Below The Knee - Market Signal

WoundCare Fund: +2.33%  (week ending Feb 26, 2026)

Sharp outperformance vs. broader markets:

•    NASDAQ: +1.49%

•    S&P 500: +0.96%

•    Dow Jones: +0.36%

Outperformance: +84 to +197 basis points

▲  Top Movers

🔼  LeMaitre Vascular  +23.76%

A move of this size typically reflects strong earnings momentum or upward guidance revisions. LeMaitre continues to benefit from durable demand in peripheral vascular and limb salvage procedures, where pricing discipline and focused product strategy tend to reward shareholders. Vascular remains one of the more stable growth lanes in the fund.

🔼  Covalon Technologies  +18.77%

Covalon's strength likely ties to improving revenue visibility and margin trajectory in advanced wound dressings and infection control solutions. Smaller-cap wound names can re-rate quickly when operating leverage starts to show up — especially if investors see a clearer path to profitability.

🔼  Avita Medical  +16.67%

Continued volatility, but this week to the upside. Investor confidence appears to be stabilizing around procedural growth and expanded utilization of its skin regeneration platform. When adoption metrics firm up, this name can move fast.

🔼  InfuSystem Holdings  +16.33%

Infusion services are often overlooked in wound and oncology adjacency plays. Strength here may reflect improving utilization trends and operating efficiency following Q4 2025 earnings — wound therapy revenue was up over 160% in Q4. Services-based healthcare models attract capital in stable growth environments.

■  Big Picture 

The fund's outperformance this week wasn't defensive — it was broad-based participation across vascular, advanced wound, regenerative medicine, and services.

📊  WoundCare Fund — Earnings Summary 

All fund-relevant companies that reported or provided updates during the week of Feb 19–26, 2026.

MDXG — MiMedx Group  [BEAT]

Record 2025 revenue and profitability — but 2026 guidance came in below consensus, and the market is adjusting.

Revenue: Q4: $118.1M (+27% YoY) | FY2025: $419M (+20%)    EPS: $0.14 adj. EPS (beat $0.09 est, +55% surprise)

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 will be the trough — management is guiding for sequential quarterly recovery. Surgical franchise (25% growth) is the real narrative here. Watch adoption of EpiExpress, Emerge, and the new RegenKit-Wound Gel distribution deal with RegenLab.

ORGO — Organogenesis Holdings  [BEAT]

Record Q4 beat on both revenue and EPS — but 2026 guidance signals a brutal Q1 ahead. Stock fell ~10% after-hours.

Revenue: Q4: $225.1M (+78% YoY), beat by 30%    EPS: $0.24 adj. EPS (beat $0.22 est, +9% surprise)

2026 Guidance: FY2026: 25–38% revenue decline YoY. Q1 2026: ~50% decline YoY. CMS's December 30 discarded-product commentary triggered clinical confusion and utilization shutdown across the market.

⚡ Record Q4 numbers, brutal 2026 setup. CMS's Dec 30 commentary on discarded product was the detonator. ORGO believes it was targeted at competitors gaming large-size product exploitation — but it nuked the entire market. Q1 2026 is the trough. ReNu BLA (rolling submission underway, completion in 2026) is the long-term thesis. Stock at $4.11 after-hours, down ~10% on guidance. Analysts at BTIG maintain $9.00 PT.

RCEL — AVITA Medical  [BEAT]

Stabilization year in 2025 complete. 2026 framed as execution-led growth from a smaller, more disciplined base.

Revenue: Q4: $17.6M (−4% YoY) | FY2025: $71.6M (+11%)    EPS: Q4 EPS loss of $0.38; full-year net loss $48.6M

2026 Guidance: $80–$85M revenue (+12–19%). Execution-led, not event-driven.

⚡ Reported Feb 12. Six of seven MACs now publishing ReCell payment rates. Commercial focus narrowed to ~200 core burn and trauma centers (90% of revenue). Multi-product platform story (RECELL + CoHiliX + PermeaDerm) is developing but not yet financially dominant. $60M Perceptive Advisors credit facility removes covenant overhang. 2026 is about proving the model, not blowing out numbers.

IART — Integra LifeSciences  [BEAT]

Beat on EPS and revenue in Q4, but Wound Reconstruction was a drag — down 21.4%, driven by MediHoney weakness and tough comps on Integra Skin.

Revenue: Q4: $434.9M (−1.7% reported, −2.5% organic) | FY2025: $1,635.2M (+1.5%)    EPS: $0.83 adj. EPS (beat $0.80 est); GAAP EPS $(−0.02) — $511M goodwill impairment weighed on GAAP

2026 Guidance: $1,662–$1,702M revenue; adj. EPS $2.30–$2.40. $25–30M transformation savings expected.

⚡ Reported today (Feb 26). Wound Reconstruction — the segment we track most closely — declined 21.4% in Q4. MediHoney remediation work is the culprit; Integra Skin showed improving supply reliability and strong backorder clearance. Net leverage at 4.5x is a constraint. 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 wound therapy revenue up over 160%. Record EBITDA margins despite revenue noise from contract restructuring.

Revenue: Q4: $36.2M (+7%) | FY2025: $143.4M (+6%)    EPS: Q4 EPS $0.10 (+150% YoY); FY adj. EBITDA $31.5M (+24%) — record

2026 Guidance: 6–8% pro-forma revenue growth (excl. $7.1M GE Healthcare contract restructuring); adj. EBITDA mid-to-low 20s.

⚡ Reported Feb 24. Wound care segment is the fastest-growing business in InfuSystem’s portfolio right now. 160% Q4 revenue growth reflects scale starting to compound. ERP migration and new RCM platform for wound care are near completion — watch for efficiency gains in H2 2026. Small-cap, easily overlooked, performing well.

📅  Earnings Calendar 

•    Smith+Nephew (SNN) — Monday, March 2. Watch for FY2025 results and commentary on CAMPs/biologics exposure in wound management.

•    Mediwound (MDWD) — Wednesday, March 5. NexoBrid commercial trajectory and pipeline update.

📰  News Highlights

Wound Care

[RESEARCH]  Oxygen-delivering gel targets deep tissue hypoxia — UC Riverside

A UC Riverside team led by associate professor Iman Noshadi published results in Communications Materials for an electrochemical gel that generates oxygen continuously inside wound tissue using a small battery. In diabetic mouse models, otherwise-fatal wounds closed in ~23 days. The mechanism is sound: address hypoxia directly, not just the wound surface. Still preclinical. But mechanistically, this is exactly the problem we haven’t solved with passive dressings.

[MARKET]  Royal Biologics x Jellagen: jellyfish-derived collagen enters U.S. market

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. Early commercial play, not FDA-cleared product claim. Watch what clinical settings they target first.

[MARKET]  Kane Biotech expands U.S. commercial reach for revyve® biofilm disruption gel

Kane Biotech signed multiple distribution and sales agreements for its FDA-cleared revyve® Antimicrobial Wound Gel in the U.S. Anti-biofilm is underserved in chronic wound care. This platform’s positioning is strategically distinct from antibiotics. Expanding commercial reach heading into a more complex reimbursement environment is the right sequencing.

[REGULATORY]  Polaroid Therapeutics receives CE Mark for photodynamic therapy wound platform

PTX’s photodynamic therapy platform cleared CE Mark in Europe — a meaningful step toward FDA. Light-based wound care has struggled to find workflow fit; CE Mark gives Polaroid a commercial runway and real-world adoption data to support eventual U.S. submission.

Limb Salvage

[M&A / REGULATORY]  Surmodics buyout: what the deal signals for vascular medtech in 2026

GTCR’s $627M take-private of Surmodics closed in November after the FTC antitrust challenge failed in federal court. The deal is months old but commentary is circulating this week on its implications. Three reads: (1) PE is underwriting medtech at 41% premiums — cost of capital assumptions have reset. (2) FDA-cleared devices (SurVeil DCB, approved June 2023) are acquisition accelerants. (3) The hydrophilic coatings supply chain — embedded in every PAD and CLI catheter and guidewire — is now in private hands. Track the downstream implications for device manufacturers who depend on Surmodics’ coating technology.

Foot & Ankle

[REGULATORY]  MiRus receives FDA 510(k) clearance for IO Expandable Wedge Osteotomy System

MiRus cleared 510(k) for the IO system — built on its proprietary MoRe Superalloy — and launched immediately. The clinical case: Evans osteotomies have historically used static wedges chosen preoperatively. The IO system lets surgeons assess correction intraoperatively and lock once alignment is optimal. Accommodates bone graft for biological integration. For adult-acquired flatfoot and complex multiplanar deformities, that’s a real advance.

[MARKET]  Stryker launches Synchfix EVT at ACFAS 2026 — first flexible syndesmotic device with adolescent indication

The adolescent indication is the actual story. Weber B, Weber C, and Maisonneuve patterns in young athletes — a defined, previously off-label population — now has a labeled, cleared option. Sterile, single-use, knotless, with integrated tensioning handles. Also received a Red Dot Design Award.

[MARKET]  Smith+Nephew signs exclusive U.S. distribution deal with RMR Ortho for A’TOMIC Nitinol Fixation System

The A’TOMIC system uses nitinol shape-memory properties to deliver active, continuous compression at fusion, fracture, and osteotomy sites. Smith+Nephew’s second extremity distribution deal in as many months — they’re using established channel access to bolt on differentiated fixation tech without building from scratch.

[MARKET]  Treace, Zimmer Biomet, and Medline surface at ACFAS 2026

Treace highlighted new lapidus fusion innovations and updated positive clinical data. Zimmer Biomet previewed upcoming data releases at AAOS. Medline debuted expanded ankle fracture and foot reconstruction plating systems. The conference cycle remains the primary commercial activation mechanism in foot and ankle.

💡  Strategic Insight: The CAMPs Reimbursement Reset Is Still Playing Out

Both MiMedx and Organogenesis entered 2026 under the same 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 calls “transition year” dynamics include slowed claims processing in WISeR states, increased audits and callbacks, and some providers exiting the market entirely. MiMedx described outright “dumping” of product at very low prices 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.

MiMedx’s $148M net cash position and $100M share repurchase authorization says management believes in the long thesis. Their surgical franchise (25% growth) is the bridge. The wound care market recovery is expected to be sequential across 2026 quarters. That’s not a collapse narrative — it’s a reset narrative. The two are different.

ORGO results are in: $225.1M Q4 revenue (+78% YoY), EPS $0.24 vs $0.22 est. But 2026 guided -25% to -38%. Q1 guided -50%. CMS Dec 30 commentary is the culprit. CAMPs Wound Care Summit (West Palm Beach, March 6–7) is now the next critical read on how the market responds.

📅  Upcoming Events

Feb 27 – Mar 1

SALSAL Community Screening Event — Phoenix, AZ

Save a Leg, Save a Life Foundation community screening event for PAD, CLI, and diabetic complications. Community awareness and early screening focus.

Feb 27 – Mar 1

Global Foot and Ankle Summit — Goa, India

Theme: Revisiting The Complex: Mastering The Art Of Revision Surgery. International focus on advanced reconstruction techniques.

🔥 March 6–7

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 including KOLs, regulatory experts, and commercial leadership from Organogenesis, MiMedx, and other CAMP manufacturers. The event for biologics market intelligence.

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 Diabetic Limb Salvage (DLS) Conference, co-presented with the Wound Healing Foundation (WHF), is the premier multidisciplinary event on diabetic limb preservation. Faculty include leading vascular surgeons, podiatrists, wound care specialists, and researchers. CME-accredited. Registration open at dlsconference.com.

🔥 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.

🎯  THE SIGNAL

►  The CAMPs market is contracting before it expands.

MiMedx’s Q4 beat + guidance miss tells the whole story. Record 2025, reset 2026. The $127/cm² cap and WISeR prior auth are pulling weaker players out of the market. Companies with clinical differentiation and documentation infrastructure will emerge with higher share. This is consolidation via reimbursement, not M&A.

►  InfuSystem’s wound care unit is compounding fast — and almost no one is watching.

160% Q4 wound care revenue growth inside a $36M quarterly business. INFU is a small-cap with a diversified service model, but the wound care segment is growing like a focused pure-play. Migrating to new RCM platform reduces processing costs and expands volume capacity. Track this one.

►  Nitinol fixation is having a moment in foot and ankle.

MiRus (IO Expandable Wedge with MoRe Superalloy) and Smith+Nephew/RMR Ortho (A’TOMIC shape-memory compression) both leaned on material science as the differentiation axis this week. Surgeons are getting comfortable with active, adaptive implants. The era of passive static fixation as default is eroding.

►  Stryker just closed the adolescent syndesmotic gap.

Off-label practice becomes labeled, cleared indication. That’s not incremental — that’s a reimbursement and liability inflection point. The adolescent market for syndesmotic fixation was real before Synchfix EVT; now it has a device built for it.

►  The DLS/WHF conference in April is non-negotiable for the limb salvage community.

MedStar Georgetown’s Diabetic Limb Salvage Conference sits at the intersection of vascular surgery, podiatry, and wound care — exactly the multidisciplinary convergence this market needs. Washington DC, April 8–11. If you’re tracking PAD, CLI, and DFU outcomes, this is the room to be in.

►  Oxygen as therapy is early, credible, and underinvested.

UC Riverside’s electrochemical gel addresses the mechanism that kills limbs: deep tissue hypoxia. It’s preclinical in mice. But the logic is mechanistically sound, the publication venue is credible, and the technology is translatable. Put it on the watchlist now, before it has a commercial story.

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Below the Knee is an independent market intelligence newsletter.  |  www.belowtheknee.co  |  Feb 26, 2026

Analysis and opinions are solely those of the author and do not constitute investment advice.