FAN is BACK and before we dive into this issue, we wanted to provide a big FAN shout out to two legends of the foot and ankle game that have moved on from their leadership roles...Patrick Fisher (Stryker/Wright) and Pete Denove (Arthrex). These are two OG's of Foot and Ankle, much respect to both of you for all you have contributed to the industry and good luck in your future endeavors.

As we approach nearly 20k subscribers to the newsletter we want to thank the foot and ankle community for your continued support and readership. We are grateful for our FANs. Please reach out with news, tips, and comments to footandanklenews@gmail.com.

Sincerely,

Big Foot

This issue presented by...  

Speaking of new companies looking to break into foot and ankle, this issue of FAN is sponsored by InduceXT, a multi growth factor human allograft developed specifically for Foot and Ankle surgery. 

InduceXT is a pioneer in advanced bone regeneration technology. The bioimplant is created using the proprietary Natural Matrix Protein (NMP®) Process which unlocks growth factors in human bone, such as BMP-2, BMP-7, TGF-ß1, VEGF, and PDGF, making them bioavailable for superior osteoinduction and osteoregeneration. InduceXT’s bioimplants are designed to provide optimal handling characteristics and long-term shelf stability, making them a preferred choice for Foot and Ankle surgery​.  Check them out today! INDUCE XT

The Golden Demobone is awarded to surgeons who provide first class attention to their social media posts when it comes to education in the foot and ankle world. This week's winner checks all those boxes with a variety of train wreck revisions and practical advice for trending procedures. From MIS Bunions to Revision TAR, the posts on the page have thought, purpose, and effort in presentation. In addition to surgical posts, you may receive some solid right wing memes in his daily stories!

Featured Post - Allograft TAR

Congrats to Dr. Jeffrey E. McAlister, DPM aka @BestAzAnkleDoc

Kamran Hamid, MD @thisiskomron

Jeffery Earhardt, MD @dr_earhart_trauma

Norman A Siddique, DPM @BaltimoreFootDoc

David Dalhstrom, MD @xlr8.sportsmed

Daniel Patton, MD @theanklefixer

Robert Rozbruch, MD @limblengthening

I know what you are saying…oh shit not another god damn Lapidus Jig.

I get it. Almost every major manufacturer has some form of jig or another, some better than others. I think it can be argued that the latest iterations have spiraled out of control in terms of complexity. Severely over engineered. Massive jigs with tons of pins leading to significantly longer procedure times.

Enter the Relja Clamp, developed by Dr. Rob Arniot, DPM, just outside of Milwaukee, WI. Home of the simple things in life…Beer, Cheese, Bratwurst, and Lapidus Clamps.

Why do we think this clamp deserves a look? The Relja clamp is simple by design. If you are looking for an extra hand in the OR to achieve, hold, and maintain triplanar correction this product is worth exploring. 

• Total of 2 Pins with NO Incisions Required to Apply the Guide
• Fully Radiolucent Clamp
• Minimal Learning Curve
• Distal Jig out of the way of Fixation
• Achieves correction in frontal plane, transverse plane, and sagittal plane
• Allows for Compression
• Single Use, Sterile Packed

In an effort to bolster their soft tissue portfolio, Stryker closed on their acquisition of Artelon earlier this month. We love to see another one of our featured “Little Guys, Big Idea’s” get scooped up, in fact we featured them back in the newsletter back on 12/15/2021. 

The terms of the deal have not been made public, but rumor has it Artelon was around 20M in sales. Let’s assume a 10 to 12X multiple consisting of some upfront cash and a back end kicker tied to sales metrics over the next 36 months. That leaves us at around 125 to 150M up front with another 100M in potential earn outs. That is all made up, maybe the numbers will come out, maybe not. Bottom line they secured a solid exit.

Stryker and their reps get a new toy to be able to compete against Arthrex and gain some market share in soft tissue. It bolsters their position as a market leader in the foot and ankle space. It is unclear if this will go to the foot and ankle team or the sports team, but we assume it will be both and that will add to the internal competition between the two. Overall, a solid purchase for Stryker. 

The distributors who helped carry the load for Artelon are now in a position where they will need to fill a hole in their bag. It could come from ConMed and their acquisition of a couple years ago, the Biorez BIOBRACE product, but that is another story for another time.

The Artelon Playbook - How Did They Pull This Off?



Artelon is an amazing story of revamping an existing technology and for that matter, the company as a whole, showing everyone it truly takes 20 years to make an overnight success. Let’s review the Artelon play book and see how they did it.

Identify a Niche with Massive Market Potential

Soft tissue reconstruction in foot and ankle, specifically lateral ankle stabilization and deltoid ligament reconstructions, checks both of those boxes. The focus is narrow and the market is huge. Toss in the fact that you can kit the product with limited SKU’s and a high ASP immediately makes the product a winner for the independent distributors carrying the product. Being able to play in both the ASC and Hospital markets gave Artelon the ability for quick wins in the ASC’s while weathering the storm for Hospital approvals.

Find an Adversary

Arthrex is without a doubt the king of Soft Tissue and the Internal Brace product line has sold hundreds of millions of dollars in product. The internal brace is designed to be a “no stretch” implant. Artelon made the argument that a “seat belt” effect made the internal brace too rigid for lateral ankle repair. I will leave it up to the surgeons to debate that fact, but either way a solid strategy to take on the market leader in the promotion of their product.

Identify Surgeon Champions

Artelon had just the right recipe of DPM and MD advocates from across the highest profile Foot and Ankle Centers and Fellowship groups across the country. This stable of highly respected surgeons created a massive resource for the Marketing and MedEd team to work their magic and spread the word about the product across the country. Kudos to Janzen Cole and his team, you guys are wizards!

Start with an Exit in Mind

Aaron Smith, the CEO of Artelon, worked for Wright Medical as the Senior Director of Extremities during a time of explosive growth for the Company. He was at the ground floor in the very early days of the foot and ankle revolution. His ties to Stryker ran deep after the integration of the Wright Medical team and it was obvious that Stryker would be the best landing spot for Artelon if they could move the product. They did and the rest is history. Aaron was the man for the job and he got it done! Congrats to the team at Artelon and those who helped them get there.

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