Arthroscopy Devices Market to Increasing Prevalence of Osteoarthritis and Preference for Minimally Invasive Procedures to Drive Future Growth

Arthroscopy Devices Market to 2018 Increasing Prevalence of Osteoarthritis and Preference for Minimally Invasive Procedures to Drive Future Growth

GBI Research Report Guidance GBI Research Report Guidance The Global Arthroscopy Devices Market: Device Overview chapter provides the overview of devices included under arthroscopy in this report. Chapter four provides information on market size for the 2004 2011 historic period and the 2011 2018 forecast period, as well as trends; dynamics, covering drivers and restraints; and the competitive landscape. Chapter five discusses arthroscopes, arthroscopy shavers, arthroscopy Fluid Management Systems (FMSs), arthroscopy implants, arthroscopy radio frequency systems, and arthroscopy visualization systems. It also gives information on market size for the 2004 2011 historic period and the 2011 2018 forecast period for each category, as well as market dynamics and competition. Chapter six gives information on market size for the 2004 2011 historic period and the 2011 2018 forecast period for the US, Canada, the UK, France, Germany, Italy, Spain, Japan, China, India, Australia and Brazil. A cross-country analysis of these countries is also discussed. Chapter seven gives profiles of leading arthroscopy device companies along with each company s products, features and SWOT analysis. Chapter eight focuses on pipeline products in various categories. Key products are listed and discussed in detail and product approval and expected launch dates are also provided where available. Chapter nine discusses the consolidation landscape in the arthroscopy devices industry, looking at deals which took place between 2007 and 2011. Page 2

Executive Summary The global arthroscopy devices market was valued at $XX billion in 2011 and is forecast to exceed $XXbillion by 2018 at a Compound Annual Growth Rate (CAGR) of XX% Executive Summary Global Arthroscopy Devices Market is Forecast to Reach $XX Billion by 2018 Arthroscopy Devices Market, Global, Revenue ($m), 2011 2018 CAGR: XX% Revenue ($bn) 2011 2018 Source: GBI Research s proprietary database [accessed on September 26, 2012]; Primary research interviews with marketing managers and other industry experts The global arthroscopy devices market was valued at $XX billion in 2011 and is forecast to exceed $XX billion by 2018 at a Compound Annual Growth Rate (CAGR) of XX%. The market is primarily driven by the increasing prevalence of osteoarthritis, due itself to a growing elderly population worldwide. This has led to a surge in the number of arthroscopy procedures being performed. Increasing preference for minimally invasive techniques and better implant material is another major growth driver, as is the rising number of sports injuries due to increased participation, particularly from children and adolescents, in sporting activities (Safe Kids USA, 2011). Adults aged XX years and above are also more likely to sustain sports injuries through participation in sporting activities than the younger population (AAOS, 2011). The reimbursement scenario for arthroscopy remains unfavorable, especially in the US, due to multiple changes to Relative Value Units (RVUs). The US Remains the Largest Market for Arthroscopy Devices The US is the largest market for arthroscopy devices, accounting for XX% in 2011. It was valued at $XX billion in 2011 and is forecast to reach $XX billion by 2018 at a CAGR of XX%, driven by increasing preference for minimally invasive procedures. This is in turn expected to drive adoption and increase procedure volumes. The adult population aged XX years and above in the US engaging in physical activity will lead to more sports-related injuries (AAOS, 2011), which will further fuel arthroscopic procedure volumes. Companies in the US market currently face pricing pressures due to competition and the growing need for cost-effective healthcare services, although the increase in the volume of arthroscopy procedures is expected to offset a decline in their Average Selling Price (ASP). Page 3

Table of Contents 1 Table of Contents 1 Table of Contents... 5 1.1 List of Tables... 8 1.2 List of Figures... 9 2 Introduction...10 3 Global Arthroscopy Devices Market: Device Overview...11 3.1 Arthroscopes...11 3.2 Arthroscopic Shavers...11 3.3 Arthroscopy Fluid Management Systems...11 3.4 Arthroscopy Implant Devices...11 3.4.1 Arthroscopy Knee Implants...11 3.4.2 Arthroscopy Shoulder Implants...11 3.4.3 Arthroscopy Small-Joint Implants...11 3.5 Arthroscopy Radio Frequency Systems...11 3.6 Arthroscopy Visualization Systems...11 4 Global Arthroscopy Devices Market: Market Characterization...12 4.1 Global Arthroscopy Devices Market, Revenue ($m), 2004 2011...12 4.2 Global Arthroscopy Devices Market, Revenue ($m), 2011 2018...13 4.3 Global Arthroscopy Devices Market, Key Company Share (%), 2011...14 4.4 Global Arthroscopy Devices Market: Key Trends...15 4.4.1 Arthroscopy has become the Gold Standard for Most Surgeries Performed on Joints...15 4.4.2 Integrated Inflow/Outflow Pumping in Fluid Management Systems to Drive Future Growth...15 4.5 Global Arthroscopy Devices: Market Dynamics...16 4.5.1 Market Drivers...16 4.5.2 Market Restraints...18 5 Global Arthroscopy Devices Market: Segment Analysis and Forecasts...21 5.1 Arthroscopes Market, Global, Revenue ($m), 2004 2011...21 5.2 Arthroscopes Market, Global, Revenue ($m), 2011 2018...22 5.3 Arthroscopic Shavers Market, Global, Revenue ($m), 2004 2011...23 5.4 Arthroscopic Shavers Market, Global, Revenue ($m), 2011 2018...24 5.5 Arthroscopy Fluid Management Systems Market, Global, Revenue ($m), 2004 2011...25 5.6 Arthroscopy Fluid Management Systems Market, Global, Revenue ($m), 2011 2018...26 5.7 Arthroscopy Implants Market, Global, Revenue ($m), 2004 2011...27 5.8 Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018...28 5.9 Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2004 2011...29 5.10 Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2011 2018...30 5.11 Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2004 2011...31 5.12 Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2011 2018...32 6 Global Arthroscopy Devices Market: Country Analysis and Forecasts...33 6.1 Arthroscopy Devices Market: Cross-Country Analysis...33 6.2 Historic and Forecast Revenue, By Country...35 6.2.1 Arthroscopy Devices Market, US, Revenue ($m), 2004 2011...35 6.2.2 Arthroscopy Devices Market, US, Revenue ($m), 2011 2018...36 6.2.3 Arthroscopy Devices Market, Canada, Revenue ($m), 2004 2011...38 6.2.4 Arthroscopy Devices Market, Canada, Revenue ($m), 2011 2018...39 6.2.5 Arthroscopy Devices Market, Germany, Revenue ($m), 2004 2011...40 6.2.6 Arthroscopy Devices Market, Germany, Revenue ($m), 2011 2018...41 6.2.7 Arthroscopy Devices Market, UK, Revenue ($m), 2004 2011...42 6.2.8 Arthroscopy Devices Market, UK, Revenue ($m), 2011 2018...43 6.2.9 Arthroscopy Devices Market, France, Revenue ($m), 2004 2011...44 Page 5

Table of Contents 6.2.10 Arthroscopy Devices Market, France, Revenue ($m), 2011 2018...45 6.2.11 Arthroscopy Devices Market, Italy, Revenue ($m), 2004 2011...46 6.2.12 Arthroscopy Devices Market, Italy, Revenue ($m), 2011 2018...47 6.2.13 Arthroscopy Devices Market, Spain, Revenue ($m), 2004 2011...48 6.2.14 Arthroscopy Devices Market, Spain, Revenue ($m), 2011 2018...49 6.2.15 Arthroscopy Devices Market, Japan, Revenue ($m), 2004 2011...50 6.2.16 Arthroscopy Devices Market, Japan, Revenue ($m), 2011 2018...51 6.2.17 Arthroscopy Devices Market, China, Revenue ($m), 2004 2011...52 6.2.18 Arthroscopy Devices Market, China, Revenue ($m), 2011 2018...53 6.2.19 Arthroscopy Devices Market, Australia, Revenue ($m), 2004 2011...54 6.2.20 Arthroscopy Devices Market, Australia, Revenue ($m), 2011 2018...55 6.2.21 Arthroscopy Devices Market, India, Revenue ($m), 2004 2011...56 6.2.22 Arthroscopy Devices Market, India, Revenue ($m), 2011 2018...57 6.2.23 Arthroscopy Devices Market, Brazil, Revenue ($m), 2004 2011...58 6.2.24 Arthroscopy Devices Market, Brazil, Revenue ($m), 2011 2018...59 7 Global Arthroscopy Devices Market: Competitive Assessment...60 7.1 Smith & Nephew Plc....60 7.1.1 Business Overview...60 7.1.2 Marketed Products...60 7.2 Arthrex, Inc...61 7.2.1 Business Overview...61 7.2.2 Marketed Products...61 7.3 DePuy Synthes Companies...62 7.3.1 Business Overview...62 7.3.2 Marketed Products...62 7.4 Conmed Corporation...63 7.4.1 Business Overview...63 7.4.2 Marketed Products...63 7.5 Stryker Corporation...64 7.5.1 Business Overview...64 7.5.2 Marketed Products...64 7.6 ArthroCare Corporation...65 7.6.1 Business Overview...65 7.6.2 Marketed Products...65 8 Global Arthroscopy Devices Market: Product Pipeline Analysis...66 8.1 Arthroscopy Devices Product Pipeline Summary...66 8.1.1 Arthroscopy Devices: List of Pipeline Products...66 8.1.2 Arthroscopy Devices: Profiles of Key Pipeline Products...66 9 Global Arthroscopy Devices Market: Consolidation Landscape...70 9.1 Key Deals: 2007 2011...70 9.1.1 Smith & Nephew Endoscopy s Acquisition of Tenet Medical Engineering...70 9.1.2 Kensey Nash s Acquisition of Minority Stake in Orteq Sports Medicine...70 9.1.3 Tornier s Acquisition of C2M Medical...70 9.1.4 Greatbatch s Acquisition of Precimed...71 9.1.5 Avalign Technologies Acquisition of Nemcomed...71 9.1.6 Symmetry Medical s Acquisition of TNCO...72 9.1.7 LISI s Completes Acquisition of Hugueny...72 10 Appendix...73 10.1 Definitions...73 10.2 Arthroscopes...73 10.3 Arthroscopic Shavers...73 10.4 Arthroscopy Fluid Management Systems...73 Page 6

Table of Contents 10.5 Arthroscopy Implant Devices...73 10.5.1 Arthroscopy Knee Implants...73 10.5.2 Arthroscopy Shoulder Implants...73 10.5.3 Arthroscopy Small-Joint Implants...73 10.6 Arthroscopy Radio Frequency Systems...73 10.7 Arthroscopy Visualization Systems...73 10.8 Acronyms...74 10.9 Sources...74 10.10 Research Methodology...76 10.10.1 Secondary Research...76 10.10.2 Primary Research...76 10.10.3 Models...77 10.10.4 Forecasts...77 10.10.5 Expert Panels...77 10.11 Contact Us...77 10.12 Disclaimer...77 Page 7

Table of Contents 1.1 List of Tables Table 1: Arthroscopy Devices Market, Global, Revenue ($m), 2004 2011...12 Table 2: Arthroscopy Devices Market, Global, Revenue ($m), 2011 2018...13 Table 3: Arthroscopy Devices Market, Global, Key Company Revenue ($m), 2011...14 Table 4: Arthroscopy Devices Market, Global, Number of Arthroscopy Procedures, 2006 2011...17 Table 5: Arthroscopes Market, Global, Revenue ($m), 2011 2018...22 Table 6: Arthroscopic Shavers Market, Global, Revenue ($m), 2004 2011...23 Table 7: Arthroscopic Shavers Market, Global, Revenue ($m), 2011 2018...24 Table 8: Arthroscopy Fluid Management Systems Market, Global, Revenue ($m), 2004 2011...25 Table 9: Arthroscopy Fluid Management Systems Market, Global, Revenue ($m), 2011 2018...26 Table 10: Arthroscopy Implants Market, Global, Revenue ($m), 2004 2011...27 Table 11: Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018...28 Table 12: Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2004 2011...29 Table 13: Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2011 2018...30 Table 14: Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2004 2011...31 Table 15: Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2011 2018...32 Table 16: Arthroscopy Devices Market, Cross-Country Analysis, Global, CAGR (%), 2004 2018...33 Table 17: Arthroscopy Devices Market, US, Revenue ($m), 2004 2011...35 Table 18: Arthroscopy Devices Market, US, Revenue ($m), 2011 2018...36 Table 19: Arthroscopy Devices Market, Canada, Revenue ($m), 2004 2011...38 Table 20: Arthroscopy Devices Market, Canada, Revenue ($m), 2011 2018...39 Table 21: Arthroscopy Devices Market, Germany, Revenue ($m), 2004 2011...40 Table 22: Arthroscopy Devices Market, Germany, Revenue ($m), 2011 2018...41 Table 23: Arthroscopy Devices Market, UK, Revenue ($m), 2004 2011...42 Table 24: Arthroscopy Devices Market, UK, Revenue ($m), 2011 2018...43 Table 25: Arthroscopy Devices Market, France, Revenue ($m), 2004 2011...44 Table 26: Arthroscopy Devices Market, France, Revenue ($m), 2011 2018...45 Table 27: Arthroscopy Devices Market, Italy, Revenue ($m), 2004 2011...46 Table 28: Arthroscopy Devices Market, Italy, Revenue ($m), 2011 2018...47 Table 29: Arthroscopy Devices Market, Spain, Revenue ($m), 2004 2011...48 Table 30: Arthroscopy Devices Market, Spain, Revenue ($m), 2011 2018...49 Table 31: Arthroscopy Devices Market, Japan, Revenue ($m), 2004 2011...50 Table 32: Arthroscopy Devices Market, Japan, Revenue ($m), 2011 2018...51 Table 33: Arthroscopy Devices Market, China, Revenue ($m), 2004 2011...52 Table 34: Arthroscopy Devices Market, China, Revenue ($m), 2011 2018...53 Table 35: Arthroscopy Devices Market, Australia, Revenue ($m), 2004 2011...54 Table 36: Arthroscopy Devices Market, Australia, Revenue ($m), 2011 2018...55 Table 37: Arthroscopy Devices Market, India, Revenue ($m), 2004 2011...56 Table 38: Arthroscopy Devices Market, India, Revenue ($m), 2011 2018...57 Table 39: Arthroscopy Devices Market, Brazil, Revenue ($m), 2004 2011...58 Table 40: Arthroscopy Devices Market, Brazil, Revenue ($m), 2011 2018...59 Table 41: Smith & Nephew Plc, Marketed Products...60 Table 42: Arthrex, Inc., Marketed Products...61 Table 43: DePuy, Inc., Key Marketed Products...62 Table 44: Conmed Corporation, Marketed Products...63 Table 45: Stryker Corporation, Marketed Products...64 Table 46: ArthroCare Corporation, Marketed Products...65 Table 47: Arthroscopy Devices, Global, Pipeline Products, 2012...66 Table 48: Agili-C, Product Status, 2012...66 Table 49: ArthroARM, Product Status, 2012...67 Table 50: Arthroscopy Compatible Device, Product Status, 2012...67 Table 51: Articulinx Intercarpometacarpal Cushion, Product Status, 2012...67 Table 52: Aspiration Device, Product Status, 2012...68 Table 53: ATOUS, Product Status, 2012...68 Table 54: Pivot Hip Arthroscopy System, Product Status, 2012...68 Table 55: Shoulder Labral Anchor Delivery System, Product Status, 2012...69 Table 56: Synovial Shunt, Product Status, 2012...69 Page 8

Table of Contents 1.2 List of Figures Figure 1: Arthroscopy Devices Market, Global, Revenue ($m), 2004 2011...12 Figure 2: Arthroscopy Devices Market, Global, Revenue ($m), 2011 2018...13 Figure 3: Arthroscopy Devices Market, Global, Key Company Share (%), 2011...14 Figure 4: Arthroscopy Devices Market, Global, Number of Arthroscopy Procedures, 2006 2011...16 Figure 5: Arthroscopy Implants Market, Global, Revenue ($m), 2004 2011...27 Figure 6: Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018...28 Figure 7: Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2004 2011...29 Figure 8: Arthroscopy Radio Frequency Systems Market, Global, Revenue ($m), 2011 2018...30 Figure 9: Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2004 2011...31 Figure 10: Arthroscopy Visualization Systems Market, Global, Revenue ($m), 2011 2018...32 Figure 11: Arthroscopy Devices Market, Cross-Country Analysis, Global, CAGR (%), 2004 2018...33 Figure 12: Arthroscopy Devices Market, US, Revenue ($m), 2004 2011...35 Figure 13: Arthroscopy Devices Market, US, Revenue ($m), 2011 2018...36 Figure 14: Arthroscopy Devices Market, Canada, Revenue ($m), 2004 2011...38 Figure 15: Arthroscopy Devices Market, Canada, Revenue ($m), 2011 2018...39 Figure 16: Arthroscopy Devices Market, Germany, Revenue ($m), 2004 2011...40 Figure 17: Arthroscopy Devices Market, Germany, Revenue ($m), 2011 2018...41 Figure 18: Arthroscopy Devices Market, UK, Revenue ($m), 2004 2011...42 Figure 19: Arthroscopy Devices Market, UK, Revenue ($m), 2011 2018...43 Figure 20: Arthroscopy Devices Market, France, Revenue ($m), 2004 2011...44 Figure 21: Arthroscopy Devices Market, France, Revenue ($m), 2011 2018...45 Figure 22: Arthroscopy Devices Market, Italy, Revenue ($m), 2004 2011...46 Figure 23: Arthroscopy Devices Market, Italy, Revenue ($m), 2011 2018...47 Figure 24: Arthroscopy Devices Market, Spain, Revenue ($m), 2004 2011...48 Figure 25: Arthroscopy Devices Market, Spain, Revenue ($m), 2011 2018...49 Figure 26: Arthroscopy Devices Market, Japan, Revenue ($m), 2004 2011...50 Figure 27: Arthroscopy Devices Market, Japan, Revenue ($m), 2011 2018...51 Figure 28: Arthroscopy Devices Market, China, Revenue ($m), 2004 2011...52 Figure 29: Arthroscopy Devices Market, China, Revenue ($m), 2011 2018...53 Figure 30: Arthroscopy Devices Market, Australia, Revenue ($m), 2004 2011...54 Figure 31: Arthroscopy Devices Market, Australia, Revenue ($m), 2011 2018...55 Figure 32: Arthroscopy Devices Market, India, Revenue ($m), 2004 2011...56 Figure 33: Arthroscopy Devices Market, India, Revenue ($m), 2011 2018...57 Figure 34: Arthroscopy Devices Market, Brazil, Revenue ($m), 2004 2011...58 Figure 35: Arthroscopy Devices Market, Brazil, Revenue ($m), 2011 2018...59 Figure 36: Arthroscopy Devices Market, Global, Competitive Assessment, 2012...60 Page 9

Introduction 2 Introduction The global arthroscopy device market comprises arthroscopes, arthroscopy implants, arthroscopy fluid management systems, arthroscopy shaver systems, and arthroscopy radiofrequency systems. Arthroscopy procedures are performed on joints such as the knee, shoulder, hip, elbow, wrist and ankle. Arthroscopic joint repair is the most rapidly growing segment in the treatment of sports-related injuries. Technological advances have greatly improved the safety and efficacy of arthroscopy devices, which are extremely valuable tools for treating sports injuries such as damage to the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL) and meniscus. Minimally invasive techniques are playing a more significant role as the global population ages, as they tend to be outpatient or ambulatory procedures. Over the last couple of decades, R&D in arthroscopy has proved to be a transforming milestone as it has critically reduced recuperation times. Page 10

Global Arthroscopy Devices Market: Market Characterization In 2011, the arthroscopy market was dominated by Smith & Nephew, Arthrex, and DePuy Synthes, which together accounted for nearly a XX% share 4.3 Global Arthroscopy Devices Market, Key Company Share (%), 2011 The figure below shows company shares for the global arthroscopy devices market in 2011. Figure 3: Arthroscopy Devices Market, Global, Key Company Share (%), 2011 Others Smith & Nephew Plc ArthroCare Corporation Stryker Corporation Arthrex, Inc. ConMed Corporation DePuy Synthes Companies Source: GBI Research s proprietary database [accessed on September 26, 2012]; Primary research interviews with marketing managers and other industry experts The table below shows key company shares for the global arthroscopy devices market from 2011 to 2018. Table 3: Arthroscopy Devices Market, Global, Key Company Revenue ($m), 2011 Company Name Smith & Nephew Plc Arthrex, Inc. DePuy Synthes Companies Conmed Corporation Stryker Corporation ArthroCare Corporation Others Total Revenue ($m) Source: GBI Research s proprietary database [accessed on September 26, 2012]; Primary research interviews with marketing managers and other industry experts In 2011, the arthroscopy market was dominated by Smith & Nephew, Arthrex, and DePuy Synthesis, which together accounted for nearly a XX% share. Smith & Nephew was the market leader with a share of XX%. In 2010, Smith & Nephew garnered $XXm of sales from arthroscopy devices, an increase of XX% over 2010. Smith & Nephew s leading arthroscopy shaver system is Dyonics Platinum. Arthrex is the second largest company with a XX% share of the market in 2011. Arthrex recent product launches include the XXmm Biocomposite Suture, QuickFix, New Accessory Dilator System, ClearCut, XX mm Bio-Corkscrew FT and SabreTooth. DePuy Synthes is the third biggest company with a share of XX%. Its leading arthroscopy product in terms of sales in 2011 was the VAPR system. Conmed Corporation (XX%), Stryker Corporation (XX%) and Arthrocare Corporation (XX%) also had significant presence in the global arthroscopy devices market in 2011. Page 14

Global Arthroscopy Devices Market: Segment Analysis and Forecasts The global arthroscopy implants market was valued at $XX billion in 2011 and is forecast to reach $XX billion by 2018 at a CAGR of XX% due to the increasing prevalence of osteoarthritis and preference for minimally invasive procedures 5.8 Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018 The figure below shows the global revenue for the arthroscopy implants market from 2011 to 2018. Figure 6: Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018 Revenue ($m) 2011 2012 2013 2014 2015 2016 2017 2018 Arthroscopy knee implants Arthroscopy shoulder implants Arthroscopy small joint implants Source: GBI Research s proprietary database [accessed September 26, 2012]; interviews with marketing managers and other industry experts The table below shows the global revenue for the arthroscopy implants market from 2011 to 2018. Table 11: Arthroscopy Implants Market, Global, Revenue ($m), 2011 2018 Arthroscopy knee implants Arthroscopy shoulder implants Arthroscopy small-joint implants Total 2011 2012 2013 2014 2015 2016 2017 2018 CAGR 2011 2018 Source: GBI Research s proprietary database [accessed September 26, 2012]; interviews with marketing managers and other industry experts The global arthroscopy implants market was valued at $XX billion in 2011 and is forecast to reach $XX billion by 2018 at a CAGR of XX% due to the increasing prevalence of osteoarthritis and preference for minimally invasive procedures. Technological innovations such as better implant material and high-quality visualization systems are other major factors that will drive future growth. Page 28

Appendix 10 Appendix 10.1 Definitions 10.1.1 Arthroscopes An arthroscope is a type of endoscope which is inserted into a joint cavity through a very small incision to help the surgeon to visualize the interior of a joint and correct the deformities present. 10.1.2 Arthroscopic Shavers Arthroscopic shavers are powered systems used to scrape and cut tissues and bones and remove debris during arthroscopic surgery. They are most commonly used to debride defective cartilage and remove the inflamed inner lining of the joint. 10.1.3 Arthroscopy Fluid Management Systems FMSs are used for the irrigation and/or aspiration of fluids into or from a surgical work site during an arthroscopic procedure. They are used during minimally invasive surgery to fulfill a variety of irrigation/aspiration functions, such as tissue lavage and joint distension. One unit is one arthroscopy FMS. 10.1.4 Arthroscopy Implant Devices Arthroscopy implants are used to repair and realign joints. The market scope includes interference screws, suture anchors and meniscus tacks. Arthroscopy knee implants, arthroscopy shoulder implants and arthroscopy small-joint implants are covered under this segment. 10.1.4.1 Arthroscopy Knee Implants Arthroscopy knee implants are used for knee stabilization so that the joint line is in the correct position and the kneecap is accurately aligned for proper joint movement. One unit includes two interference screws, one suture anchor, one tubing set and one cannula. 10.1.4.2 Arthroscopy Shoulder Implants Arthroscopy shoulder implants are used for shoulder stabilization and arthroscopic rotator cuff repair. One unit includes one suture anchor, one tubing set and one cannula. 10.1.4.3 Arthroscopy Small-Joint Implants Arthroscopy small-joint implants are used for the replacement and fixation of joints, such as those in the elbow, hand, wrist, foot and ankle. One unit consists of one tubing set and one cannula. 10.1.5 Arthroscopy Radio Frequency Systems Arthroscopic radio frequency systems are used in arthroscopic procedures for the ablation and resection of soft tissue through the controlled application of RF energy. One unit is one arthroscopy radio frequency system. 10.1.6 Arthroscopy Visualization Systems Arthroscopy visualization systems are devices that aid in the visualization and interpretation of endoscopic images. They include endoscopic cameras, endoscopic light sources, monitor and display systems, printers, and other accessories. One unit is one arthroscopy visualization system. Page 73

Appendix 10.2 Acronyms ACL: ASP: Anterior Cruciate Ligament Average Selling Price ATOUS: Arthroscopic Trans-Osseous Universal Suture Passer CAGR: CMS: CPT: ENT: FDA: FMS: HD: PCL: RVU: THA: TKA: Compound Annual Growth Rate Center for Medicaid and Medicaid Services Current Procedural Terminology Ear, Nose and Throat Food and Drug Administration Fluid Management System High Definition 10.3 Sources Posterior Cruciate Ligament Relative Value Unit Total Hip Arthroscopy Total Knee Arthroscopy American Academy of Orthopedic Surgeons (2010). Why women have an increased risk of ACL injury, Available from: http://www.aaos.org/news/aaosnow/nov10/research3.asp. [Accessed on October 5, 2012]. American Academy of Orthopedic Surgeons (2011), SPORTS MEDICINE MEDIA GUIDE, Availablefrom:http://www.sportsmed.org/uploadedFiles/Content/Media/News_Room/Sports%20Med ia%20guide%202011%20final.pdf American Academy of Orthopedic Surgeons (2011a) MPFS presents problems for orthopedics. Available from: http://www.aaos.org/news/aaosnow/dec11/cover1.asp. [Accessed on October 5, 2012]. American Academy of Orthopedic Surgeons (2011b) MPFS presents problems for orthopedics, Meniscectomy repair codes. Available from: http://www.aaos.org/news/aaosnow/dec11/cover1.asp. [Accessed on October 5, 2012]. American Academy of Orthopedic Surgeons (2011c) MPFS presents problems for orthopedics. Meniscectomy repair codes, Available from: http://www.aaos.org/news/aaosnow/dec11/cover1.asp. [Accessed on October 5, 2012]. American Academy of Orthopedic Surgeons (2009). Information about Common Musculoskeletal Diseases/Disorders. Available from: http://www.aaos.org/research/stats/patientstats.asp. [Accessed on October 5, 2012]. Arthrex (2012), Arthroscopy Products, Available from: http://www.arthrex.com/ [Accessed on October 5, 2012]. Arthrocare (2012), Sports Medicine Products, Available from: http://www.arthrocaresportsmedicine.com/products [Accessed on October 5, 2012]. Conmed Corporation (2012), LINVATEC ARTHROSCOPY, Available from: http://www.conmed.com/products_arthro.php [Accessed on October 5, 2012]. DePuy (2012), Healthcare Professionals / Products / search results, Available from: Healthcare Professionals / Products / search results [Accessed on October 5, 2012]. Page 74

Appendix Food and Drug Administration (2011). Summary of MedSun Reports Describing Problem with Arthroscopic Shaver Blades and Burrs. Available from: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/news/printer.cfm?id=1520. [Accessed on October 5, 2012]. Franklin J, et al. (2008). Sex differences in the association between body mass index and total hip or knee joint replacement resulting from osteoarthritis, Annals of Rheumatic Diseases, The EULAR Journal; 68(4):536-540 Gioe JT, et al. (2011). Do Premium Joint Implants Add Value? Analysis of High Cost Joint Implants in a Community Registry. Clinical Orthopaedics and Related Research; 469(1): 48 54. Kirkley A, et al. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine; 359: 1097 1107. Moseley JB, et al. (2002). A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New England Journal of Medicine; 347: 81 88. OR Today (2012). Dual-flow irrigation systems save arthroscopy centers money, study finds, Available from: http://ortoday.com/dual-flow-irrigation-systems-save-arthroscopy-centers-money/ [Accessed on October 5, 2012] Safe Kids USA (2011), Sports and Recreation Safety, Available from: http://www.safekids.org/assets/docs/ourwork/research/2011-sports-fact-sheet.pdf Smith and Nephew (2012), Arthroscopy Products, Available from: http://www.smithnephew.com/us/professional/products/all-products/dyonics/ [Accessed on October 5, 2012]. Stryker Corporation (2012), Arthroscopy, Available from: http://www.stryker.com/enus/products/endoscopy/arthroscopy/index.htm [Accessed on October 5, 2012]. U.S. News (2009). Osteoarthritis. Available from: http://health.usnews.com/health-conditions/bonejoint-health/osteoarthritis. [Accessed on October 5, 2012]. Ueblacker P, et al. (2005). [Sports injuries and overuse syndromes]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz; 48(8): 927 938. US Census Bureau (2009a), Census Bureau Reports World's Older Population Projected to Triple by 2050, Available from: http://www.census.gov/newsroom/releases/archives/international_population/cb09-97.html [Accessed on October 5, 2012] US Census Bureau (2009b), Census Bureau Reports World's Older Population Projected to Triple by 2050, Available from: http://www.census.gov/newsroom/releases/archives/international_population/cb09-97.html [Accessed on October 5, 2012] World Health Organization (2012). Obesity and overweight. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/. [Accessed on October 5, 2012]. Zhang YD and Jordan MJ (2010). Epidemiology of Osteoarthritis. Clinics in Geriatric Medicine; 26(3): 355 369. Page 75

Appendix 10.4 Research Methodology GBI Research s dedicated research and analysis teams consist of experienced professionals in marketing and market research with consulting backgrounds in the medical devices industry and advanced statistical expertise. GBI Research adheres to the codes of practice of the Market Research Society (www.mrs.org.uk) and the Society of Competitive Intelligence Professionals (www.scip.org). All GBI Research databases are continuously updated and revised. The following research methodology is followed for all databases and reports. 10.4.1 Secondary Research The research process begins with exhaustive secondary research on internal and external sources being carried out to source qualitative and quantitative information relating to each market. The secondary research sources that are typically referred to include, but are not limited to: Company websites, annual reports, financial reports, broker reports, investor presentations and SEC filings. Industry trade journals, scientific journals and other technical literature. Internal and external proprietary databases. Relevant patent and regulatory databases. National government documents, statistical databases and market reports. Procedure registries. News articles, press releases and web-casts specific to the companies operating in the market. 10.4.2 Primary Research GBI Research conducts hundreds of primary interviews a year with industry participants and commentators in order to validate its data and analysis. A typical research interview fulfills the following functions: It provides first-hand information on the market size, market trends, growth trends, competitive landscape and future outlook. It helps in validating and strengthening the secondary research findings. It further develops the analysis team s expertise and market understanding. Primary research involves email correspondence, telephone interviews and face-to-face interviews for each market, category, segment and sub-segment across geographies. The participants who typically take part in such a process include, but are not limited to: Industry participants: CEOs, VPs, marketing/product managers, market intelligence managers and national sales managers. Hospital stores, laboratories, pharmacies, distributors and paramedics. Outside experts: investment bankers, valuation experts, research analysts specializing in specific medical equipment markets. Key opinion leaders: physicians and surgeons specializing in different therapeutic areas corresponding to different kinds of medical equipment. Page 76

Appendix 10.4.3 Models Where no hard data is available GBI Research uses modeling and estimates in order to produce comprehensive data sets. The following rigorous methodology is adopted: Available hard data is cross referenced with the following data types to produce estimates: Demographic data: population, split by segment. Macro-economic indicators: Gross Domestic Product, Inflation rate.. Healthcare Indicators: health expenditure, physician s base, healthcare infrastructure and facilities. Selected epidemiological and procedure statistics. Data is then cross-checked by the expert panel. All data and assumptions relating to modeling are stored and are available to clients on request. 10.4.4 Forecasts GBI Research uses proprietary forecast models. The following four factors are utilized in the forecast models: Historic growth rates. Macro indicators such as population trends and healthcare spending. Forecast epidemiological data. Qualitative trend information and assumptions. Data is then cross-checked by the expert panel. 10.4.5 Expert Panels GBI Research uses a panel of experts to cross verify its databases and forecasts. GBI Research s expert panel comprises marketing managers, product specialists, international sales managers from medical device companies; academics from research universities, KOLs from hospitals, consultants from venture capital funds and distributors/suppliers of medical equipment and supplies. Historic data and forecasts are relayed to GBI Research s expert panel for feedback and adjusted in accordance with this feedback. 10.6 Disclaimer All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher, GBI Research. Page 77