0001558370-22-017842 | 10-Q | XBRL Viewer

Long-Term Debt - Long-Term Debt - Table (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Contractual maturities of the long-term debt
Total, net	$ 20,000	$ 18,469
Current Portion		(8,059)
Long-term debt	20,000	10,410
SWK/Term Loan Facility
Contractual maturities of the long-term debt
Total, net	$ 20,000	17,077
Note to Tissue Supplier
Contractual maturities of the long-term debt
Total, net		$ 1,392

Long-Term Debt - SWK Loan Facility (Details) - USD ($)		2 Months Ended	9 Months Ended
Long-Term Debt - SWK Loan Facility (Details) - USD ($)	Aug. 10, 2022	Sep. 30, 2022	Sep. 30, 2022
Long-Term Debt
Deferred financing costs			$ 468,000
SWK Loan Facility
Long-Term Debt
Maximum borrowing capacity	$ 25,000,000
Proceeds from Issuance of Debt	21,000,000
Borrowing capacity	$ 4,000,000
Quarterly principal amortization (percent)		5.00%	5.00%
Interest in-kind spread basis	4.50%
Exit fee (as a percent)	6.50%
Prepayment penalty prior to first anniversary (as a percent)	2.00%
Prepayment penalty after first anniversary (as a percent)	2.00%
Weighted average interest rate		11.70%
Common stock, par value (in dollar per share)	$ 0.001
Exercise price (in dollar per share)	$ 6.65
Maximum shares issuable at closing	157,894
Maximum additional shares issuable upon additional borrowing	30,075
Warrant value	$ 600,000
Deferred financing costs	$ 500,000
Percentage of casualty proceeds in excess of $250,000 to redeem loan balance	100.00%
Casualty proceeds threshold amount in excess of which is used to redeem loan balance	$ 250,000
Threshold amount in excess of which exempted from mandatory prepayment	$ 1,000,000
SWK Loan Facility \| Maximum
Long-Term Debt
Warrants issued	187,969
SWK Loan Facility \| SOFR
Long-Term Debt
Basis spread on variable rate	8.75%
Interest in-kind spread basis	4.75%
SWK Loan Facility \| SOFR \| Minimum
Long-Term Debt
Basis spread on variable rate	2.75%
New Asset-Based Revolving Loan Facility
Long-Term Debt
Maximum borrowing capacity	$ 8,000,000

Stock-Based Compensation - Stock Options Activity (Details) $ / shares in Units, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares
Number of Shares
Outstanding at the beginning \| shares	1,386,811
Granted \| shares	1,075,858
Exercised \| shares	(1,881)
Forfeited \| shares	(705,341)
Outstanding at the end \| shares	1,755,447	1,386,811
Vested and exercisable at the end \| shares	688,632
Weighted- Average Exercise Price
Outstanding at the beginning (in dollars per share)	$ 13.28
Granted (in dollars per share)	5.77
Exercised (in dollars per share)	5.58
Forfeited (in dollars per share)	10.83
Outstanding at the end (in dollars per share)	9.68	$ 13.28
Vested and exercisable at the end (in dollars per share)	$ 10.40
Weighted-Average Remaining Contractual Term (years)
Outstanding (in years)	7 years 2 months 12 days	7 years 9 months 18 days
Vested and exercisable (in years)	4 years 2 months 12 days
Aggregate Intrinsic Value
Aggregate Intrinsic Value (in dollars) \| $	$ 1,329	$ 179
Vested and exercisable at the end (in dollars) \| $	$ 419
Other Disclosures
Weighted average grant date fair value of options granted	$ 3.15
Total unrecognized compensation expense \| $	$ 4,100
Weighted-average recognition period	2 years 6 months
Options to purchase common stock
Stock-Based Compensation
Exercise price as a percentage of market value of share of common stock at closing on the date of the grant	100.00%
Vesting period	4 years
Options to purchase common stock \| Minimum
Stock-Based Compensation
Contractual term	7 years
Options to purchase common stock \| Maximum
Stock-Based Compensation
Contractual term	10 years

Long-Term Debt - MidCap Loan and Credit Facilities (Details) $ in Thousands			1 Months Ended				3 Months Ended	7 Months Ended	9 Months Ended
	Aug. 10, 2022 USD ($)	May 31, 2017 USD ($)	Aug. 10, 2022	Jul. 31, 2019 USD ($)	Feb. 28, 2018 USD ($)	Dec. 31, 2017 USD ($)	Sep. 30, 2021	Aug. 10, 2022	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)
Long-Term Debt
Loss on extinguishment of debt									$ (311)	$ 3,029
May 2017 Financing [Member]
Long-Term Debt
Loss on extinguishment of debt									$ 1,200
MidCap Loan Facility [Member]
Long-Term Debt
Face amount of debt		$ 12,000
Proceeds from Issuance of Debt				$ 3,500	$ 3,000	$ 1,500
Total amount outstanding				$ 20,000
Interest rate		2.25%
Weighted average interest rate			9.50%				9.50%	9.50%		9.50%
Prepayment amount of loan	$ 16,000
Prepayment of principal and interest	12,800
Prepayment and exit fees paid	1,700
MidCap Loan Facility [Member] \| LIBOR
Long-Term Debt
Variable rate divider		1.00
Basis spread on variable rate		7.25%
MidCap Credit Facility [Member]
Long-Term Debt
Maximum borrowing capacity		$ 8,000
Interest rate		2.25%
Weighted average interest rate							7.20%	7.20%		7.20%
Prepayment amount of loan	$ 1,500
MidCap Credit Facility [Member] \| LIBOR
Long-Term Debt
Basis spread on variable rate		4.95%

Summary of Significant Accounting Policies - Basis of Presentation (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Summary of Significant Accounting Policies
Net loss	$ (9,910)	$ (8,316)	$ (27,457)	$ (15,768)
Accumulated deficit	$ (132,548)		(132,548)		$ (105,091)
Cash used in operating activities			16,189	9,059
Cash used in financing activities			$ 5,732	$ 7,503

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Stock-Based Compensation (Tables)

9 Months Ended

Sep. 30, 2022

Stock-Based Compensation

Summary of stock options outstanding, exercisable and vested or expected to vest


				Weighted-
				Average
		Weighted-		Remaining		Aggregate
		Average		Contractual		Intrinsic
		Exercise		Term		Value
	Number of Shares	Price		(years)		(in thousands)
Outstanding, December 31, 2021	1,386,811	$	13.28		7.8	$	179
Granted	1,075,858	$	5.77
Exercised	(1,881)	$	5.58
Forfeited	(705,341)	$	10.83
Outstanding, September 30, 2022	1,755,447	$	9.68		7.2	$	1,329
Vested and exercisable, September 30, 2022	688,632	$	10.40		4.2	$	419

Summary of weighted-average assumptions were used to determine the fair value of options


	Nine Months Ended
	September 30,
	2022		2021
Expected term (years)	6.2		6.0
Risk-free interest rate	2.0	%	1.0	%
Volatility factor	53	%	64	%
Dividend yield	—		—

Schedule of RSU activity


		Weighted-
		Average
	Number of Shares	Grant Date
	Underlying RSUs	Fair Value
Unvested, December 31, 2021	235,985	$	15.98
Granted	586,083	$	4.08
Vested	(238,142)	$	6.64
Forfeited	(210,594)	$	11.42
Unvested, September 30, 2022	373,332	$	5.89

Schedule of stock-based compensation expense recognized

Stock-based compensation expense recognized during the three and nine months ended September 30, 2022 and 2021 was comprised of the following (in thousands):


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2022		2021		2022		2021
Sales and marketing	$	343	$	185	$	841	$	488
General and administrative		(120)		622		1,465		1,557
Research and development		8		139		432		391
Cost of goods sold		66		53		135		126
Total stock-based compensation expense	$	297	$	999	$	2,873	$	2,562

Long-Term Debt

9 Months Ended

Sep. 30, 2022

Long-Term Debt

Long-Term Debt

Note 6. Long-Term Debt

On May 31, 2017, in connection with the Company’s acquisition of CorMatrix described in Note 7, Aziyo entered into a $12 million term loan facility (the “MidCap Loan Facility”) and an $8.0 million asset-backed revolving line of credit (the “MidCap Credit Facility”), under which the Company’s borrowing capacity was limited by certain qualifying assets, with a financial institution (the “May 2017 Financing”). The MidCap Loan Facility was amended in December 2017, February 2018 and July 2019 (all amendments being considered modifications) such that an additional $1.5 million, $3.0 million, and $3.5 million, respectively were received by the Company bringing the total aggregate principal amount outstanding under the MidCap Loan Facility to $20 million. The borrowings under the MidCap Loan Facility and the MidCap Credit Facility were fully repaid with a portion of the proceeds from the SWK Loan Facility (as defined below) as more fully described below.

On August 10, 2022 (the “Closing Date”), the Company entered into a senior, secured term loan facility with SWK Funding LLC, as agent, and other lenders party thereto (the “SWK Loan Facility”) for an aggregate principal amount of $25 million, with $21 million drawn on the Closing Date (the “Initial Term Loan”) and $4 million that becomes available, subject to the achievement of specified operational and financial metrics by September 30, 2023 (the “Additional Term Loan”). The SWK Loan Facility also allows for the establishment of a separate, new asset-based revolving loan facility of up to $8 million, which had not been entered into as of September 30, 2022. The SWK Loan Facility matures on August 10, 2027 and accrues interest, payable quarterly in arrears. Principal amortization of the SWK Loan Facility starts on November 15, 2024, which amortization may be extended to November 17, 2025 if conditions to draw the Additional Term Loan have been satisfied. Principal payments during the amortization period will be limited based on revenue-based caps. As of September 30, 2022, quarterly principal payments are scheduled to begin on November 15, 2024, in an amount equal to 5% of the Initial Term Loan with the balance paid at maturity. The SWK Loan Facility also includes both revenue and liquidity covenants, restrictions as to payment of dividends, and is secured by all assets of the Company, subject to certain customary exceptions. As of September 30, 2022, Aziyo was in compliance with its financial covenants under the agreement governing the SWK Loan Facility (the “SWK Loan Facility Agreement”).

All of the SWK Loan Facility borrowings take the form of Secured Overnight Financing Rate (“SOFR”) loans and bear interest at a rate per annum equal to the sum of an applicable margin of (i) 8.75% and the “Term SOFR Rate” (based upon an interest period of 3 months), or (ii) if the Company has elected the PIK Interest option (as defined below), 4.75% and the “Term SOFR Rate.” The Company may elect a portion of the interest due, to be paid in-kind at a rate per annum of 4.5% (“PIK Interest”), and such election may be made (x) until November 15, 2024 if the conditions to draw the Additional Term Loan have not been met, or (y) if such conditions to draw the Additional Term Loan have been satisfied, until November 17, 2025. The “Term SOFR Rate” is subject to a floor of 2.75%. The agreement governing the SWK Loan Facility also includes an exit fee equal to 6.5% of the aggregate principal amount funded prior to termination and prepayment penalties equal to: (i) if such prepayment occurs prior to the first anniversary of the Closing Date, 2% of the aggregate principal amount funded prior to the termination plus remaining unpaid interest payments scheduled to be paid during the first year of the loan or (ii) if such prepayment occurs after the first anniversary of the Closing Date but prior to the second anniversary of the Closing Date, 2% of the aggregate principal amount funded prior to the termination. The weighted average interest rate on the SWK Loan Facility was 11.7% for the period from August 10, 2022 through September 30, 2022.

On August 10, 2022, the Company issued to SWK Funding LLC a warrant (the “Warrant”) to purchase, in the aggregate, up to 187,969 shares of Class A common stock of the Company, $0.001 par value per share at an exercise price of $6.65 per share. The Warrant is immediately exercisable for up to 157,894 shares of Class A common stock from time to time on or after the Closing Date. Subject to and effective upon the borrowing of the Additional Term Loan, the Warrant will be exercisable for up to an additional 30,075 shares of Class A common stock. The exercise price and number of shares of Class A common stock issuable upon exercise of the Warrant are subject to adjustment in the event of stock dividends, stock splits and certain other events affecting the Class A common stock. Unless earlier exercised or terminated in accordance with its terms, the Warrant will expire on the seventh anniversary of the Closing Date. Upon issuance, the Company valued the Warrant at approximately $0.6 million using the Black Scholes model. The recognition of the Warrant as well as deferred financing costs of approximately $0.5 million incurred in securing the SWK Loan Facility served to reduce the recorded value of the associated debt. The debt discount and deferred financing costs will be recognized as interest expense through the maturity of the loan.

The Company used $16 million of the proceeds of the SWK Loan Facility to repay all outstanding obligations on the MidCap Loan Facility and MidCap Credit Facility. Such payment included (i) $12.8 million to repay all outstanding principal and accrued interest on the MidCap Loan Facility, (ii) $1.7 million to pay the prepayment and exit fees on the MidCap Loan Facility and (iii) $1.5 million to repay the outstanding balance, accrued interest and exit fees on the MidCap Credit Facility. The prepayment fees, payment of unaccrued exit fees and the write-off of unamortized deferred financing costs resulted in a loss to the Company of approximately $1.2 million which has been recorded as other expense in the accompanying condensed consolidated statements of operations for the three and nine months ended September 30, 2022.

The SWK Loan Facility Agreement requires certain mandatory prepayments, subject to certain exceptions, with: (1) 100% of any net casualty proceeds in excess of $250,000 and (2) for non-ordinary course asset sales, an amount equal to the difference between (x) the proportion of divested gross profit (as defined in the SWK Loan Facility Agreement) to the Company’s total gross profit (as defined in the SWK Loan Facility Agreement) multiplied by the outstanding loans under the SWK Loan Facility and (y) the difference between $1,000,000 and the aggregate sale proceeds of any assets previously sold during the fiscal year. No such mandatory prepayments were required during the three and nine months ended September 30, 2022.

Borrowings under the MidCap Loan Facility, as amended, bore interest at a rate per annum equal to the sum of (x) the greater of (i) 2.25% and (ii) the applicable London Interbank Offered Rate for U.S. dollar deposits divided by 1.00 minus the maximum effective reserve percentage for Eurocurrency funding (“LIBOR”) plus (y) 7.25%. The weighted average interest rate on MidCap Loan Facility was 9.5% from January 1, 2022 through August 10, 2022 (the “Repayment Date”) and July 1, 2022 through the Repayment Date. The weighted average interest rate on the MidCap Loan Facility was 9.5% for both the three and nine months ended September 30, 2021.

Borrowings under the MidCap Credit Facility bore interest at a rate per annum equal to the sum of (x) the greater of (i) 2.25% and (ii) LIBOR plus (y) 4.95%. The weighted average interest rate on MidCap Credit Facility was 7.2% from

January 1, 2022 through the Repayment Date and July 1, 2022 through the Repayment Date. The weighted average interest rate on MidCap Credit Facility was 7.2% for both the three and nine months ended September 30, 2021.

During 2017, the Company restructured certain of its liabilities with a tissue supplier and entered into an unsecured promissory note totaling $2.1 million. The note bears interest at 5% and includes quarterly interest-only payments in 2017 and quarterly interest and principal payments from March 31, 2018 through August 31, 2021. The Company used $1.4 million of the proceeds from the SWK Loan Facility to repay the remaining balance on the promissory note; however the accrued interest on the promissory note was forgiven by the lender. Such forgiveness resulted in a gain to the Company of approximately $0.4 million which has been recorded as other income in the accompanying condensed consolidated statements of operations for the three and nine months ended September 30, 2022.

In May 2020, Aziyo entered into a promissory note with Silicon Valley Bank that provided for the receipt by the Company of loan proceeds totaling approximately $3.0 million (the “PPP Loan”) pursuant to the Paycheck Protection Program under the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”). In September 2021, Aziyo was notified by the U.S. Small Business Administration that the entire balance of the Company’s PPP Loan and all related accrued interest was forgiven. Such forgiveness resulted in a gain to the Company of approximately $3.0 million which has been recorded as other income in the accompanying condensed consolidated statements of operations for the nine months ended September 30, 2021.

Long-term debt was comprised of the following (in thousands):


	September 30,		December 31,
	2022		2021
SWK/MidCap Loan Facility, net of unamortized discount and deferred financing costs	$	20,000	$	17,077
Note to Tissue Supplier		—		1,392
Total		20,000		18,469
Current Portion		—		(8,059)
Long-Term Debt	$	20,000	$	10,410

The fair value of all debt instruments, which is based on inputs considered to be Level 2 under the fair value hierarchy, approximates the respective carrying values as of September 30, 2022 and December 31, 2021.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Summary of Significant Accounting Policies (Tables)

9 Months Ended

Sep. 30, 2022

Summary of Significant Accounting Policies

Summary of reconciliation of cash and restricted cash included in the consolidated balance sheets

The following table provides a reconciliation of cash and restricted cash included in the condensed consolidated balance sheets to the amounts included in the statements of cash flows (in thousands).


	September 30,
	2022		2021
Cash	$	8,101	$	22,543
Restricted cash		—		83
Total cash and restricted cash shown in statements of cash flows	$	8,101	$	22,626

Summary of estimated useful lives of the assets


Processing and research equipment		5 to 10 years
Office equipment and furniture		3 to 5 years
Computer hardware and software		3 years

Schedule of largest customers as well as their respective percentage of total accounts receivable


	Three Months Ended		Nine Months Ended
	September 30,		September 30,
	2022	2021	2022	2021
Percent of revenues derived from:
ACE Surgical Supply	11%	9%	10%	4%
Surgalign Holdings	11%	9%	11%	10%
Medtronic Sofamor Danek USA	-	3%	-	13%


	September 30,	December 31,
	2022	2021
Percent of accounts receivable derived from:
ACE Surgical Supply	5%	3%
Surgalign Holdings	13%	12%
Medtronic Sofamor Danek USA	-	-

Net Loss Per Share Attributable to Common Stockholders (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Numerator:
Net loss attributable to common stockholders	$ (9,910)	$ (8,316)	$ (27,457)	$ (15,768)
Denominator:
Weighted average common shares outstanding - basic	13,660,555	10,235,350	13,618,580	10,229,974
Weighted average number of common shares, diluted	13,660,555	10,235,350	13,618,580	10,229,974
Net loss per common share attributable to common stockholders, basic (in dollar per share)	$ (0.73)	$ (0.81)	$ (2.02)	$ (1.54)
Net loss per common share attributable to common stockholders, diluted (in dollar per share)	$ (0.73)	$ (0.81)	$ (2.02)	$ (1.54)

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash	$ 8,101	$ 30,393
Restricted cash		35
Accounts receivable, net	7,159	5,996
Inventory	10,192	9,554
Receivables of FiberCel litigation costs	17,234
Prepaid expenses and other current assets	970	1,450
Total current assets	43,656	47,428
Property and equipment, net	1,359	1,200
Intangible assets, net	15,918	18,466
Other assets	89	76
Total assets	61,022	67,170
Current liabilities:
Accounts payable	2,618	1,582
Accrued expenses	8,935	6,375
Payables to tissue suppliers	3,210	2,467
Current portion of long-term debt		8,059
Current portion of revenue interest obligation	7,750	2,750
Revolving line of credit		4,763
Contingent liability for FiberCel litigation	17,643
Other current liabilities	12	5
Total current liabilities	40,168	26,001
Long-term debt	20,000	10,410
Long-term revenue interest obligation	11,449	16,540
Other long-term liabilities	86	698
Total liabilities	71,703	53,649
Commitments and contingencies (Note 8)
Stockholders' equity (deficit):
Additional paid-in capital	121,854	118,599
Accumulated deficit	(132,548)	(105,091)
Total stockholders' equity (deficit)	(10,681)	13,521
Total liabilities and stockholders' equity	61,022	67,170
Class A Common stock
Stockholders' equity (deficit):
Common stock	9	9
Class B Common stock
Stockholders' equity (deficit):
Common stock	$ 4	$ 4

Commitments and Contingencies

9 Months Ended

Sep. 30, 2022

Commitments and Contingencies.

Commitments and Contingencies

Note 8. Commitments and Contingencies

Operating Leases

The Company leases two production facilities and one administrative and research facility under non-cancelable operating lease arrangements that expire through November 2025. Each of these leases contain renewal options and escalation clauses based upon increases in the lessors’ operating expenses and other charges. The Company also has a short-term lease for a small administrative-only facility.

The Company records rent expense on a straight-line basis over the life of the lease and the difference between the average rent expense and cash payments for rent is recorded as deferred rent and is included in other current and long-term liabilities on the balance sheet. Rent expense was approximately $0.3 million for both the three months ended September 30, 2022 and 2021, and was approximately $0.9 million for both the nine months ended September 30, 2022 and 2021, and is included as a component of either cost of goods sold or general and administrative expenses.

Cook Biotech License and Supply Agreements

Aziyo has entered into a license agreement with Cook Biotech (“Cook”) for an exclusive, worldwide license to the porcine tissue for use in the Company’s Cardiac Patch and CanGaroo products, subject to certain co-exclusive rights retained by Cook (the “Cook License Agreement”). The term of such license is through the date of the last to expire of the licensed Cook patents, which is anticipated to be July 2031. Along with this license agreement, Aziyo entered into a supply agreement whereby Cook would be the exclusive supplier to Aziyo of the licensed porcine tissue. Under certain limited circumstances, Aziyo has the right to manufacture the licensed product and pay Cook a royalty of 3% of sales of the Aziyo-manufactured tissue. The supply agreement expires on the same date as the related license agreement. No royalties were paid to Cook during the three and nine months ended September 30, 2022 or 2021. Aziyo has also entered into an amendment to the Cook License Agreement (the “Cook Amendment”) in order to add fields of exclusive use. Specifically, the Cook Amendment provides for a worldwide exclusive license to the porcine tissue for use with neuromodulation devices in addition to cardiovascular devices. The Cook Amendment includes license fee payments of $0.1 million per year in each of the years 2021 through 2026. Such license payments would accelerate if a change in control, as defined in the Cook Amendment, occurs within Aziyo. The Company, in its sole discretion, can terminate the Cook License Agreement at any time.

Legal Proceedings

From time to time, the Company may be involved in claims and proceedings arising in the course of the Company’s business. The outcome of any such claims or proceedings, regardless of the merits, is inherently uncertain. The Company records accruals for contingencies when it is probable that a liability has been incurred and the amount can be reasonably estimated. These accruals are adjusted periodically as assessments change or additional information becomes available.

FiberCel Litigation

In June 2021, the Company announced a voluntary recall of a single lot of FiberCel fiber viable bone matrix. Since September 2021, 55 lawsuits in Indiana, Delaware, Florida, Maryland, Colorado, Michigan, Ohio, Kentucky, Oregon, North Carolina and Louisiana have been filed against Aziyo Biologics Inc., certain Medtronic entities, and others alleging that the plaintiffs were exposed to and/or contracted tuberculosis and/or suffered substantial symptoms and complications following the implantation of FiberCel during spinal fusion operations. Such lawsuits were filed in Indiana state court (collectively, the “Indiana State Complaints”); the Superior Court of the State of Delaware (collectively, the “Delaware State Complaints”); the Circuit Court of Maryland (collectively, the “Maryland State Complaints”); the Court of Common Pleas of Ohio (“Ohio State Complaint”); the Northern District of Ohio (“Ohio Federal Complaint”); the U.S. District Court for the Western District of North Carolina (“North Carolina Federal Complaint”); the U.S. District Court

for the Northern District of Florida (“Florida Federal Complaint”); U.S. District Court for the Eastern District of Michigan and the Eastern District of Michigan (collectively “Michigan Federal Complaints.”); the U.S. District Court for the District of Colorado (“Colorado Federal Complaint”); the U.S. District Court for the District of Oregon (“Oregon Federal Complaint”); the Fayette, Kentucky Circuit Court and the U.S. District Court for the Eastern District of Kentucky (collectively, “Kentucky Complaints.”); the U.S. District Court for the Western District of Louisiana (“Louisiana Federal Complaint”).

Plaintiffs in the Indiana State Complaints allege a cause of action under Indiana’s Product Liability Act, citing manufacturing defects, defective design and failure to properly warn and instruct, and several of the complaints allege loss of consortium. Plaintiffs in these actions assert that the defendants are strictly liable or have breached the duty of care owed to plaintiffs by failing to exercise reasonable care in designing, manufacturing, marketing and labeling FiberCel and are seeking various types of damages, including economic damages, non-economic damages and loss of consortium. Plaintiffs in one of the Indiana State Complaints allege causes of action for product liability, negligence, breach of express and implied warranties, and punitive damages. Each of the plaintiffs in the Delaware State Complaints alleges negligence, breach of implied warranty, breach of express warranty, and medical monitoring and punitive damages, and two also allege loss of consortium. Plaintiffs in the Delaware State Complaints are seeking economic, consequential, and punitive damages. The Maryland State Complaints assert claims of negligence, breach of implied warranty, breach of express warranty, medical monitoring, and loss of consortium. The Florida Federal Complaint contains three strict liability claims for defective design, defective manufacture, and failure to warn. A claim for punitive damages is also pled. The Ohio State Complaint alleges causes of action for product liability and negligence and seeks compensatory damages. The Colorado Federal Complaint asserts causes of action for strict product liability, misrepresentation, negligence, breach of express warranty, and breach of implied warranty of merchantability. The Michigan Federal Complaints assert causes of action for negligence, gross negligence breach of implied warranty, breach of express warranty, intentional infliction of emotional distress, and liability under the res ipsa loquitur doctrine. The Michigan Federal Complaints seek compensatory damages and punitive damages. The North Carolina Federal Complaint alleges causes of action for negligence, defective design, breach of implied warranty, breach of express warranty, and loss of consortium, and seeks both compensatory and punitive damages. The Oregon Federal Complaint asserts strict liability claims for defective design, defective manufacture, and failure to warn, and seeks compensatory damages. The Ohio Federal Complaint asserts strict liability claims for defective manufacturing, inadequate warning, nonconformance with representations, and also alleges loss of consortium and seeks compensatory damages. The Kentucky Complaints assert strict liability claims based on manufacturing defect, design defect, failure to warn, negligence, breach of implied warranty, breach of express warranty, and seek recovery for medical monitoring, loss of consortium, compensatory damages, and punitive damages. The Louisiana Federal Complaint asserts claims of violation of the Louisiana products liability act, negligence and gross negligence, breach of implied warranty, breach of express warranty and seek recovery for medical monitoring.

In addition to the above, there have been 42 claims related to the FiberCel recall that have not yet resulted in a lawsuit. The Company refers to all of the aforementioned litigation, or claim notices, collectively as the “FiberCel Litigation.”

In October 2022, the Company engaged in a process to negotiate and attempt to resolve many of the cases in the FiberCel Litigation. The Company also mediated and resolved a Maryland lawsuit in August 2022. In total, Aziyo’s liability in 24 of the cases was settled (23 of which are pending finalization of the related settlement agreements) for a total of approximately $7.2 million. The settled matters included cases from the Indiana State Complaints, Ohio State Complaint, Florida Federal Complaint, Colorado Federal Complaint, Delaware State Complaints and Maryland Complaint, along with claims in six states. Of these settled matters, one case was both settled and paid as of September 30, 2022 for a total cash outlay of $1.3 million. For the remaining 73 cases, the Company estimated a probable loss related to each case and has recorded a liability at an estimated amount of $11.7 million bringing the total estimated liability at September 30, 2022 to $17.6 million, which is recorded as Contingent Liability for FiberCel Litigation in the accompanying condensed consolidated balance sheets. Although we believe there is a possibility that a loss in excess of the amount recognized exists, we are unable to estimate the possible loss or range of loss in excess of the amount recognized at this time. In order to reasonably estimate the liability for the unsettled FiberCel Litigation cases, the Company, along with outside legal counsel, has assessed a variety of factors, including (i) the extent of the injuries incurred, (ii) recent experience on the settled claims, (iii) settlement offers made to the other parties to the litigation and (iv) any other factors that may have a material effect on the FiberCel Litigation. While the Company believes its estimated liability to be reasonable, the actual

loss amounts are highly variable and turn on a case-by-case analysis of the relevant facts. As more information is learned about asserted claims and potential future trends, adjustments may be made to this Contingent Liability for FiberCel Litigation as appropriate.

Defense costs are recognized in the accompanying condensed consolidated statements of operations as incurred.

The Company has purchased insurance coverage that, subject to common contract exclusions, provided coverage for the FiberCel Litigation product liability losses as well as legal defense costs. Additionally, the Company has various potential indemnity and/or contribution rights against third party sources with respect to certain product liability losses. When settlements are reached and/or amounts are recorded in the related Contingent Liability for FiberCel Litigation, the Company calculates amounts due to be reimbursed pursuant to the terms of the coverage and related agreements, and pursuant to other indemnity or contribution claims, in respect of product liability losses and related defense costs. The amounts probable of reimbursement or recovery from this calculation are recorded as receivables. The determination that the recorded receivables are probable of collection is based on the terms of agreements reached in respect of indemnity and contribution claims as well as the advice of the Company’s outside legal counsel. These receivables at September 30, 2022 totaled $17.2 million and are recorded as Receivables of FiberCel Litigation Costs in the accompanying condensed consolidated balance sheets.

The indemnity and contribution receivables amount at September 30, 2022 represents amounts that are not believed to be subject to any current dispute. At September 30, 2022, the Company continues to pursue up to $3.8 million or more in additional amounts in respect of such indemnity and contribution claims and as such, has not been reflected as part of this receivable. The Company will vigorously pursue its position with respect to this amount and while uncertain, does expect to be successful in recovering at least an additional $3.8 million or more.

As of both September 30, 2022 and December 31, 2021, the Company was not a party to, or aware of, any material legal matters or claims except for the FiberCel Litigation.

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2022	Nov. 11, 2022
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Document Period End Date	Sep. 30, 2022
Entity File Number	001-39577
Entity Registrant Name	Aziyo Biologics, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	47-4790334
Entity Address State Or Province	MD
Entity Address, Address Line One	12510 Prosperity Drive
Entity Address, Adress Line Two	Suite 370
Entity Address, City or Town	Silver Spring
Entity Address, Postal Zip Code	20904
City Area Code	240
Local Phone Number	247-1170
Title of 12(b) Security	Class A Common Stock, par value $0.001 per share
Trading Symbol	AZYO
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Central Index Key	0001708527
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Amendment Flag	false
Class A Common stock
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		9,460,964
Class B Common stock
Document Information [Line Items]
Entity Common Stock, Shares Outstanding		4,313,406

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
Net sales	$ 12,389	$ 11,485	$ 36,522	$ 36,529
Cost of goods sold	7,340	7,796	22,294	20,897
Gross profit	5,049	3,689	14,228	15,632
Sales and marketing	4,915	4,783	15,139	14,285
General and administrative	4,487	3,516	13,223	10,501
Research and development	1,966	2,289	6,855	5,890
FiberCel litigation costs	1,474	77	1,908	226
Total operating expenses	12,842	10,665	37,125	30,902
Loss from operations	(7,793)	(6,976)	(22,897)	(15,270)
Interest expense	1,302	1,328	3,721	4,034
Other (income) expense, net	803		803	(3,579)
Loss before provision for income taxes	(9,898)	(8,304)	(27,421)	(15,725)
Income tax expense	12	12	36	43
Net loss	$ (9,910)	$ (8,316)	$ (27,457)	$ (15,768)
Net loss per share - basic (in dollar per share)	$ (0.73)	$ (0.81)	$ (2.02)	$ (1.54)
Net loss per share - diluted (in dollar per share)	$ (0.73)	$ (0.81)	$ (2.02)	$ (1.54)
Weighted average common shares outstanding - basic	13,660,555	10,235,350	13,618,580	10,229,974
Weighted average common shares outstanding - diluted	13,660,555	10,235,350	13,618,580	10,229,974

Stock-Based Compensation - Restricted Stock Units (Details) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2022 USD ($) $ / shares shares
Weighted-Average Grant Date Fair Value
Weighted-average recognition period	2 years 6 months
Restricted stock units
Weighted-Average Grant Date Fair Value
Unrecognized compensation costs \| $	$ 1.7
Weighted-average recognition period	2 years
Restricted stock units \| Minimum
Stock-Based Compensation
Vesting period	3 years
Restricted stock units \| Maximum
Stock-Based Compensation
Vesting period	4 years
Restricted stock units \| 2020 Plan
Number of Shares Underlying RSUs
Unvested at the beginning	235,985
Granted	586,083
Vested	(238,142)
Forfeited	(210,594)
Outstanding at the end	373,332
Weighted-Average Grant Date Fair Value
Unvested at the beginning (in dollars per share) \| $ / shares	$ 15.98
Granted (in dollars per share) \| $ / shares	4.08
Vested (in dollars per share) \| $ / shares	6.64
Forfeited (in dollars per share) \| $ / shares	11.42
Unvested at the ending (in dollars per share) \| $ / shares	$ 5.89
Total fair value of the restricted stock units granted \| $	$ 2.4
Performance-Based RSU
Number of Shares Underlying RSUs
Granted	289,282
Performance-Based RSU \| Minimum
Weighted-Average Grant Date Fair Value
Expected term (years)	2 years
Performance-Based RSU \| Maximum
Weighted-Average Grant Date Fair Value
Expected term (years)	3 years

Stock-Based Compensation

9 Months Ended

Sep. 30, 2022

Stock-Based Compensation

Stock-Based Compensation

Note 4. Stock-Based Compensation

In 2015, the Company established the Aziyo Biologics, Inc. 2015 Stock Option/Stock Issuance Plan, as amended (the “2015 Plan”) which provided for the granting of incentive and non-qualified stock options to employees, directors and consultants of the Company. On October 7, 2020, in connection with the Company’s initial public offering (“IPO”), the Company adopted the Aziyo Biologics, Inc. 2020 Incentive Award Plan (the “2020 Plan”), which authorizes the grant of incentive and non-qualified stock options, restricted stock, restricted stock units and stock appreciation rights to employees, directors and consultants. Shares of Class A common stock totaling 1,636,000 were initially reserved for issuance pursuant to the 2020 Plan. In addition, the shares reserved for issuance under the 2020 Plan will also include shares reserved but not issued under the 2015 Plan as well as an annual increase as set forth in the 2020 Plan. As of September 30, 2022, the Company had 756,809 shares of Class A common stock available for issuance under the 2020 Plan.

On June 21, 2022, C. Randal Mills, Ph.D., a member of the Board of Directors (the “Board”) of the Company, was appointed as the Company’s Interim President and Chief Executive Officer, succeeding Ronald Lloyd, who stepped down as the Company’s President and Chief Executive Officer and as a member of the Board. In connection with his appointment as the Interim President and Chief Executive Officer, Dr. Mills and the Company entered into an employment agreement for an initial term of 90 days (such period, the “Interim Period”). On August 9, 2022, Dr. Mills was appointed to the role of President and Chief Executive Officer of the Company, thereby ending the Interim Period, and his employment agreement was extended pursuant to the terms thereof.

In accordance with the terms of his employment agreement, Dr. Mills (1) received a stock option award to purchase 456,278 shares of Class A common stock of the Company (the “Option Grant”) on June 21, 2022; three-fifths of such Option Grant is subject to time-based vesting (the “Time-Based Options”) and two-fifths of such Option Grant is subject to performance-based vesting (the “Performance Based Options”) and (2) is eligible to receive 224,734 restricted stock units (the “RSU Grant”); three-fifths of such RSU Grant is subject to time-based vesting (the “Time-Based RSUs”) and two-fifths of such RSU Grant is subject to performance-based vesting (the “Performance-Based RSUs”). One-third of the Time-Based Options vested on August 9, 2022 (end of the Interim Period), and two-thirds of the Time-Based Options vest over a four-year vesting schedule with 25% vesting on the first anniversary of June 21, 2022 and the remaining portion vesting in twelve equal quarterly installments. One-third of the Time-Based RSUs vest on the grant date, and two-thirds of the Time-Based RSUs vest over a four-year vesting schedule in equal annual installments. The Performance-Based Options and Performance-Based RSUs each vest in equal installments upon the achievement of certain share price thresholds for twenty consecutive days of trading at each respective threshold. Pursuant to the terms of the employment agreement, all of these awards were deemed granted on June 21, 2022, for purposes of and in accordance with ASC 718, Accounting for Stock Based Compensation; however, the RSUs had not been legally granted as of September 30, 2022. It is anticipated that such RSUs will be legally granted prior to December 31, 2022, and the vested shares underlying the award will be deemed outstanding as of such time.

In connection with his resignation as President and Chief Executive Officer, Mr. Lloyd and the Company entered into a separation agreement, pursuant to which Mr. Lloyd remained a full-time, non-officer employee of the Company through September 30, 2022 to assist with the transition of his duties to his successor. On September 30, 2022, Mr. Lloyd received: (i) cash severance in an amount equal to his base salary for a period of 12 months and 100% of his annual target bonus and (ii) the COBRA benefits, during the 12-month period following September 30, 2022. The Company recognized Mr. Lloyd’s severance costs totaling approximately $0.6 million over the period from June 21, 2022 through September 30, 2022, and as of September 30, 2022, all such expenses were included in Accrued Expenses in the accompanying condensed consolidated balance sheets.

Stock Options

The Company’s policy is to grant stock options at an exercise price equal to 100% of the market value of a share of Class A common stock at closing on the date of the grant. The Company’s stock options have contractual terms of seven to ten years, and generally vest over a four-year period from the date of grant.

A summary of stock option activity under the Company’s 2015 Plan and 2020 Plan for the nine months ended September 30, 2022 is as follows:


				Weighted-
				Average
		Weighted-		Remaining		Aggregate
		Average		Contractual		Intrinsic
		Exercise		Term		Value
	Number of Shares	Price		(years)		(in thousands)
Outstanding, December 31, 2021	1,386,811	$	13.28		7.8	$	179
Granted	1,075,858	$	5.77
Exercised	(1,881)	$	5.58
Forfeited	(705,341)	$	10.83
Outstanding, September 30, 2022	1,755,447	$	9.68		7.2	$	1,329
Vested and exercisable, September 30, 2022	688,632	$	10.40		4.2	$	419

The weighted average grant date fair value of options granted during the nine months ended September 30, 2022 was $3.15. As of September 30, 2022, there was approximately $4.1 million of total unrecognized compensation expense related to unvested stock options. These costs are expected to be recognized over a weighted-average period of 2.5 years.

The Company uses the Black-Scholes model to value its time-based stock option grants and expenses the related compensation cost using the straight-line method over the vesting period. The fair value of stock options is determined on the grant date using assumptions for the estimated fair value of the underlying common stock, expected term, expected volatility, dividend yield, and the risk-free interest rate. Before the completion of the Company’s IPO, the Board determined the fair value of common stock considering the state of the business, input from management, third party valuations and other considerations. The Company uses the simplified method for estimating the expected term used to determine the fair value of options. The expected volatility of the Class A common stock is primarily based on the historical volatility of comparable companies in the industry whose share prices are publicly available. The Company uses a zero-dividend yield assumption as the Company has not paid dividends since inception nor does it anticipate paying dividends in the future. The risk-free interest rate approximates recent U.S. Treasury note auction results with a similar life to that of the option. The period expense is then determined based on the valuation of the options, and is recognized on a straight-line basis over the requisite service period for the entire award.

The following weighted-average assumptions were used to determine the fair value of options granted during the nine months ended September 30, 2022 and 2021:


	Nine Months Ended
	September 30,
	2022		2021
Expected term (years)	6.2		6.0
Risk-free interest rate	2.0	%	1.0	%
Volatility factor	53	%	64	%
Dividend yield	—		—

For the Performance-Based Options granted as described above, the Company accounted for the awards as market condition awards and used an option pricing model, the Monte Carlo model, to determine the fair value of the respective equity instruments and an expense recognition term of approximately three years.

Restricted Stock Units

Restricted stock units (“RSUs”) represent rights to receive common shares at a future date. There is no exercise price and no monetary payment is required for receipt of restricted stock units or the shares issued in settlement of the award. The Company’s RSUs generally vest over a three to four year period from the date of grant.

A summary of the RSU activity under the Company’s 2020 Plan for the nine months ended September 30, 2022 is as follows:


		Weighted-
		Average
	Number of Shares	Grant Date
	Underlying RSUs	Fair Value
Unvested, December 31, 2021	235,985	$	15.98
Granted	586,083	$	4.08
Vested	(238,142)	$	6.64
Forfeited	(210,594)	$	11.42
Unvested, September 30, 2022	373,332	$	5.89

The total fair value of the RSUs granted during the nine months ended September 30, 2022 was $2.4 million.

During the nine months ended September 30, 2022, the Company granted 289,282 Performance-Based RSUs. All such RSUs, including those granted to Dr. Mills and described above, vest only if or when the Company’s Class A common stock closing price is at or exceeds a defined share price for a defined period of time. As such, all of these awards have been accounted for as market condition awards. Given the nature of these market condition arrangements, an option pricing model, the Monte Carlo model, was used to determine the fair value of these RSUs as well as the expense recognition term of two to three years using the graded vesting method.

As of September 30, 2022, $1.7 million of unrecognized compensation costs related to RSUs is expected to be recognized over a weighted average period of two years.

Employee Stock Purchase Plan

The Company makes shares of its Class A common stock available for purchase under the Aziyo Biologics, Inc. 2020 Employee Stock Purchase Plan (the “ESPP”). The ESPP provides for separate six-month offering periods that begin in March and September of each year. Under the ESPP, employees may purchase a limited number of shares of Aziyo Class A common stock at 85% of the fair market value on either the first day of the offering period or the purchase date, whichever is lower. The ESPP is considered compensatory for purposes of stock-based compensation expense. The number of shares reserved under the ESPP will automatically increase on the first day of each fiscal year through January 1, 2030, in an amount as set forth in the ESPP. As of September 30, 2022, the total shares of Class A common stock

authorized for issuance under the ESPP was 380,997, of which 279,345 remained available for future issuance. During the nine months ended September 30, 2022, 74,408 shares of Class A common stock were issued under the ESPP.

Stock-Based Compensation Expense

Stock-based compensation expense recognized during the three and nine months ended September 30, 2022 and 2021 was comprised of the following (in thousands):


	Three Months Ended				Nine Months Ended
	September 30,				September 30,
	2022		2021		2022		2021
Sales and marketing	$	343	$	185	$	841	$	488
General and administrative		(120)		622		1,465		1,557
Research and development		8		139		432		391
Cost of goods sold		66		53		135		126
Total stock-based compensation expense	$	297	$	999	$	2,873	$	2,562

Recently Issued Accounting Standards

9 Months Ended

Sep. 30, 2022

Recently Issued Accounting Standards

Recently Issued Accounting Standards

Note 3. Recently Issued Accounting Standards

In November 2019, the FASB issued ASU 2019-10, “Financial Instruments - Credit Losses (Topic 326), Derivative and Hedging (Topic 815), and Leases (Topic 842), Effective Dates.” The FASB deferred the effective dates of the new credit losses standard for all entities except filers with the Securities and Exchange Commission (the “SEC”) that are not smaller reporting companies (“SRCs”) to fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. The FASB also aligned the effective dates of ASU 2017-04 on goodwill impairment with the new effective dates of the credit losses standard. The FASB deferred the effective dates of its new standards on hedging and leases for entities that are not public business entities (“PBEs”) (and for leases, for entities that are not non-for-profit (“NFP”) entities that have issues, or are conduit bond obligors for, certain securities; and are not employee benefit plans (“EBPs”) that file or furnish financial statements with or to the SEC) to fiscal years beginning after December 15, 2020, and interim periods in the following year. The FASB is also reconsidering its philosophy on establishing effective dates

for major standards for private companies, NFPs, EBPs and smaller public companies. The FASB has developed a two-bucket approach that would give these entities more time to implement major new standards. The Company is evaluating this standard to determine if adoption will have a material impact on the Company’s consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, Leases. The standard requires that lessees recognize a right-of-use asset and a lease liability for virtually all of their leases (other than leases that meet the definition of a short-term lease). The liability will be equal to the present value of lease payments. The asset will be based on the liability subject to certain adjustments. For income statement purposes, the FASB retained a dual model, requiring leases to be classified as either operating or finance. Operating leases will result in straight-line expense (similar to current operating leases) while finance leases will result in a front-loaded expense pattern (similar to current capital leases). In November 2019, the FASB issued 2019-10 which extended the adoption of ASU 2016-02 for the Company to be effective for periods ending after December 15, 2022. While early adoption is permitted, the Company will adopt the standard in the fourth quarter of 2022 for the full 2022 year, and expects to recognize right-of-use assets and lease liabilities for operating leases of approximately $2.4 million.

- Definition

The entire disclosure for change in accounting principle. Includes, but is not limited to, nature, reason, and method of adopting amendment to accounting standards or other change in accounting principle.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/extlink&oid=126986314&loc=SL124402458-218513

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Summary of Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2022

Summary of Significant Accounting Policies

Basis of Presentation and Liquidity

The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by GAAP for complete financial statements and should be read in conjunction with the Company’s consolidated financial statements and accompanying notes included in the Company's annual report on Form 10-K (“Annual Report”) for the fiscal year ended December 31, 2021. The financial information as of September 30, 2022 and for the three and nine months ended September 30, 2022 and 2021 is unaudited, but in the opinion of management, all adjustments considered necessary for a fair statement of the results for these interim periods have been included. The condensed consolidated balance sheet data as of December 31, 2021 was derived from audited financial statements but does not include all disclosures required by GAAP. The results of the Company’s operations for any interim period are not necessarily indicative of the results that may be expected for any other interim period or any future year or period.

The condensed consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. Intercompany accounts and transactions have been eliminated in consolidation.

In accordance with Accounting Standards Update (“ASU”) 2014-15, Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern (Subtopic 205-40), the Company has evaluated whether there are conditions and events, considered in the aggregate, that raise substantial doubt about the Company’s ability to continue as a going concern within one year after the date that the consolidated financial statements are issued. For the nine months ended September 30, 2022, the Company incurred a net loss of $27.5 million, and as of September 30, 2022, the Company had an accumulated deficit of $132.5 million. In addition, during the nine months ended September 30, 2022, the Company used $16.2 million and $5.7 million of cash in operating and financing activities, respectively, and expects to continue to incur cash outflows for the remainder of the year. Because of the numerous risks and uncertainties associated with the Company’s commercialization and development efforts, the Company is unable to predict when it will become profitable, and it may never become profitable. The Company’s inability to achieve and then maintain profitability would negatively affect its business, financial condition, results of operations and cash flows.

In order to mitigate the current and potential future liquidity issues caused by the matters noted above, the Company may seek to raise capital through the issuance of common stock or debt, restructure its Revenue Interest Obligation (as such term is defined, and further described, in Note 7), or pursue asset sale or licensing transactions. However, such transactions may not be successful and the Company may not be able to raise additional equity or debt, restructure its Revenue Interest Obligation, or sell or license assets on acceptable terms, or at all. As such, based on its current operating plans, the Company believes there is uncertainty as to whether its future cash flows along with its existing cash, potential availability under the SWK Loan Facility (described in Note 6), issuances of additional equity and cash

generated from expected future sales will be sufficient to meet the Company’s anticipated operating needs through twelve months from the financial statement issuance date. Due to these factors, there is substantial doubt about the Company’s ability to continue as a going concern within one year after the issuance of the financial statements.

The accompanying condensed consolidated financial statements do not include any adjustments that might result from the outcome of this uncertainty. That is, the accompanying financial statements have been prepared assuming that the Company will continue as a going concern, which contemplates continuity of operations, realization of assets, and satisfaction of liabilities in the ordinary course of business.

Reclassifications

Certain reclassifications have been made to prior year amounts to conform to current year financial statement presentation. The reclassifications relate to the separate presentation of prior year costs related to the FiberCel Litigation (see Note 8 for further discussion). Such costs were formerly shown as a component of general and administrative expenses in the accompanying condensed consolidated statements of operations.

Use of Estimates

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions relating to inventory, receivables, long-lived assets, the valuation of stock-based awards, the valuation of the Revenue Interest Obligation and deferred income taxes are made at the end of each financial reporting period by management. Management continually re-evaluates its estimates, judgments and assumptions, and management's evaluation could change. Actual results could differ from those estimates.

Impact of COVID-19

The Company continues to closely monitor the impact of the COVID-19 pandemic and its variants on its business. In March 2020, the World Health Organization declared COVID-19 a global pandemic and recommended various containment and mitigation measures worldwide. Since that time, the number of procedures performed using the Company's products has intermittently decreased, as governmental authorities in the United States have recommended, and in certain cases required, that elective, specialty and other non-emergency procedures and appointments be suspended or canceled in order to avoid patient exposure to medical environments and the risk of potential infection with COVID-19, and to focus limited resources and personnel capacity on the treatment of COVID-19 patients. As a result, beginning in March 2020, a significant number of procedures using the Company's products have intermittently been postponed or cancelled, which has negatively impacted sales of its products. These measures and challenges will likely continue for the duration of the pandemic, which is uncertain, and may reduce the Company's net sales in the future and negatively impact its business, financial condition and results of operations while the pandemic continues.

Net Loss per Share Attributable to Common Stockholders

Our common stock has a dual class structure, consisting of Class A common stock, $0.001 par value per share (the “Class A common stock) and Class B common stock, $0.001 par value per share (the “Class B common stock). Other than voting rights, the Class B common stock has the same rights as the Class A common stock, and therefore both are treated as the same class of stock for purposes of the earnings per share calculation. Basic net loss per share attributable to common stockholders is calculated by dividing the net loss attributable to common stockholders by the weighted-average shares outstanding during the period. For purposes of the diluted net income (loss) per share attributable to common stockholders calculation, stock options and restricted stock units (“RSUs”) are considered to be common stock equivalents. All common stock equivalents have been excluded from the calculation of diluted net loss per share attributable to common stockholders, as their effect would be anti-dilutive for all periods presented. Therefore, basic and diluted net loss per share were the same for both periods presented.

Fair Value of Financial Instruments

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. To increase the comparability of fair value measures, the following hierarchy prioritizes the inputs to valuation methodologies used to measure fair value:

Level 1 - Valuations based on quoted prices for identical assets and liabilities in active markets.

Level 2 - Valuations based on observable inputs other than quoted prices included in Level 1, such as quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets and liabilities in markets that are not active, or other inputs that are observable or can be corroborated by observable market data.

Level 3 - Valuations based on unobservable inputs reflecting the Company’s own assumptions, consistent with reasonably available assumptions made by other market participants. These valuations require significant judgment.

The estimated fair value of financial instruments disclosed in the financial statements has been determined by using available market information and appropriate valuation methodologies. The carrying value of all current assets and current liabilities approximates fair value because of their short-term nature.

Cash and Restricted Cash

The Company maintains its cash balances at banks and financial institutions. The balances are insured up to the legal limit. The Company maintains cash balances that may, at times, exceed this insured limit.

Under the provisions of the Company’s former revolving credit facility, the MidCap Credit Facility (as such term is defined, and further described in Note 6), the Company had a lockbox arrangement with the banking institution whereby daily lockbox receipts were contractually utilized to pay down outstanding balances on the MidCap Credit Facility debt. Lockbox receipts that had not yet been applied to the MidCap Credit Facility were classified as restricted cash in the accompanying condensed consolidated balance sheets. The following table provides a reconciliation of cash and restricted cash included in the condensed consolidated balance sheets to the amounts included in the statements of cash flows (in thousands).


	September 30,
	2022		2021
Cash	$	8,101	$	22,543
Restricted cash		—		83
Total cash and restricted cash shown in statements of cash flows	$	8,101	$	22,626

Accounts Receivable and Allowances

Accounts receivable in the accompanying balance sheets are presented net of allowances for doubtful accounts and other credits. The Company grants credit to customers in the normal course of business, but generally does not require collateral or any other security to support its receivables.

The Company evaluates the collectability of accounts receivable based on a combination of factors. In circumstances where a specific customer is unable to meet its financial obligations to the Company, a provision to the allowance for doubtful accounts is recorded to reduce the net recognized receivable to the amount that is reasonably expected to be collected. For all other customers, a provision to the allowance for doubtful accounts is recorded based on factors including the length of time the receivables are past due, the current business environment and the Company’s historical experience. Provisions to the allowance for doubtful accounts are recorded to general and administrative expenses. Account balances are charged off against the allowance when it is probable that the receivable will not be recovered.

Inventory

Inventory, consisting of purchased materials, direct labor and manufacturing overhead, is stated at the lower of cost or net realizable value, with cost determined generally using the average cost method. Inventory write-downs for unprocessed and certain processed donor tissue are recorded based on the estimated amount of inventory that will not pass the quality control process based on historical data. At each balance sheet date, the Company also evaluates inventory for excess quantities, obsolescence or shelf life expiration. This evaluation includes analysis of the Company’s current and future strategic plans, historical sales levels by product, projections of future demand, the risk of technological or competitive obsolescence for products, general market conditions and a review of the shelf life expiration dates for products. To the extent that management determines there is excess or obsolete inventory or quantities with a shelf life that is too near its expiration for the Company to reasonably expect that it can sell those products prior to their expiration, the Company adjusts the carrying value to estimated net realizable value.

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed on the straight-line method over the following estimated useful lives of the assets:


Processing and research equipment		5 to 10 years
Office equipment and furniture		3 to 5 years
Computer hardware and software		3 years

Leasehold improvements are amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset.

Repairs and maintenance costs are expensed as incurred.

Long-Lived Assets

Purchased intangible assets with finite lives are carried at acquired fair value, less accumulated amortization. Amortization is computed over the estimated useful lives of the respective assets.

The Company periodically evaluates the period of depreciation or amortization for long-lived assets to determine whether current circumstances warrant revised estimates of useful lives. The Company reviews its property and equipment and intangible assets for impairment whenever events or changes in circumstances indicate the carrying value of an asset may not be recoverable. Impairment exists when the carrying value of the company’s asset exceeds the related estimated undiscounted future cash flows expected to be derived from the asset. If impairment exists, the carrying value of that asset is adjusted to its fair value. A discounted cash flow analysis is used to estimate an asset’s fair value, using assumptions that market participants would apply. The results of impairment tests are subject to management’s estimates and assumptions of projected cash flows and operating results. Changes in assumptions or market conditions could result in a change in estimated future cash flows and could result in a lower fair value and therefore an impairment, which could impact reported results. There were no impairment losses for the three and nine months ended September 30, 2022 or 2021.

Revenue Recognition

The Company’s revenue is generated from contracts with customers in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) 606. The core principle of ASC 606 is that the Company recognizes revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the Company expects to be entitled in exchange for those goods or services. The ASC 606 revenue recognition model consists of the following five steps: (1) identify the contracts with a customer, (2) identify the performance obligations in the contract, (3) determine the transaction price, (4) allocate the transaction price to the performance obligations in the contract and (5) recognize revenue when (or as) the entity satisfies a performance obligation.

As noted above, the Company enters into contracts to sell and distribute products to healthcare providers or commercial partners, or produce and sell products under contract manufacturing arrangements with corporate customers, and in all such cases, customers are billed under ship and bill contract terms. Revenue is recognized when the Company has met its performance obligations pursuant to its contracts with its customers in an amount that the Company expects to be entitled to in exchange for the transfer of control of the products to the Company’s customers. For all product sales, the Company has no further performance obligations and revenue is recognized at the point control transfers which occurs either when: (i) the product is shipped via common carrier; or (ii) the product is delivered to the customer or distributor, in accordance with the terms of the agreement.

A portion of the Company’s product revenue is generated from consigned inventory maintained at hospitals and from inventory physically held by direct sales representatives. For these types of product sales, the Company retains control until the product has been used or implanted, at which time revenue is recognized.

The Company elected to account for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. Amounts billed to customers for shipping and handling are included as part of the transaction price and recognized as revenue when control of the underlying products is transferred to the customer. The related shipping and freight charges incurred by the Company are included in sales and marketing costs.

Contracts with customers state the final terms of the sale, including the description, quantity, and price of each implant distributed. The payment terms and conditions in the Company’s contracts vary; however, as a common business practice, payment terms are typically due in full within 30 to 60 days of delivery. The Company, at times, extends volume discounts to customers.

The Company permits returns of its products in accordance with the terms of contractual agreements with customers. Allowances for returns are provided based upon analysis of the Company’s historical patterns of returns matched against the revenues from which they originated. The Company records estimated returns as a reduction of revenue in the same period revenue is recognized.

Deferred Rent

The Company recognizes rent expense by the straight-line method over the lease term. Funds received from the lessor used to reimburse the Company for the cost of leasehold improvements are recorded as a deferred credit resulting from a lease incentive and are amortized over the lease term as a reduction of rent expense.

Stock-Based Compensation Plans

The Company accounts for its stock-based compensation plans in accordance with FASB ASC 718, Accounting for Stock Compensation. FASB ASC 718 requires the measurement and recognition of compensation expense for all stock-based awards made to employees and directors, including employee stock options and restricted stock. Stock-based compensation cost is measured at the grant date, based on the calculated fair value of the award, and is recognized as an expense on a straight-line basis over the requisite service period of the entire award.

Research and Development Costs

Research and development costs, which include mainly salaries, outside services and supplies, are expensed as incurred.

Concentration of Credit Risk

Financial instruments that potentially subject the Company to significant concentrations of credit risk consist primarily of cash. At September 30, 2022, the Company maintained $7.8 million in bank deposit accounts that are in excess of the $0.25 million insurance provided by the Federal Deposit Insurance Corporation in one federally insured financial institution. The Company has not experienced any losses in such accounts.

Significant Customers

The Company sells certain of its products under large contract manufacturing or distribution arrangements. The following table presents percentage of total revenues derived from the Company’s largest customers as well as their respective percentage of total accounts receivable:


	Three Months Ended		Nine Months Ended
	September 30,		September 30,
	2022	2021	2022	2021
Percent of revenues derived from:
ACE Surgical Supply	11%	9%	10%	4%
Surgalign Holdings	11%	9%	11%	10%
Medtronic Sofamor Danek USA	-	3%	-	13%


	September 30,	December 31,
	2022	2021
Percent of accounts receivable derived from:
ACE Surgical Supply	5%	3%
Surgalign Holdings	13%	12%
Medtronic Sofamor Danek USA	-	-

Comprehensive Income (Loss)

Comprehensive income (loss) comprises net income (loss) and other changes in equity that are excluded from net income (loss). For the three and nine months ended September 30, 2022 and 2021, the Company’s net loss equaled its comprehensive loss and accordingly, no additional disclosure is presented.

Income Taxes

The Company uses the asset and liability method of accounting for income taxes. Deferred income taxes are recorded to reflect the tax consequences on future years for differences between the tax basis of assets and liabilities and their financial reporting amounts at each year-end based on enacted tax laws and statutory tax rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to amounts that are more likely than not to be realized.

The Company is subject to income taxes in the federal and state jurisdictions. Tax regulations within each jurisdiction are subject to the interpretation of the related tax laws and regulations and require significant judgment to apply. In accordance with the authoritative guidance on accounting for uncertainty in income taxes, the Company recognizes tax liabilities for uncertain tax positions when it is more likely than not that a tax position will not be sustained upon examination and settlement with various taxing authorities. Liabilities for uncertain tax positions are measured based upon the largest amount of benefit that is more likely than not (greater than 50%) of being realized upon settlement. The Company’s policy is to recognize interest and/or penalties related to income tax matters in income tax expense.

Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2022

Summary of Significant Accounting Policies

Summary of Significant Accounting Policies

Note 2. Summary of Significant Accounting Policies

Basis of Presentation and Liquidity

The condensed consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. Intercompany accounts and transactions have been eliminated in consolidation.

Reclassifications

Use of Estimates

Impact of COVID-19

Net Loss per Share Attributable to Common Stockholders

Fair Value of Financial Instruments

Level 1 - Valuations based on quoted prices for identical assets and liabilities in active markets.

Cash and Restricted Cash


	September 30,
	2022		2021
Cash	$	8,101	$	22,543
Restricted cash		—		83
Total cash and restricted cash shown in statements of cash flows	$	8,101	$	22,626

Accounts Receivable and Allowances

Inventory

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed on the straight-line method over the following estimated useful lives of the assets:


Processing and research equipment		5 to 10 years
Office equipment and furniture		3 to 5 years
Computer hardware and software		3 years

Leasehold improvements are amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset.

Repairs and maintenance costs are expensed as incurred.

Long-Lived Assets

Purchased intangible assets with finite lives are carried at acquired fair value, less accumulated amortization. Amortization is computed over the estimated useful lives of the respective assets.

Revenue Recognition

Deferred Rent

Stock-Based Compensation Plans

Research and Development Costs

Research and development costs, which include mainly salaries, outside services and supplies, are expensed as incurred.

Concentration of Credit Risk

Significant Customers


	Three Months Ended		Nine Months Ended
	September 30,		September 30,
	2022	2021	2022	2021
Percent of revenues derived from:
ACE Surgical Supply	11%	9%	10%	4%
Surgalign Holdings	11%	9%	11%	10%
Medtronic Sofamor Danek USA	-	3%	-	13%


	September 30,	December 31,
	2022	2021
Percent of accounts receivable derived from:
ACE Surgical Supply	5%	3%
Surgalign Holdings	13%	12%
Medtronic Sofamor Danek USA	-	-

Comprehensive Income (Loss)

Income Taxes

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
OPERATING ACTIVITIES:
Net loss	$ (27,457)	$ (15,768)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	2,796	2,797
(Gain) loss on extinguishment of debt	311	(3,029)
Amortization of deferred financing costs and debt discount	63	91
Interest expense recorded as additional revenue interest obligation	1,983	1,987
Stock-based compensation	2,873	2,562
Changes in operating assets and liabilities:
Accounts receivable	(1,163)	1,647
Inventory	(638)	285
Receivables of FiberCel litigation costs	(17,234)
Prepaid expenses and other	467	1,615
Accounts payable and accrued expenses	4,029	(1,456)
Obligations to tissue suppliers	743	419
Contingent liability for FiberCel litigation	17,643
Deferred revenue and other liabilities	(605)	(209)
Net cash used in operating activities	(16,189)	(9,059)
INVESTING ACTIVITIES:
Expenditures for property, plant and equipment	(406)	(344)
Net cash used in investing activities	(406)	(344)
FINANCING ACTIVITIES:
Additional issuance costs in connection with Private Placement	(110)
Net borrowings (repayments) under revolving line of credit	(4,763)	(4,558)
Proceeds from stock option exercises	10	26
Proceeds from long-term debt	21,000
Deferred financing costs	(468)
Repayments of long-term debt	(18,615)	(1,111)
Costs related to the extinguishment of debt	(633)
Payments on revenue interest obligation	(2,075)	(2,068)
Payments for taxes upon vesting of restricted stock units	(395)
Proceeds from sales of common stock through Employee Stock Purchase Plan	317	208
Net cash used in financing activities	(5,732)	(7,503)
Net decrease in cash and restricted cash	(22,327)	(16,906)
Cash and restricted cash, beginning of period	30,428	39,532
Cash and restricted cash, end of period	8,101	22,626
Supplemental Cash Flow and Non-Cash Financing Activities Disclosures:
Cash paid for interest	5,047	3,788
Fair value of warrants issued	$ 560
Forgiveness of SBA PPP loan		$ 3,029

Recently Issued Accounting Standards (Details) - Pro Forma $ in Millions	Oct. 01, 2022 USD ($)
Recently Issued Accounting Standards
Accounting Standards Update [Extensible Enumeration]	us-gaap:AccountingStandardsUpdate201602Member
Right-of-use assets	$ 2.4
Lease liabilities	$ 2.4

- Definition

Indicates amendment to accounting standards.

+ References

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+ Details

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY (DEFICIT) - USD ($) $ in Thousands	Common Stock Class A Common stock	Common Stock Class B Common stock	Additional Paid-in Capital	Accumulated Deficit	Total
Balance at the beginning at Dec. 31, 2020	$ 7	$ 3	$ 101,080	$ (80,259)	$ 20,831
Balance at the beginning (in shares) at Dec. 31, 2020	7,091,960	3,134,162
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Proceeds from stock option exercises			26		26
Proceeds from stock option exercises (in shares)	3,305
Proceeds from sale of common stock through Employee Stock Purchase Plan			208		208
Proceeds from sale of common stock through Employee Stock Purchase Plan (in shares)	27,244
Stock-based compensation			2,562		2,562
Net loss				(15,768)	(15,768)
Balance at the ending at Sep. 30, 2021	$ 7	$ 3	103,876	(96,027)	7,859
Balance at the ending (in shares) at Sep. 30, 2021	7,122,509	3,134,162
Balance at the beginning at Jun. 30, 2021	$ 7	$ 3	102,668	(87,711)	14,967
Balance at the beginning (in shares) at Jun. 30, 2021	7,095,265	3,134,162
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Proceeds from sale of common stock through Employee Stock Purchase Plan			208		208
Proceeds from sale of common stock through Employee Stock Purchase Plan (in shares)	27,244
Stock-based compensation			1,000		1,000
Net loss				(8,316)	(8,316)
Balance at the ending at Sep. 30, 2021	$ 7	$ 3	103,876	(96,027)	7,859
Balance at the ending (in shares) at Sep. 30, 2021	7,122,509	3,134,162
Balance at the beginning at Dec. 31, 2021	$ 9	$ 4	118,599	(105,091)	13,521
Balance at the beginning (in shares) at Dec. 31, 2021	9,245,146	4,313,406
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Proceeds from stock option exercises			10		$ 10
Proceeds from stock option exercises (in shares)	1,881				1,881
Additional issuance costs in connection with Private Placement			(110)		$ (110)
Proceeds from sale of common stock through Employee Stock Purchase Plan			317		317
Proceeds from sale of common stock through Employee Stock Purchase Plan (in shares)	74,408
Vesting of restricted stock units, net of shares withheld and taxes paid			(395)		(395)
Vesting of restricted stock units (in shares)	139,529
Issuance of warrants in connection with debt financing			560		560
Stock-based compensation			2,873		2,873
Net loss				(27,457)	(27,457)
Balance at the ending at Sep. 30, 2022	$ 9	$ 4	121,854	(132,548)	(10,681)
Balance at the ending (in shares) at Sep. 30, 2022	9,460,964	4,313,406
Balance at the beginning at Jun. 30, 2022	$ 9	$ 4	121,256	(122,638)	(1,369)
Balance at the beginning (in shares) at Jun. 30, 2022	9,306,838	4,313,406
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Proceeds from stock option exercises			10		10
Proceeds from stock option exercises (in shares)	1,881
Proceeds from sale of common stock through Employee Stock Purchase Plan			126		126
Proceeds from sale of common stock through Employee Stock Purchase Plan (in shares)	32,063
Vesting of restricted stock units, net of shares withheld and taxes paid			(395)		(395)
Vesting of restricted stock units (in shares)	120,182
Issuance of warrants in connection with debt financing			560		560
Stock-based compensation			297		297
Net loss				(9,910)	(9,910)
Balance at the ending at Sep. 30, 2022	$ 9	$ 4	$ 121,854	$ (132,548)	$ (10,681)
Balance at the ending (in shares) at Sep. 30, 2022	9,460,964	4,313,406

Commitments and Contingencies - Legal Proceedings (Details) $ in Millions	1 Months Ended		3 Months Ended	9 Months Ended
	Oct. 31, 2022 USD ($) lawsuit state	Aug. 31, 2022 lawsuit state	Oct. 31, 2022 USD ($) lawsuit	Sep. 30, 2022 USD ($) lawsuit claim
Legal Proceedings
Number of lawsuits filed				55
Number of cases settled	24	24
Cases pending finalization of the related settlement agreements			23
Loss Contingency Carrying Value \| $	$ 7.2		$ 7.2	$ 17.6
Number of states where litigation matters are settled \| state	6	6
Number of case settled and paid			1
Settlement amount \| $			$ 1.3
Loss contingency pending				73
Loss contingency accrual \| $				$ 11.7
Loss contingency receivable \| $				17.2
Additional loss contingency receivable \| $				$ 3.8
Number of claims not resulted lawsuit yet				42
INDIANA \| Product Lability
Legal Proceedings
Number of lawsuits filed				1
DELAWARE \| Loss of Consortium
Legal Proceedings
Number of lawsuits filed				2
FLORIDA
Legal Proceedings
Number of lawsuits filed \| claim				3

Commitments and Contingencies - Operating Leases (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2022 USD ($) product	Sep. 30, 2021 USD ($)
Commitments and Contingencies.
Number of production facilities under operating lease			2
Number of administrative and research facility under operating lease			1
Rent expense \| $	$ 0.3	$ 0.3	$ 0.9	$ 0.9

Inventory (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Inventory
Raw materials	$ 2,055	$ 1,880
Work in process	617	834
Finished goods	7,520	6,840
Total	$ 10,192	$ 9,554

Stock-Based Compensation - Employee Stock Purchase Plan (Details) - Employee Stock Purchase Plan	9 Months Ended
	Sep. 30, 2022 shares
Stock-Based Compensation
Offering period	6 months
Price of the common stock purchased as percentage of fair market value of common stock	85.00%
Grant of equity awards authorized	380,997
Awards available for grant	279,345
Shares issued under ESPP	74,408

Summary of Significant Accounting Policies - Concentration of Credit risk (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Concentration Risk [Line Items]
Bank deposit accounts	$ 7.8		$ 7.8
Revenues \| Customer concentration risk \| ACE Surgical Supply
Concentration Risk [Line Items]
Concentration risk (as a percent)	11.00%	9.00%	10.00%	4.00%
Revenues \| Customer concentration risk \| Surgalign Holdings
Concentration Risk [Line Items]
Concentration risk (as a percent)	11.00%	9.00%	11.00%	10.00%
Revenues \| Customer concentration risk \| Medtronic Sofamor Danek USA
Concentration Risk [Line Items]
Concentration risk (as a percent)		3.00%		13.00%
Accounts Receivable \| Customer concentration risk \| ACE Surgical Supply
Concentration Risk [Line Items]
Concentration risk (as a percent)			5.00%		3.00%
Accounts Receivable \| Customer concentration risk \| Surgalign Holdings
Concentration Risk [Line Items]
Concentration risk (as a percent)			13.00%		12.00%

Stock-Based Compensation - 2020 Plan (Details) - 2020 Plan - shares	Sep. 30, 2022	Oct. 07, 2020
Stock-Based Compensation
Grant of equity awards authorized		1,636,000
Awards available for grant	756,809

Summary of Significant Accounting Policies - Cash and Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Sep. 30, 2021	Dec. 31, 2020
Cash and Restricted Cash
Cash	$ 8,101	$ 30,393	$ 22,543
Restricted cash		35	83
Total cash and restricted cash shown in statements of cash flows	$ 8,101	$ 30,428	$ 22,626	$ 39,532

Net Loss Per Share Attributable to Common Stockholders - Anti-dilutive securities (Details) - shares	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities	2,128,779	1,626,119
Options to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities	1,755,447	1,390,234
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities	373,332	235,885

Related Party Transactions (Details) - KeraLink International - USD ($)	12 Months Ended
	Dec. 31, 2018	May 31, 2021
Related Party Transaction [Line Items]
Amount of settlement received	$ 400,000
Shares sale proceeds over which Keralink to pay Aziyo	550,000	$ 550,000
Amount to receive from KeraLink upon sale of shares over $550,000	$ 550,000
Amount remitted from sale of shares		$ 550,000
Period for Keralink to pay Aziyo	3 days

Long-Term Debt - Paycheck Protection Program, CARES Act (Details) - USD ($) $ in Thousands	1 Months Ended	9 Months Ended
	May 31, 2020	Sep. 30, 2022	Sep. 30, 2021
Debt Instrument [Line Items]
Gain on extinguishment of debt		$ (311)	$ 3,029
PPP loan
Debt Instrument [Line Items]
Proceeds from issuance of debt	$ 3,000
Gain on extinguishment of debt		$ 3,000

Summary of Significant Accounting Policies - Revenue Recognition (Details)	9 Months Ended
	Sep. 30, 2022
Minimum
Disaggregation of Revenue [Line Items]
Term of payment	30 days
Maximum
Disaggregation of Revenue [Line Items]
Term of payment	60 days

Stock-Based Compensation - Randal Mills (Details)		9 Months Ended
Stock-Based Compensation - Randal Mills (Details)	Jun. 21, 2022 period shares	Sep. 30, 2022 shares
Stock-Based Compensation
Options granted		1,075,858
Options to purchase common stock
Stock-Based Compensation
Vesting term		4 years
Performance-Based RSU
Stock-Based Compensation
Restricted stock units (RSU) granted		289,282
Dr. Mills
Stock-Based Compensation
Employment agreement initial term	90 days
Dr. Mills \| Options to purchase common stock
Stock-Based Compensation
Options granted	456,278
Time-based awards percentage	60.00%
Performance-based awards percentage	40.00%
Dr. Mills \| Time Based Options \| Tranche one
Stock-Based Compensation
Percentage of vesting	33.00%
Vesting term	80 days
Dr. Mills \| Time Based Options \| Tranche Two
Stock-Based Compensation
Percentage of vesting	66.00%
Vesting term	4 years
Awards that vest on first anniversary	25.00%
Number of quarter of vesting \| period	12
Dr. Mills \| Restricted stock units
Stock-Based Compensation
Time-based awards percentage	60.00%
Performance-based awards percentage	40.00%
Restricted stock units (RSU) granted	224,734
Dr. Mills \| Performance-Based RSU
Stock-Based Compensation
Share price threshold period	20 days
Dr. Mills \| Time-Based RSU \| Tranche one
Stock-Based Compensation
Percentage of vesting	33.00%
Vesting term	0 days
Dr. Mills \| Time-Based RSU \| Tranche Two
Stock-Based Compensation
Percentage of vesting	66.00%
Vesting term	4 years

Summary of Significant Accounting Policies - Net Loss per Share Attributable to Common Stockholders (Details) - $ / shares	Sep. 30, 2022	Dec. 31, 2021
Class A Common stock
Net Loss per Share Attributable to Common Stockholders
Common stock, par value (in dollar per share)	$ 0.001	$ 0.001
Class B Common stock
Net Loss per Share Attributable to Common Stockholders
Common stock, par value (in dollar per share)	$ 0.001	$ 0.001

Segment Information (Details) $ in Thousands	3 Months Ended		9 Months Ended
Segment Information (Details) $ in Thousands	Sep. 30, 2022 USD ($)	Sep. 30, 2021 USD ($)	Sep. 30, 2022 USD ($) segment	Sep. 30, 2021 USD ($)
Segment Reporting Information [Line Items]
Number of operating segments \| segment			1
Total sales	$ 12,389	$ 11,485	$ 36,522	$ 36,529
Core Products
Segment Reporting Information [Line Items]
Total sales	8,949	8,588	26,141	29,230
Non-Core Products
Segment Reporting Information [Line Items]
Total sales	$ 3,440	$ 2,897	$ 10,381	$ 7,299

Summary of Significant Accounting Policies - Property and Equipment (Details)	9 Months Ended
	Sep. 30, 2022
Computer hardware and software
Property, Plant and Equipment [Line Items]
Estimated useful lives	3 years
Minimum \| Processing and research equipment
Property, Plant and Equipment [Line Items]
Estimated useful lives	5 years
Minimum \| Office equipment and furniture
Property, Plant and Equipment [Line Items]
Estimated useful lives	3 years
Maximum \| Processing and research equipment
Property, Plant and Equipment [Line Items]
Estimated useful lives	10 years
Maximum \| Office equipment and furniture
Property, Plant and Equipment [Line Items]
Estimated useful lives	5 years

Revenue Interest Obligation - (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	May 31, 2017	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Debt Instrument [Line Items]
Sales milestone payment	$ 5,000
Revenue Interest Obligation.
Debt Instrument [Line Items]
Interest expense related to revenue interest obligation		$ 700	$ 700	$ 2,000	$ 2,000
Ligand Pharmaceuticals
Debt Instrument [Line Items]
Estimated present value on the acquisition date	27,700
Annual minimum sale	$ 2,750
Percentage of future sales	5.00%
Term of agreement	10 years
Cumulative sales of products exceed $100.0 \| Ligand Pharmaceuticals
Debt Instrument [Line Items]
Payments due based on cumulative sales	$ 5,000
Cumulative sales	100,000
Cumulative sales of products exceed $300.0 \| Ligand Pharmaceuticals
Debt Instrument [Line Items]
Payments due based on cumulative sales	5,000
Cumulative sales	$ 300,000