MDT17002 Global Market for Arthroscopy and Sports Medicine Devices · 2018-04-19 · Other leading competitors in the global arthroscopic visualization products market in 2016 included

GLOBAL MARKET FOR ARTHROSCOPYAND SPORTS MEDICINE DEVICES

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1. CLINICAL OVERVIEW

Arthroscopy is used by orthopedic surgeons to visualize, diagnose, and treat problems

inside a joint. The technique has drastically changed joint surgery, allowing surgeons

to view inside the joint through incisions as small as one centimeter in length.

Arthroscopic surgery has a wide range of applications in treating sports injuries of the

ankle, elbow, hip, knee, shoulder, and wrist, among other sites; it also may be used

to treat osteoarthritis in mid-stage patients with partially damaged cartilage or who

have a coexisting problem such as a meniscal tear or loose piece of cartilage.

Each year, nearly 2 million people in the US suffer sports-related injuries and receive

treatment in emergency departments; this includes approximately 570,000 basketball

injuries, 557,000 bicycling injuries, 466,000 football injuries, 265,000 baseball and

softball injuries, and 231,000 soccer injuries (Misra, 2014).

In the EU28 countries, approximately 6.1 million people were admitted to hospital for

sports injuries from 2008-10; this included 5.6 million outpatients and 419,000

inpatients. In the EU, the number of sport injuries is increasing, most likely due to

increased participation in sports. The share of women injured in sports accidents has

been steadily increasing, which most likely reflects the increasing participation of

women in athletics. Among European women, the share of women injured in sports

increased from 26% in 1996 to 36% in 2010. Similarly, the incidence of sports injuries

in European adolescents increased for the same time period. This is due to the

increased popularity of sports and other outdoor activities (EU IDB, 2013).

Exhibit 1-1 presents the incidence of sports injuries treated at emergency departments

in the US. Exhibit 1-2 presents the incidence of hospital patients admitted for sports

injuries in the EU28 countries. Exhibit 1-3 presents the incidence of hospital-treated

sports injuries by type of sports in the EU28 countries. Exhibit 1-4 presents key facts

and figures for sports injuries in the EU28 countries.



Exhibit 1-4: Sports injuries, key facts and figures, EU28, 2008-10

Epidemiology/prevalence

Annually, about 6.1 million people are being treated in hospital for a sports injury

32% of sports injuries affect adolescents and young adults (15-24 years of age)

Team ball sports account for about 44% of all hospital-treated sports injuries; by specific type of ball sports the ranking is: Soccer (71%), Handball (9%), Basketball (6%), Volleyball (6%)

The majority of sports injuries (60%) result from participation in organized sports

For most types of sports, more men are injured than women; notable exceptions are acrobatic sports (57% women) and horse riding (90% women). This reflects gender preferences in the types of sports.

Source: EU Injuries Database, Report on injury statistics, 2008-2010; Eurostat – hospital discharge statistics



ConMed offers the IM4000 HD camera system, which features an autoclavable

1080-pixel camera head. The camera features 3D perception and a prism mounted

on the camera head for improved flexibility and durability.

Olympus America/Olympus offers an autoclavable 3CCD HD camera system

featuring remote control and one-touch zoom capabilities. The camera head features

an eyepiece or quick-lock connection that attaches to a line of autoclavable

telescopes; the heads feature remote-controlled 0.9-1.8 zoom and remote-controlled

focus capabilities for improved image quality.

Karl Storz Endoscopy-America offers a variety of endoscope camera heads

including HD and 3D systems. The company’s cameras integrate with its Image

Capture digital documentation system.

Stryker offers a line of endoscopic cameras including the 1488 HD autoclavable

3-chip camera, which features a durable camera head, an ergonomic design,

and optimal surgical brightness. The company also offers the 1588 AIM (Advanced

Imaging Modalities) Camera and the Precision AC (autoclavable) HD camera.

Richard Wolf Medical Instruments offers the ENDOCAM Logic HD, a combination

of a single-chip HD camera and light emitting diode (LED) light sources for high-

quality resolution. The images may be displayed on widescreen monitors.

2.1.3 Image management systems

For image management, ConMed offers three products: a digital recording system,

an HD still capture system, and a Sony full-page color printer for HD image capture.

Smith & Nephew offers the 660HD Image Management System for recording,

editing, printing, and storing surgical images and videos in HD format. The system’s

camera head buttons and graphical interface were developed to offer greater image

resolution.

Stryker offers the SDC3 Information Management System, which provides

advanced digital image capturing, data management, customizable user profiles,

wireless connectivity, an integrated surgical timeout, and single-button



2.1.6 Competitive analysis

In 2016, Smith & Nephew led the global arthroscopic visualization products market

with sales of approximately $378.6m and a 21.0% market share. Revenue in Smith

& Nephew’s Arthroscopic Enabling Technologies division was flat year-on-year

(underlying growth) in 2015, but grew 2% in 2016. In 2016, the company launched

its LENS Surgical Imaging system, for which it reported strong sales. In reporting

company revenue by geographic region, Smith & Nephew reported 3% growth on an

underlying basis in the US in 2016 and flat year-on-year sales in established

markets (ie Australia, Canada, Europe, Japan, and New Zealand), although it noted

that Japan and France delivered strong performances.

In emerging markets, Smith & Nephew reported double-digit growth that was offset

by weakness in China and the Gulf States, resulting in flat year-on-year growth. The

company noted that the slow-down in China was compounded by destocking in its

distributor channel during 2016, but that by the end of the year most franchises in

the country had returned to growth as the level of stock in the channel was adjusted.

The company also reported headwinds in the Gulf States, but noted that it sees

long-term growth potential in emerging markets.

ConMed was the second-leading supplier to the global arthroscopic visualization

products market in 2016, with a 13.0% share. ConMed reported a decline of 2.3% in

revenue in its Orthopedic Surgery division, primarily in the US; within this division,

the company reported challenges in its Arthroscopy Enabling Devices unit,

particularly for its resection and fluid management products, but noted that it had

refocused marketing efforts for the Edge arthroscopic radiofrequency (RF) system

for soft tissue ablation, which it expects will help to stabilize sales.

Other leading competitors in the global arthroscopic visualization products market in

2016 included Olympus with an estimated share of 11.1%, and Stryker with a 10.4%

share. The remainder of the market is highly fragmented and includes suppliers such

as Arthrex, DePuy Synthes Mitek/Johnson & Johnson, Karl Storz, Richard Wolf

Medical Instruments, and Zimmer (which purchased Biomet in 2014), among others.

Exhibit 2-2 presents the leading competitors in the global arthroscopic visualization

products market in 2016.



repairs. The company’s GII anchor is a titanium device featuring nitinol arcs, a small

size, and high pull-out strength.

3.3.1.2 Bioresorbable anchors

Resorbable suture anchors are used for shoulder procedures such as Bankart

repairs, biceps tenodesis procedures, ligament reconstruction, rotator cuff repair,

and SLAP lesion procedures.

Arthrex offers multiple knotted and knotless suture anchors for use in soft tissue

reinforcement and repair procedures. The company offers the 5.5mm

Bio-Corkscrew FT suture anchor, a resorbable anchor made of PLLA for use in

rotator cuff repair procedures. Arthrex also developed a resorbable “push in” suture

anchor called the Bio-SutureTak, which is equipped with a molded suture eyelet for

fixing soft tissue to bone in the shoulder joint. The Bio-SutureTak is offered in

diameters of 3.3mm and 3.7mm, and packaged with a disposable handled inserter

for faster deployment at the implant site.

Zimmer Biomet offers a broad portfolio of suture anchors. The ALLthread

LactoSorb resorbable anchors are manufactured from LactoSorb Copolymer, 82% L-

lactic acid and 18% glycolic acid, or LactoSorb L15 Copolymer, 85% L-lactic acid

and 15% glycolic acid; the anchors are double-loaded with the MaxBraid suture.

DePuy Synthes offers the Versalok PEEK Knotless Anchor System, indicated for

rotator cuff repair and biceps tenodesis in the shoulder, and also for various fixation

procedures in the knee and elbow. The company also sells its shoulder fixation

devices in a bioresorbable option comprising Biocryl Rapide, a biocomposite that

combines beta-tricalcium phosphate and a PLGA co-polymer. The company’s Healix

Advance family of anchors features a multi-thread design and is available in multiple

sizes and suture loading configurations.

Stryker sells the ReelX PEEK knotless anchors for shoulder and small joint repair.

The anchors feature a locking mechanism and an expandable anchor body.

Smith & Nephew offers a variety of suture anchors for shoulder repair and other

indications. However, the company’s ability to market the products will be prohibited



and $117.3m in sales and included Biocomposites, ConMed, Medtronic, Stryker,

Tornier, and Zimmer Biomet, among others. Exhibit 3-9 presents the leading

competitors in the shoulder fixation devices market for 2016.

Smith & Nephew enhanced its position in the shoulder fixation market following its

acquisition of ArthroCare in May 2014. The transaction, which was valued at

$1.5bn, enabled Smith & Nephew to add shoulder anchor products to its sports

medicine division and to rebalance its product portfolio toward higher-growth market

segments (Smith & Nephew, 2014). In its 2016 financial statements, the company

noted that its strength in the shoulder repair market continues to underpin the

company’s overall performance (Smith & Nephew ,2017). Nevertheless, Smith &

Nephew faced a setback in December 2016, when a federal jury in the US ruled that

the company, along with ArthroCare, had infringed two of Arthrex’s patents on its

knotless and cross-support suture anchor technology, including the Bioraptor,

Footprint, Healicoil, LabraLock, Multifix, Spyromite, Speedfix, Speedlock, Spartan,

Speedscrew, Titan Ti, and TwinFix products. The court granted Arthrex $17m in

damages, and the company announced that it would seek an injunction prohibiting

Smith & Nephew and ArthroCare from further manufacturing or selling the infringing

devices in the US.

3.4 Hip Fixation Devices

Fixation devices used in hip repair procedures include knotted and knotless suture

anchors, which are available in resorbable and nonresorbable options. Hip

arthroscopy procedures have been increasing at a tremendous rate over recent

years. Improvements in surgical technologies and the number of qualified surgeons

able to perform the procedure have contributed to the increase. Between 2007 and

2011, the number of hip arthroscopies performed in the US increased by 250% (Sing

et al, 2015). In England, the number of hip arthroscopies performed in NHS hospitals

increased by 727% between 2002 and 2013 (Palmer et al., 2016).

In the past, hip arthroscopy was limited to treatment of a number of intra-articular

pathologies, such as chondrolabral damage, femoroacetabular impingement (FAI),

labral tears, loose bodies, and pigmented villonodular synovitis (PVNS). More

recently, the indications have expanded to include several peri-articular pathologies,

such as psoas impingement/snapping, peri-trochanteric space disorders,



Company Listing

Arthrex, Inc. www.arthrex.com

Biocomposites Ltd. www.biocomposites.com

Cayenne Medical/Zimmer Biomet www.cayennemedical.com

ConMed Corporation www.conmed.com

Corin Medical Holdings www.coringroup.com

DePuy Synthes/ Johnson & Johnson www.depuysynthes.com

Inion OY www.inion.com

Ivy Sports Medicine GMBH http://www.ivysportsmed.com/

Johnson & Johnson www.jnj.com

Karl Storz AG www.karlstorz.com

Medtronic Corporation www.medtronic.com

Olympus America, Inc./ Olympus Corporation www.olympusamerica.com

Richard Wolf Medical Instruments Corporation/Richard Wolf GmbH www.richardwolfusa.com

Smith & Nephew PLC www.smith-nephew.com

Stryker Corporation www.stryker.com

Tornier, Inc. www.tornier.com

Zimmer Biomet Holdings, Inc. www.zimmer.com



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MDT17002 Global Market for Arthroscopy and Sports Medicine Devices · 2018-04-19 · Other leading competitors in the global arthroscopic visualization products market in 2016 included