skin substitutes event addressing new CMS reimbursement rules effective Jan 1, 2026. 350+ attendees, KOLs, regulatory experts, and commercial leadership from Organogenesis, MiMedx, and other CAMP manufacturers. Key topics: reimbursement evidence requirements, LCD policy changes, documentation best practices, regulatory pathway updates. If you're tracking CAMPs, this is the room.
March 17–18 Wound Care Today 2026 — Telford, UK Hands-on skills, product demos, 50+ exhibitors. European wound care market focus.
April 8–11 🔥 DLS/WHF — Diabetic Limb Salvage Conference — Washington, DC (MedStar Georgetown) The premier multidisciplinary event on diabetic limb preservation. Faculty include leading vascular surgeons, podiatrists, wound care specialists, and researchers. CME-accredited. If you're tracking PAD, CLI, and DFU outcomes, this is the room to be in.
April 8–12 🔥 SAWC Spring / Wound Healing Society Annual Meeting — Charlotte, NC World's leading interdisciplinary wound care conference. Thousands of attendees, 80+ sessions, evidence-based education. Mark your calendars - I’ll be there and hope to see you!
🚀 Looking Ahead
February made one thing clear: the industry is bifurcating.
Companies with reimbursement resilience, clinical evidence, and operational discipline are separating from those that relied on favorable coverage environments, momentum stories, or distribution depth alone.
The CAMPs market is contracting before it expands — companies with documentation infrastructure and clinical differentiation will capture higher share in a smaller but more defensible market.
InfuSystem's wound care unit is compounding fast, and almost no one is watching. 160% Q4 growth inside a services business doesn't make headlines — until it does.
Nitinol fixation is having its moment in foot and ankle. Surgeons are getting comfortable with active, adaptive implants. The era of passive static fixation as default is eroding.
AI wound care is no longer a forecast story — it's a market structure story. The question is no longer whether AI will reshape wound care. It's which platforms will own the workflow.
Oxygen as therapy is early, credible, and underinvested. UC Riverside's electrochemical gel addresses the mechanism that kills limbs: deep tissue hypoxia. Put it on the watchlist now, before it has a commercial story.
The next 60 days — the CAMPs Summit, Q1 earnings, and SAWC — will provide the clearest read yet on how deep the reset goes and how quickly the recovery builds.
The opportunity is real. So is the work required to capture it.
Let's keep building.
— Scott
If these insights resonate and you're navigating growth, portfolio strategy, or commercialization in wound care or limb salvage, I work with teams facing exactly these decisions. Reach out if it makes sense to compare notes. belowtheknee.co/consulting
Below the Knee is an independent market intelligence newsletter covering wound care, foot & ankle, and limb salvage markets. Analysis and opinions are solely those of the author and do not constitute investment advice.