Medartis Aktie

Okay. So, good morning, everybody. Maybe we can take a seat. You can put down a little bit of volume. We are not so many people. Yes. Again, welcome to now, rainy Basel. The sun from yesterday is gone. But I'm very happy that you made it to our investor and media event around the FESSH, the world's biggest hand congress. And I'm so surprised to look what Fabian -- I love it when Fabian has also here our products on the table. And by the way, the sexy nail is here. Some people who discussed yesterday night with me, they know about the sexy nail. It's our brand-new launch for the U.S. some are looking at what we are doing. Is this becoming an erotic shop? No. Medartis is just becoming disruptive, different. And I hope you see this also throughout the FESSH. We have my road map, my strategy road map, a little bit where do we stand by end of May. Then I think very interesting for you at 10:00 around with Marc Ammann, our EVP, Innovation, Digitalization, Research and Development. Marc speaking about our road map and the sexy nail. And then I'm very happy to welcome Daniel Herren, Dr. Daniel Herren from the Schulthess Clinic in Zurich. He's sitting there. And we thought we should invite the pope of CMC1 Prosthesis because you are not only placed, I don't know how many you will discuss it. You will say it, but you are also the renowned hand surgeon in Switzerland and in the world, and we are very happy to have Daniel here to explain you a little bit what is it about TOUCH. It's all about TOUCH, TOUCH, TOUCH. And wherever we are, we speak about TOUCH, but we will also speak about Medartis and our other company -- group companies today. So Daniel will provide us with a voice of the expert, and maybe some of you will become patients. Who knows? It starts with 40 years of age, especially in women, right? And you will explain why. Then we have a Q&A session. Very important there, we put the launch here, so that we have enough time. I think you will have questions. We'll do a flying buffet here and then off to the FESSH.

From head to toe, nothing has changed since our strategy, our well-known strategy in the meantime, literally from head to toe. We start with our legacy. We would like to become and we see more and more coming also with market share gains in the U.S., the world market leader in hand and wrist and upper extremities is our focus, but it means also that lower extremities. Foot and ankle is an area where we are continuing to launch new products. Marc will speak about it. We have new products in the pipeline, ankle fusion, for example, which will come also in the U.S.

So it's not an area where we will step out. But if we look how big is the market potential in segment and how big is our addressable market with our portfolio, you can see that we are in upper extremities quite close. Our portfolio in hand, wrist up to the elbow is complete, is world class, especially now with TOUCH. What is missing is shoulder. Shoulder, we have some portfolio gaps. It's an addressable market of CHF 1.7 billion. I could not care less that everybody says lower extremity is the fastest-growing segment. But if you are in the fastest-growing segment, not present or with a market share below 5%, 6% present, you have no chance to win.

And what I said already in the beginning of 2025, we are here to win, not just to play in the market. This cannot be our ambitious at Medartis. And therefore, we are focusing on our legacy, where we have a lot. And if you see our competitors, what is very interesting, you see here that, for example, Stryker, they are stepping out of the CMF business. They are divesting in the CMF business. Of course, with all respect, we have all the strong competitors. And we have competitors like a German company from Tuttlingen who passed -- KLS Martin, they did a fantastic job over the last 10 years. They passed Medartis on the left and on the right. But we still have opportunities to catch up. At the same time, they passed with CMF, they lost focus on hand and wrist, and they are now catching up. So what we are catching up in CMF, they are catching up also in hand and wrist.

But here, we have an extremely good portfolio, and I think Daniel can confirm this later. And the TOUCH prosthesis when we speak about hand is a logical addition, but we have also wonderful other products. So we are covering everything. We are covering and you know that Medartis comes from art. And art in our logo was very prominent when Medartis was founded 29 years ago. Why art? And this is something I've learned in my 18 months now with Medartis still being a little bit a dental guy. I'm not yet the orthopedic guy, to be honest. But what I've learned is that hand surgeons, in my eyes, with all respect, Daniel, you are artists. You're really doing artwork sometimes to reconstruct the hand. Of course, if you have a big trauma case, if you have an accident. The same applies to CMF. This is art, reconstruction of a face, especially of patients -- of tumor patients. This is art. And this is bringing back life to the patients. It is wonderful to see, but it's a very filigree part.

Whereas also placing a TOUCH is not so easy. So therefore, we have an education-based approach where when it comes to corrections and also when it comes to trauma cases, this is a little bit more tough, rough work when you go to an OR midnight after a car accident. So we cover it everywhere within our Medartis group. We became in 2025 in our transformation year, the Medartis Group.

The focus with Medartis on our 3 big strategic pillars like CMF, the upper extremities and also lower. We have this KeriMedical integrated and leave it stand-alone company with a unique TOUCH prosthesis where we say today the hip for the thumb. And then we entered with 51% last year, the value segment with NeoOrtho and I came back to this.

What also changed is that we have now 6 production facilities. We will not do this each year. But 6 production facilities, we are expanding. And this is an important information for you. Mario is here. If you have afterwards questions, everybody of my EMB members can answer when we have the Q&A session, not only myself, Peter is also here when you have finance questions, it's better to ask Peter. But Mario can explain the Project Flash. We are fully on track. And I'm very happy, Mario, that we passed very successfully a 3-day FDA audit in our new production facility, the FDA audit finished yesterday night and passing an FDA audit is a big thing in the U.S. So we did this as well.

70% until end of the year of the products needed in the U.S. will be produced in Warsaw. Next year 2027, first to second quarter, 80% we will produce here fully on track. You see here the KeriMedical. This is a picture of the KeriMedical production facility in Archamps. And I think, Fabian, maybe next year, we can do such an event also to invite to Archamps to see where the famous TOUCH is produced.

We are doubling this production facility currently, doubling the size to be prepared for the future. And we need to do this today because we see all over the world, a volume increase for TOUCH. We did 43,000 TOUCH last year. We will do 60,000 TOUCH this year worldwide, and it will kick in further. So that both the Archamps production facility and the Besancon production facility, we have no picture here, are doubled in the size in Besancon. We will construct a brand-new facility. And doubling the size of the production, it does not mean only doubling the volume. This is more at times 3 to 4x pushing up the volume for TOUCH to be prepared.

Then we have our brand-new CADskills production facility in Belgium in Ghent where -- and this is also interesting, you should know and maybe this in our full year meeting here in March or it came not over so well. This is a strategic acquisition. We got access now to 3D titanium printing. And this is scalable. So in Belgium, in Ghent, we will do the printing for personalized implants for CMF, but also for trauma cases for Europe. We will scale up and are in the process now to bring this production technology to Brazil because we are currently printing for Latin America and Argentina, third party makes no sense. We will install it in Brazil. We will do it in Brazil. U.S. is not yet planned because you need FDA approval. This takes at least another year. So we see by the end of 2027 to have also the personalized production in the U.S.

Then we are sitting here in our headquarters in the main production facility. And let me say, it is very important that we are not only a Swiss company, that we are a Basel-Stadt, Basel City-based company. This comes also from our legacy. This has a lot to do with Thomas Straumann. And yes, we analyzed, moved. This is our obligation to see are there the other opportunities. And yes, it was a lot in the press, not by [ Mr. Schmoke, ] but by other people that publish.

The others are moving to Arlesheim. Medartis might move to Arlesheim, I can tell you. We are committed to Basel-Stadt, and we will stay here until 2039, at least, and we will expand our production facility here means we get additional space. And everybody from Basel, I know we have a lot of Zurich. They love Zurich here, but also the people from Basel. This is for the Stucki Park also very important that we are staying here. So we are very happy. And I think Mario is also happy to have some production here. And then last but not least, absolute record in 14 months, our brand-new facility in Brazil, 12,000 square meters, the first step, first phase, next phases to come for our NeoOrtho production.

I will not go and I will not do now, and I have no time because Fabian told me, Matthias, you have maximum 1 hour. I could speak an hour about culture. But I was asked also yesterday night from a few of you. Do you feel changes? Yes, definitely. But I would challenge you and say, please ask my team members if they feel changes because they are longer here. If they see a difference. I feel a difference. There is a different vibe. There is a different focus. There is fun, fun. We see smiling people also in Medartis headquarter. And I think when we are smiling and when we have fun, the things are going easier. So our culture is a process, which will never stop. Therefore, in each meeting, I'm touching it, but we have to measure it somehow.

So what we did is we did our Glint survey. And the Glint survey is an engagement survey, it's anonymous, done with all employees worldwide. The employees can participate. The Medartis employees had this done twice a year over the last, I don't know, 7, 8 years. Twice a year, it makes no sense because in 1 year, you don't change the results. We have done it now, and we expected rough feedback. I was not expecting a score of 79%. This is, by the way, the highest score you see Medartis had in the history. I expected a lower score because the people know it's anonymous and they know we had so many changes, so many -- also the strategy implementation over 2025.

So I think this is very nice. And what is very important are the details that 87% participated including production people. We gave them access. So we provided computers for them to answer and that 5,600 comments, people all over the world, in Japanese, in Portuguese, in English, in French, they take the time to comment, to write positive or challenging comments. And my team together with me, we are reading those comments. We are taking this very serious, and we are giving feedback. And then we are stepping up. But we have areas they are above 80%. We have even areas that have scores above 90%. So it's -- for me, for the EMB, for us, it is a confirmation that the strategy is working. The strategy is showing results, and we are on the right way. But it will never stop to improve it.

And this brings me to this high-performance culture and high-performance team. Only if we have a team based on this culture, believing in the culture, we can have the fundament for our strategic priorities. Each strategic priorities is owned by an EMB member. And you can only have one owner of a priority, of a strategic priority. If you have 2, you are missing already the focus and one can shy away from the other. So one owner and you can imagine who are the owners, especially improving cash flow. This is with Peter, and we are all very relaxed. And when Peter has a smile on his face, I know we are on track. If Peter is grumpy, then we have an issue. And you see he has a smile on his face, Peter. We are never relaxed, but we are in a very good shape.

So accelerate the U.S., I'm very happy how things are coming together. I think that we are getting more and more traction in the U.S. We see positive momentum. We see the gap closed in -- closing in Florida. It's quite a work. It's not yet there where I would like to see the U.S.? Definitely not. But maybe I'm also a little bit too pushy and ambitious and really doing the things fast. But I told you and I will not provide so many figures today that I expect the U.S. to grow minimum 20%, and we are fully on track. So I think this is a good message. And let's see. And also in the future, of course, this will accelerate because in the future, TOUCH will kick in more. We are still in the launch phase.

When it comes to KeriMedical. We have here our Global Head of Commercial for KeriMedical, Loic. I'm really super positive. It was the right decision to leave this company stand-alone. It was not the easiest decision, although the easiest decision would have been include, incorporate this company and then it's all fine. So leaving the company stand-alone, you get frictions, you get discussions, you get different opinions. And this is beautiful. I love it. I love it because it pushes us out of the comfort zone. Very happy with the performance. And I already said it to Loic, congrats. Also in Europe, the performance is sensational. You can say it, Loic, by end of May, Europe is growing by more than 25%. And Europe are the countries where we have 9, 10 years, 8 years, 5 years in Germany, Keri already on the market with high market shares.

Value strategy I'm coming to this. Regional share gains. I think the most difficult part is for Europe. So Mareike, she's also here with her team. When you have already in big countries, 40%, 45% market share, you still have to increase your shares. This is new surgeons onboarding, new hospitals onboarding. We are well on track. Otherwise Mareike and her team would not maintain this very ambitious growth rate, which I have showed already last year. So also here, on track.

Innovation and digitalization, this is never ending. And Marc will speak with you about what we are doing, where we are going to, where are our thoughts? Definitely not the next plate and screw. What is coming in orthopedic? And as I said already, a smile on Peter's face, improved cash flow. This is his pillar, all fine so far, on track. This is a girl from Panama. And we are bringing together Switzerland and Brazil one more time, the wonderful panorama of Switzerland chocolate together with Caipirinha. Is there something better? Definitely not. And those countries, those cultures can benefit so much. I think the Brazilians can learn so much from the Swiss, but the Swiss can also learn a little bit from the Brazilian culture, this taking it easy, there are no problems. We will solve it. We will be fast, and we will just do it. And this and much more brings both companies together.

And we have Medartis and NeoOrtho, so much in common. The 2 founders, Thomas Straumann and Geninho Thome, they don't speak the same language. Thomas doesn't speak Portuguese, and Geninho doesn't speak English, unfortunately. But they understand with a glass of wine or Caipirinha, they don't need the language because they have the same mindset. They are entrepreneurs par excellence, both have created world-leading dental companies. Thomas with Straumann and Geninho with Neodent. Both found together in 2012, became friends and figured out that they have created inside the dental company another company which was Medartis in Straumann, and which was NeoOrtho in Neodent, separated 2012 when Neodent was sold.

And now this is coming again, and I say it every time Geninho would not have sold NeoOrtho to any other company. He doesn't need the money. This is his passion. He did it because he knew the people behind Medartis. So we have a fantastic basis. We are bringing them together next week for the first time again after many, many years because we are with the Board in Brazil starting Monday, and we are Tuesday night opening the new production facility.

And why we are doing this? We are addressing a Latin American market, which is predominantly value and again I have no time to explain value again, but value is not making a premium product cheaper. Value is a total different approach. You need high-quality products. You do not need the latest innovation. You do not need this top-notch [indiscernible] Switzerland education, but you need education and you need an affordable price for the public health system, which is normally half of the price of a premium product. This means you cannot produce those products in Switzerland. You are normally producing a factor III cheaper in Brazil with the same machines than in Switzerland, the overhead cost.

And then you see the CHF 470 million addressable market we have in value in Latin America. And of course, the 2 biggest markets are Argentina and Brazil. Somebody told me, oh, Argentina, Argentina is booming. Argentina is the country at the moment. Hopefully, Milei makes it further. But we're going there. This is the addressable market we have. So what we are doing currently? NeoOrtho, of course, Brazilian-based currently. All what we do was Brazil. We now started the launch in Mexico through our own subsidiary. This is already going on. Here in Argentina, we are launching, we are still thinking opening next year, maybe an own subsidiary because you need control, because if you run such a country with a distributor, you pay twice. You pay a commission to do the business and you pay again when you would like to have your own business back. This is in Latin America, a little bit tricky and totally different to the rest of the world.

Colombia, I put it for the moment on hold. It was planned after Argentina. We might go first to Peru because Colombia is very, very dangerous, very, very difficult at the moment. Not at all compliant. We have to wait now until the political situation is a little bit stable. It makes no sense to enter now Colombia, but a very important market, so we might go to Peru and definitely Chile. Chile is the most European market in Latin America. The only thing missing there is that they speak German, but they are very European with the highest prices. And you see also that still the value segment is only 72%. But when the value segment is becoming above 60% of the whole market, it makes sense and to enter. And this is also the reason why we are not focusing with NeoOrtho currently on the U.S. The U.S. is still a premium dominated market.

This might change quickly over the next years. But at the moment, I would say the value segment in the U.S. is not bigger than 15%. That makes no sense to go in, but and I leave this decision to the regions. Mareike with EMEA region is currently analyzing where to go, where are the countries to launch. We have a dedicated person doing this. And Europe is on the agenda. We are currently doing the whole MDI and CE Mark registration.

Maybe a word when it comes to the portfolio, NeoOrtho has a portfolio which is very comparable to Medartis. They are very strong in face. It's NeoFace. Our product is called MODUS.With NeoOrtho, it's NeoFace. They are very strong in hand and wrist. And normally, in the value segment, you copy the best. So if you see the blades from NeoOrtho today, you remind our first hand plates, we had at Medartis as well. It's very -- it's a nice -- and it's normal and it's a compliment for Medartis that 10, 15 years ago, NeoOrtho copied the hand plates from Medartis, and it's a fantastic product. And sometimes you have problem to differentiate what was really Medartis, what is NeoOrtho because from the quality of the product is the same, but the different locking system different.

Then we have spine with NeoOrtho, but the Spine business is only in Brazil. We will not expand with the spine business. It's a totally different area. It's not something where Medartis will end. It was present with NeoOrtho, and we will maintain it for Brazil. It's very important for our tender business. And then also, we have foot and foot and ankle products for NeoOrtho.

The new production footprint, as I said, I think it's a huge advantage to produce not only cost-wise, but also you have no tariffs in the Mercosul in the Latin American area. You are very fast out of Brazil to all the markets. And yes, we have lifted already once with another company. So it's a perfect location also to get qualified people, well-trained people. A lot of the automotive industry in Curitiba, all the big players are there. So good people you get there. We have a very short Anvisa registration pathway because we have a local production, and we are continuously audited by Anvisa and Anvisa, and this is important once we go to the U.S., is cooperating very, very close with FDA.

So you have an accelerated FDA registration if you have Anvisa in your own production facility in Brazil. This is a big advantage, and I hope it will stay like this. And then, of course, we are now going into the other regions. This is a project, and I would like to -- and some people, some guests here, they know me from the past. And please remember what we are currently doing with NeoOrtho is much faster than the pathway we had with Neodent. But still, we are in the beginning. This is not that in 2 years, we are international all over the world. It took us 11 years with Neodent. It will not take us with NeoOrtho 11 years, but it is a time. You need registration, you need to launch, you need to prepare the market. So it is coming, but in a good shape. And it's also boosting the Medartis business.

I'm absolutely happy with the performance of Medartis in Latin America because value is value, premium is premium. Also Medartis is benefiting now from this structure we have, this common infrastructure, this back office structure. So the performance of Medartis in Latin America over the first 5 months of this year was really outstanding in my eyes, they have built a new team and bringing a lot of momentum in.

Now we are already touching TOUCH. Strong growth. I told you, 43,000 implants last year. And when I -- when Loic just mentioned, over 25% growth year-to-date end of May, in Europe, mainly in Europe, you see that there are markets like France with 85% of market share, where we are still growing. And France is 29% of the overall European work performance for TOUCH, and we are still growing by 20% in France. How this is possible? This is patient marketing. We are driving patients to doctors to ask, hey, doctor, I have a problem, it hurts a little bit, what can we do? And if they are lucky, they find professionals like Daniel Herren, and then it goes very quick, and they have a new life. No pain and easy movement. So -- and we see this in all countries, and we also see that you have a ramp-up time when you launch because it was us Medartis launching Germany, for example. So you have to prepare the market. You have to start with educational push. And then when you have 3, 4 years in the market, it kicks in. The volume are coming. And also the patient marketing is helping because I launched it now also in Europe. And you know before we acquired KeriMedical, we had 3 markets. We had Germany, we had Austria, and we had the U.K. where we were already responsible.

Australia is still small because we are waiting for the reimbursement. It should come this year. We are doing 260 cases, but it's all paid out of pocket. So it will kick in when we have the reimbursement. And on purpose, we have not put yet here the U.S., but of course, this will come very prominent in the future. And the U.S. launch, it's running. Now I have to find the right words. I'm surprised. Let's say it like this. I would have expected more negative feedback maybe more of let's wait, let's see. I think we are in a situation now with our courses in the U.S. that we can still, after 5 or 6 months select the doctors we like to train.

So they are queuing up. They are registered to get the trainings. We are flying in European surgeons to train them. We will start in September to have the first U.S. surgeons to train U.S. surgeons, and we can still select the best. This helps us because we can select in which areas in which regions we will be active with the training and what are the surgeons which will bring enough volume. On the other hand, what we see also is the same what we observed in Europe, that when the surgeon participated in training, he or she, they have already 3, 4 patients selected and they do, within the week, the first cases. This is also happening in the U.S. We see surgeons doing the first cases.

We have already one surgeon, and I can tell you because on social media, you will see it, who has done 100 cases since beginning of the year. This is Jonathan Tueting in Chicago, and you might meet him at FESSH. He's here. So he's really creating TOUCH. 4, 5 cases per day, very good. But this does not mean -- and please don't do the math now that all we train, they are doing 100 cases, and then we end this year, I don't know which number. No, this is not the case. We have also surgeons we have trained. They have not done 1 TOUCH yet because the reimbursement contract is not authorized in the hospital. So we have also a clinical team and a reimbursement team behind because with the reimbursement price of around $6,500, you can imagine that the hospitals are getting a little bit careful to get it in. And insurance companies, not the hospitals, insurance companies, to allow the procedure. For the hospitals, it's a win-win because they get a lot of money from the reimbursement.

The insurance companies are getting careful. We have a team behind explaining the insurance company doing this is an administration work, explaining all the fast recovery of the patient and the benefit of getting a TOUCH. It's all working fantastically what we are doing in parallel, and it's all based on the learnings we got in Europe. And therefore, the team is expanding. We are hiring each month new people for our Keri team in the U.S. and I aligned with Peter. What I also can tell you is that May was the first month we sold more than 150 TOUCH in the U.S. I think this gives you a little bit of sense that we are very confident that we will reach our target of 1,200 TOUCH this year. No, Peter? More I will not say, but we are fully on track. What is all in Japan and Brazil are coming. So we started the registration in Japan, and we are starting the registration in Brazil, a huge opportunity. And now you see here, I would have thought, Fabian, that you give us the morning news from the U.S. is this here? What should I do? Click?

[Presentation]

So you see and this was only 2 examples or one example on morning TV with Jonathan. The Rush Institute in Chicago, where he's placing the TOUCH, they started early, and they are doing this media work. It's not sponsored by us. And as you can see, it's also not mentioned TOUCH, not mentioned Medartis or KeriMedical, and it should not be the case. But of course, it's clear it's the only product in the U.S., and he is getting called now from all over the U.S. People are flying in, getting the surgery, flying back at night, but we have it also in Germany. [ Handelszeitung ] this is not maybe the best newspaper, not every time the most serious, but when they speak about TOUCH, I love it.

This is the Berliner Philharmoniker, when they -- when Hakimi put in a TOUCH, and he could play again in the orchestra and gave an interview and he was so emotional that he spoke with the journalist and they made a big story out of it. This is patient traffic. And this is a part of this mouth-to-mouth communication and maybe Daniel will explain it also how his patients are coming to the clinic, this is bringing this vibe. And of course, if you're on TV and we are constantly on TV, especially in the U.S., you can imagine how many million people are watching with saying, "Oh, I have a pain, maybe I should ask." And then it is reimbursed. Yes, it's something which is helping a lot and helping a lot also the growth in Europe. And now IBRA. You know that we have here in our building on the sixth floor, and you might have seen it, the most modern installation in Europe to do orthopedic courses on cadavers. This is a top institution. It's our Caravela run by IBRA and also rent out to other companies and doing other courses throughout the year but mainly used worldwide by our surgeons and education is so important. And I ask Fabian now also in the future to add a chart at least when we speak about education. And our education partner is IBRA.

We are the industry partner for IBRA, but IBRA is so important to drive this community. IBRA grew in memberships last year. We have now 4,500 members. It's a growth of 18% because -- why? Because in 2025, we started to revamp IBRA. We became closer, we became really partners. But scientifically, we are not managing IBRA. IBRA scientifically needs to be stand-alone and they have their own opinion. We will never step in and tell them what to publish, what studies to do or what courses to bring, but we are doing -- we are running our international education through IBRA.

Actually, we should have 15,000 members, and we are in the process to revamp, so this will grow. We have a lot of professionals trained throughout the world. And we are expanding IBRA now all over the globe with the academic programs for young surgeons. I think young surgeons are the future of the industry. And we know when you start hand-in-hand with the young surgeons through a program, through an education program, through a fellowship, those surgeons stay with you. They have no reason why to change the system. So we need to get them at the beginning of the career and to involve them into IBRA, to give them a stage to lecture for us, and the same applies for women. Women in industry, it is so important.

And we are getting more and more female surgeons in the Schulthess Clinic as well, well educated, fantastic. They have another approach to the professional life, but they have also another approach using our instruments, for example. We need -- as an industry partner, we need to think about our instruments, for example, they are designed for women's hand or are they too big, too strong, those things. And IBRA will help us to get it open to bring the women in to discuss, to have courses for them. And also to have more and more women driving our education program. We will have in Florida an education center, in South Florida, hopefully starting in September, and we will have 3 education centers in Brazil. Sao Paulo and Rio for Medartis and one in Curitiba across our production facility, a little bit the same like in Basel only for NeoOrtho, where we bring the surgeons for the courses and then they come to the production, and then they can see our production and how the products are made. And I think when you have seen this and when you have done the course, you are really close to the company and committed to the product.

And finally, we have a new U.S. research and education committee. This is very important. But a lot of new things, a lot of positive things will come with IBRA, but I think it's also important not only to speak about the business, not only to speak about the marketing, not only to speak about the research and development, but also to speak about education. Education is the most important spending we do in this company. And not only for the TOUCH education. Education is the base of everything we do. Nice panels, nice charts, every marketing department can do. But a proper education with a super professional partner like IBRA worldwide, this is not so easy. And here, we are unique.

What is also unique is that we have -- and this department is reporting to Peter. We have an ESG department. We care. We care not only in Basel, we care worldwide. We have it also in Brazil, an ESG team that we are really -- give our people an understanding what's ESG. And what I say in each townhall is and we speak about ESG, like we speak about our culture that ESG is not just putting some solar panels on a production facility or avoiding plastic bottles. By the way, we could do better. I see still plastic bottles here in this auditorium today. So Peter maybe can take this up. But this is okay, part of it. ESG is also the social responsibility we have. We did yesterday a charity bike ride during FESSH for Mercy Ships to help people who are not as fortunate as we are to get access to proper treatment and surgeries.

We have a very important program with Philipp Honigmann and Florian Thieringer from the Unispital in Basel. Florian is a CMF surgeon with Nicaragua, where you have severe cases of reconstruction of faces of people, but they have no means. They have even not the blades and the screws. The products are not there. So we are doing this. This is a drop on the hot stone. But if you would do nothing, it would be nothing. So we are intensifying this is one thing.

The other thing is inclusion, diversity in the company. We need to become more open. This is part of our culture, and we need to become really diverse. The planet, this is very important, this is the future. And we have this responsibility as a company. And overall, we have to have a governance on this. And we have to have really a team on this and not -- and this is now the most important part not just publishing 30 pages in an annual report. You have to live it. And when I saw first our annual report, I said, wow, we are publishing a lot. First, I would like to know who is reading this. Second, I would like to know who of our team here understands what we are publishing. And are we living it? And this is now the sensibilization and the work Peter is doing with Alina to work on it. We have our targets.

The important thing is you can put whatever you want on those charts. You have to live it and have to prove it. And you have to -- team needs to live it. Because otherwise, the only thing you will do and there are many companies out there doing it, they are changing slightly the targets year by year. And then you are getting closer, but you never reach it. So it's very important. As well, we have a committee. This is -- and Fabian as part of it. But this is now path where really our departments are getting in and not this is just an exercise, no, now we are living this. The 2030 road maps, and we have a responsibilities. Bianca from Brazil, for example, they are international.

We're doing volunteering means we are bringing our people also in Switzerland, and especially in the U.S. U.S. are world champions with this. And we're giving them the time, you can go, you can help, please volunteer. A lot of social product projects, especially in the U.S. We are top 15 in EcoVadis. Honestly, I know what this means, but they told me it's very good. And we have a silver award. And then my question was, can we get gold. But important is that we compare each other and that we are participating in these comparisons. And yes, we have 100% renewable electricity, and we are also driving the first electric cars, not myself, but we are getting to this, then we have electric cars. And you will see at FESHH and please, when you are going to FESHH, we have our bus there, our electric Volkswagen bus, the Medartis bus. It is reformed as a photo booth for you. So please take a picture and publish it in our electric car. This would be very nice. So we care also about you.

Now the outlook, nothing has changed. We will see each other in August. 16% to 18% organic growth. We deliver what we promise and nothing changes. It is still the statement very valid. And then we see August forward going. The high teens EBITDA margin, very happy with the development. And we are on track because with that, we said from the very first beginning in 2025, you might remember, we are not only focusing on growth, top line growth, top line growth, top line growth, we are also focusing on profitability. And we have a clear target internally also for us as an EMB. And yes, we are -- Peter has a smile on his face. So I think we are on track. No, Peter? We are. Yes, we have an aging population. It's a little bit what are the growth drivers? And I'm asked. So I think, first of all, aging population, this is not only referring to TOUCH, but this is general. The population today is more active. My grandfather, when he was 65, he was sitting in an arm chair, smoking a cigar, but not riding a bicycle. Maybe a Vespa.

Today, I'm not yet 65, but we are more active. I would say, Daniel, we are 20 years younger than in the past. So you are playing soccer, you are doing things. You have accidents. You need to recover life. And this is where we have huge opportunities in all markets, and there are still markets where we were not present. This means we are expanding our serviceable addressable market, also the SAM is a market with our products, we can attend immediately and filling our gaps. Hand and wrist, we are complete, but we have other areas where -- and this is a work of Marc, but this is not something you can do overnight. Those projects normally take years, but with the sexy nail, it took us 9 months. So this was a record project. This never happened in the history of Medartis, but it was a sexy project, and it went fast and 9 months, but normally it took us some years, although until we get the especially the FDA approval.

We are going for the personalized implants. I think this is -- or we believe this is definitely the future. Personalized implants is coming more and more, not only in the CMF area, not only for reconstructing faces, but it's a way we need to attend and we can be fast. And being fast is maybe one of the attributes, which is valid for us for Medartis. We are faster than those mega competitors. If you have a huge animal, I call them the sharks of the industry, most of them are coming from the U.S. They are -- normally, they are not very flexible. They have processes and they have books of processes, which are very big. I know this from my time at Procter & Gamble. This is a big advantage to be agile, to be fast, to adapt fast and to become disruptive, not shying away to do things in the industry nobody has done so far and discuss crazy ideas, why we should have our sets, these huge sets still in 10 years. Why? Because many people say, it was like this ever in orthopedics. We could not care less that it was ever.

It's a new generation really using those sets. They cannot live. They are so heavy. We have to analyze this. Is sterile packaging coming? Yes or no? What is more ecological, sterilizing each time the sets or throwing it away. There are a lot of studies that's throwing away is better for our entire ESG than sterilizing, which is impacting heavily. So we have to work on those disruptive things. And you see here we are already advanced. We have a different system now, but guided surgery.

The digitalization, AI plays a big part in this, but AI will not replace a human, AI will not replace the robot. And I'm very bold to say that we can do surgery planning, we can do based on an x-ray the planning in the future of a treatment for distal radius that the system will tell you this plate and how many screws the surgeon needs. But I believe it will never happen that this without the influence of the surgeons will be adapted. The human being behind will remain very important, will not be replaced. But if we do not challenge the status quo, I think we will swim only in the same water, and we will not advance. And this is something we are doing, especially in our innovation area. And this means also -- and this is my last chart and Fabian, I'm too fast, that in 2030, this is our strategic plan, we are now adapting the strategic plan in August. We will start this and discuss with the Board 1 year. We have a time actualized.

So next year, end of the -- in March, I will present you the strategic plan 2031, but it's the adaptation that we have a little bit a shift in the face of the company and the dynamics of the company throughout the next 4 years now. We are already in 2026, and you see the segments are growing. And yes, Medartis will be different, will be definitely a different company throughout this journey until 2030.

And with this, question and the answers, we'll do later. I hand over to Marc. Thank you very much.

So, good morning, everybody. It's a big pleasure to be here and speak a little bit about innovation and what we're doing in our R&D departments all across the Medartis Group.

[Presentation]

So what that means is that IBRA is very important to us. IBRA is very important to us because the surgeons can try our product, live cadavers, fractured specimens. So it's very, very important to do the education for the surgeons at the patient. Second, scientific backup. So having scientific data to back up your product is also very important to the marketing on the products and get them to the surgeons. And last but not least, with the IBRA institutes, we, as an R&D department, have a space to try and test stuff during our innovation cycle. So that makes us really agile. So we just can go downstairs, let instruments and implants produce, go upstairs to the lab and try stuff out. So that really speeds up also our cycles. And that's why IBRA is so important to us in innovation and R&D.

And I mean, to do really the products, you need to understand what the patient needs. So the patient is always in the center. We need to understand the clinical problem. So we need to collaborate with the surgeons like Daniel is one to really identify these needs the surgeons have to treat the patient the best way. And that's kind of what really drives us within R&D. So working together with design surgeons and do the best for the patients.

In terms of markets, we're really focusing on the fastest-growing segments like enabling technology, so digital solutions. At CMF, we kind of revamped CMF with MODUS 2 and now also with the CADskills acquisition, we're in extremities. So basically, upper extremities we're focusing on. We want to be a market leader and foot and ankle as well and the trauma segment with our fracture plates are also within our focus.

So we're really focusing on the fastest-growing segments. And that gives us a serviceable addressable market of around CHF 5 billion currently. So that we still have a huge opportunity to grow with our product, with our services and with our customers.

Matthias already touched that one. So becoming a market leader in hand and wrist is really crucial to us. So we have a pretty complete planning portfolio. We have nice screws to treat the patients. We now have the KeriMedical products. So it's not only TOUCH, it's also KeriFlex and other products, which are delivering results to us. And we're expanding also that portfolio.

So we're working on different stuff like arthroscopy solutions and things like that for the hand and wrist portfolio. Build on our legacy, that's also crucial. I touched it already, CADskills expanding MODUS 2 and growing within CMF. We're having a real good complete portfolio in CMF as well with MODUS 2 and now we're pretty complete as well in the patient-specific solutions. And foot and ankle, last but not least, we're also doing a lot of stuff in foot and ankle.

So Matthias touched it, ankle fusion is going to be a product that is being made available next year for the European markets and the U.S. market as kind of limited availability first and then for a full launch. But that's not the only product we're working on, on foot and ankle. So we got also there a couple of products. We kicked off and working on to deliver products to the -- to our friends in the foot and ankle.

Looking at what we're doing. So we're having kind of 3 main areas we're active in. So it's basically fracture fixation. So that's everything associated with plates, screws, other fixation techniques for trauma and for elective cases. We're working on joint replacements. TOUCH is one of the examples. The TMJR for CMF is another example. We're having now the radial head, the Avenger radial head in the U.S. available. That's the third example for the joint replacement segment and enabling technologies, starting with CMX having the platform, but not stopping there. So going steps further in patient planning, fracture planning, also navigations are their topics we're heavily working on and getting products to the market very soon there as well.

We're doing that mainly for hand and wrist, for CMS. And as I said, we're also filling the gaps for lower extremities. Here, kind of a short time line where you see what kind of products or in which segments we're bringing products to the market, but not only stopping with the implant solution. So we're working on enabling technologies, expanding CMX services, working on delivery systems like sterile procedure packs, new sterile packaging, things like that, which are really important to be more efficient also in the OR.

And then intraoperative navigation, that's a big topic. We're working together with our friends in Zurich Commerce to deliver their really nice products to the OR intraoperative navigation, so do directly the planning during your operation, not only preoperatively. And also looking at new segments. So we're not stopping just with having plates and screws. We're also looking into new opportunities like soft tissue fixation and things like that.

So there are 4 key points where we're focusing on when we're doing innovation. So we're trying to simplify procedures. So having an easier use of instruments, saving time during the OR, that are really important points to the customers. That's what we are thinking and what we're hearing, reducing costs also by reducing surgical time for the facilities. That's an important point.

Preserving bone stock means that we're trying to preserve joints and bones in the body. One example could be radial head fractures. A couple of years ago, they just replaced it with the prosthesis or just took the bone out. We're having plates that makes it possible to reconstruct the radial head. So that really preserves the bone stock and keep the joint in the patient moving. And last but not least, more predictable outcomes, have the surgeons being made able to plan the treatment.

So CMX is one example. So these are elective cases. But again, we're not stopping there. So the goal is really also to provide services for fracture fixation, having more predictable outcome and also some recommendations there. A couple of examples, recent examples. First, coming to that a little later, that's the Titan Nail by providing an easy implant. You don't need to pre-drill. You can insert it right like that. You don't need to have -- to reprocess the set. You just bring it in sterile pack.

So it really makes the whole procedure much faster. So the rep doesn't need to bring the set, reprocess it, bring it to the OR. He just brings the sterile kit to the OR. Preserve bone stock, I mentioned the example with the radial head. But I mean the most important one to us currently is the TOUCH prosthesis. A couple of years ago, the trapezium was just removed. So incision, the bone was removed and the patient was kind of kept it that way. Now we're having a solution to keep parts of the trapezium in and really have the full range of motion and very active patients afterwards because they don't have pain anymore. They just go home.

I mean the doctors even need to tell them not to move too much. I'm sure he will touch that as well. And then more predictable outcomes. CMX is definitely one of these examples, having very complex cases with deformities that are hard to treat. We're providing a service there to have the planning for these cases and also the tools ready to have the intraoperative support that guides bone models and even custom-made and patient-matched implants.

Kind of the 2026 launches for that year, we're providing. So we're having the FibNail. That's going to be a U.S. product only. So that's a fibular nail, which is used for fibular fractures. So that's going to kind of across with our ankle trauma system. It's very innovative. So you can place the nail, you can rotate it. So it's kind of unique in terms of design as well. We're going to bring the proximal humerus. I'm going to show you a little bit more about that. We're going to bring line extensions for the clavicle systems.

So some new plates like medial plates, longer plates and even a plate that most people think is not really that innovative like a hook plate. But we made it, again, innovative. So we changed the whole design of the plate. It's not like all the other plates, which are kind of replacing the AC joint and are hard to place. So our plate is really easy to be placed just with some small nice changes on the whole implant design. It's patented, so nobody can do it than we can do it and the Titan.

So that's the product in the fixation groups we're delivering to the market. In terms of arthroplasty, definitely, it's TOUCH line extensions like titanium neck. We've been working or Keri team was working on the PE as well with vitamin E in it. And we're also providing now the TMJR to our CMF friends. So we're now having a custom-made jaw joint for the CMF surgeons. In terms of enabling services, we're widening up the CMX portfolio in terms of really patient-matched devices.

So that means by the end of the year, almost all of our custom-made plates are CE marked. So they're not only custom-made, they're patient-matched CE marked, which gives us also the possibility to go to other markets and get the registration there as well. Just a quick one. We just received the Australian approvement yesterday morning for the CMX service, so which was really good news. So we can start in Australia also providing CMX services soon. We're having the whole portfolio of CADskills. And another point which we're going to get to the limited availability is CMX TraumAI. You're going to see a little bit more about that soon.

So that's our new shoulder fracture plating system for the proximal humerus. It has some unique features on it. So we get a muscle sparing design of it. It's very anatomical. And that golden thing you're going in there, we call it the spiral blade. So that gives additional medial support. These fractures tend to kind of displace a little bit. So we're having additional medial support there.

And we even have biomechanical proof that this is better than just with a classical screw fixation. So there are a couple of innovations in that system, which we bring to the market to our customers, which are really unique. Titan nail, we spoke about that now. Also the sexy nail. So sexy nail was kind of the working title in the company. Matthias kind of provoked a little bit with that and even drove the team to do some new stuff like new packaging designs and stuff like that. So we're having now nice designs, colorful designs all around. The packaging, we got a nice sterile pack kits with all the instruments inside.

I'm just going to show you, they just open it during the surgery. Everything is sterile use. So you don't need the huge trace anymore, you just unpack it, ready to use, drive the screws in and you're done. So that really saves a lot of time during the OR. And just to show you, before that, the rep always needed to bring a kit like that or even a bigger one to the hospital, they needed to reprocess it. So decontamination, cleaning, reprocessing, sterilization, which took time, then it's ready to be used in the OR.

And after the surgery, it needs to be reprocessed again. So we save all that time now with the sterile packaging, which is really, really great in terms of procedure time and even rep time that we're saving. So it looks like that. You see all the instruments ready to use. That's the implant packaging. So different sizes, you just unpack, throw them into the patient and you're done. Then what we're doing is we're trying to build a whole ecosystem around the TOUCH. So we're driving -- Matthias told it, we're driving manufacturing, doubling the capacities there. We're having new line extensions to the TOUCH and obviously also scaling up the training and the accessibility in the U.S. market.

But we don't stop there. So we want to be ahead of all the other ones that could copy us at some time. So we're working on navigation. You saw a little video on the left side. And to be honest, it's pretty hard to navigate on that small tiny bone, the trapezium. So it's really a tiny, tiny bone. We manage that to get the registrations on that bone and even to navigate on that one. So we're having 2 concepts basically for navigation that what you have is the more complex one for complex cases.

So you need to do the kind of preoperative planning. But we're also working on an intraoperative navigation system, which we can't tell you too much about it, which would be really, really kind of disruptive because that doesn't exist currently on the market. We're also working together with the Keri teams, and that shows that the collaboration really is good. So on the navigation project, we're working with the Keri team from and the Medartis team and also on the salvage procedures.

So we're having there also projects, which Keri wants to incorporate our technology. So there's a close collaboration by both teams in doing these projects. We're also working on AI tools. So TraumAI is a tool that gives the surgeon the opportunity of uploading CT scans, then having kind of the reposition of the fracture. So we're having kind of the fracture situation, the reposition is done. And at the end, even some plates are put onto the repositioned bone.

You see the screw placement, so the surgeon can really check whether the implant he wants to have is the right one. We will provide some additional recommendations on the planning, so different plate selections based on our indication matrix we're having with our plates, all on our CMX portal. So the surgeon just locks in and he has after 1 or 2 days a recommendation and can then treat because usually, they wait about 3, 4 days by treating these fractures.

So there's enough time to do the planning. That's what we're going to provide soon. So we're going to tease that at the FESSH the first time to our customers. And by having the CE, which we expect in the next couple of weeks, we're going to make it available to the first customers. And when all these products, the standard products, plates and screws are not enough, we're having the patient-specific solutions ready by CMX. So again, CMX, the portal, the service we're providing, the surgeon uploads the data. We're doing the planning. We're doing some kind of first draft, the surgeon looks at it. We're having Teams calls with them. They approve it. And then we manufacture the instruments and implants, so bone models, guides and also the plate, and these are delivered to the customers. And now we're having a short demo by Andreas showing how that process looks like. So Andreas is one of our clinical product engineers working in the CMX team and doing some of the planning. He's kind of the master of mandible reconstructions. And I think that's the case, which you're going to see now.

[Presentation]

So you have seen, so everything, the portal, that's a medical device. So that's approved by the notified body and the certification authority. It's a medical device. Everything that is kind of communicated to the surgeon is on the portal. They always can revisit the cases. They can go on the portal, show the planning also to the patient, which is very important at some point. And they can do measurings and stuff like that on the portal as well. So there's a lot of features on it, and we're going to incorporate the TraumAI also on the same technology as it's shown here.

So -- and kind of a similar thing is CADskills. So by kind of having the CMF strategy focused by last year, we just looked at what kind of possibilities do we have to really be fast in providing additional services and products to our customers. And we found basically CADskills. So we looked -- we went into the first discussions by September, October and we did the final closing by May 13. So also a pretty quick process with a full-fledged due diligence. What's really unique with CADskills is they're controlling the whole procedure chain. They're starting really with the raw material. They print everything, they do the reprocessing. There are only a few steps that are made by vendors outside. They even do in-house sterilization.

So they provide their custom-made devices sterile to the surgeons or to the hospitals directly, which is pretty cool. And we're going to take that process and implement it also for our processes here. And as Matthias already mentioned, the goal is really to take all that process footprint and put it into other regions. As said, I mean, we're now having the approval in Australia. We're first going to provide the service from Basel. And at some point, we're definitely going to bring it also to APAC. We're going to bring it to LatAm and the U.S. is depending on the 510(k) as well.

CADskills in terms of products. So the products are not what we've done before. So we've done guides, bone models and plates. What CADskills is doing is they're providing TMJR. So that's the joint here. That's a fully patient-specific joint for the jaw. They're providing orbital floor implants, both in titanium and in PEEK. So they're providing both options depending on what the surgeon wants to have. We're having facial contouring implants. So to kind of change the appearance of patients whenever there is an orthognathic case or something like that. So they change the bite. At some point, there need to be some adjustments of the mandibular angle or stuff like that.

So that we can do also with facial contouring implants in PEEK and in titanium. And we also got now the technology of doing subperiosteal implants. So really kind of implants that makes it possible to fix dental prosthesis on after tumor cases or really also kind of bone loss, so massive bone loss in the upper and lower jaw. So that gives us a huge opportunity that was missing for us to be very competitive in CMF, and that's what we're having now. So the products, the service and the whole also planning technology behind that. So there's a highly skilled team also sitting in Ghent, similar to guys like Andreas we're having here, and they're doing all the planning and manufacturing in-house in Ghent at CADskills. And that was it in a nutshell.

Good morning. My name is Daniel Herren. It's a real pleasure to be here. Thank you very much for the invitation to have the opportunity to explain a little bit what's going on in the market from the front at the patient line in terms of novelties in treatment. And one of those novelties we already heard many, many times is the TOUCH prosthesis. And it's a great privilege that I can show you the experience we have with that implant might be exemplary what's going on.

And for us, surgeons, it's a huge opportunity to have such a new implant, which basically revolutionize the treatment of a very common disease. Where are we? Who I am? I'm Daniel Herren working in the Schulthess Klinik. It's a big difference. I had a former boss whose name was Schulthess. We have been ranked by Newsweek as #1 in Europe for orthopedics, #4 worldwide, and we are pretty proud about that. You can -- we can talk hours about ranking. But nevertheless, if it's so good, we take it. If it's bad, we just ignore it. I'm double certified orthopedic and hand surgeon and being in that clinic already 30 years.

So overlooking a market with quite a constant flow of patients and a constant disease pattern in these patients. However, we had a great shift from rheumatoid disease to degenerative disease treatment also in the hand. I'm the past President of the FESSH, so this is a little bit my Congress, honestly, because Basel was dedicated to give the Congress during COVID. So within a few months, we had to go from a live Congress in Basel to an online Congress. And that's the reason why Basel got this Congress again now post COVID, and I'm very happy that it happens now today. And those who have the opportunity to go there, you will see how we evolved.

And as Matthias already said in the introduction, it seems to be the biggest hand surgical congress worldwide. I'm a consultant for Medartis and KeriMedical for many, many years. I had the privilege to serve as a Board of Director member for 7 years during the IPO process, I don't have to tell you as being from the banking side that the first sessions I obtained, I didn't understand the word. But evolving over time and looking for new opportunities to enlarge the portfolio, that could give some of those contributions.

We are meanwhile looking back to 840 thumb implants in our clinic and in my team with an increasing number. We started very slow. I did a few first cases telling to my partner, if it works, you are the next, then he took over. And when we saw how good the results were clinically, we just rolled it out to the rest of the team. So let me share a bit experience about that. This is a typical patient we see every day. Let's call her Sina, she is 58 years old since already several years. That's typical. Usually, it starts after the age of 40, 45, especially in females. She has pain at the base of her thumb. She's very active, works as a nurse, has, believe it or not, 6 grandchildren, has a positive family history, which is also typical for that disease, had so far 3 cortisone injections done.

They worked for a while, calmed the situation down, but it doesn't solve the mechanical problem. Osteoarthritis, degeneration of the cartilage is a mechanical problem. And she wants a final solution. She's a bit tired of that. That's her x-ray. That's the base of the thumb. This is the so-called metacarpal one. This is the trapezium, the famous bone. It's called multangulus majus in Latin because it has several edges. It's a pretty complicated shape. And as you can see, as long as we see in the x-ray a distance between the bone in joints, this is cartilage. Cartilage has no calcium in it.

So we don't see it in the x-ray. So that's good, that's bad. This means bone is rubbing against bone. So it's a typical feature of a so-called degenerative osteoarthritis. She is not alone, by far not. Interestingly enough, if we are looking at the prevalence of osteoarthritis in different joints, we would think the hip might be the #1. It's not true. The hip is often affected, but not as often as we would think.

And if you look, the hand is involved in 70% of the cases. From the 70%, 20% is the base of the thumb, the reason for that osteoarthritis. Number one are the distal joints here in the fingers. I don't know if any in the room had this problem already. And number two is indeed the base of the thumb. Why don't we have that many more operations than in the hip? In the hands because especially the distal joint, but also the thumb tends to stiffen down over time. If you don't have cartilage anymore, the joint is just moving as it should. And it can be that it stiffens down to an amount when you don't have any movement anymore, we don't have any pain anymore. So this is the reason why we probably see much less patients than we should theoretically.

So again, when we look at the prevalence over the age of 80, more than 80% of patients have it. Again, that doesn't mean that they are symptomatic. There's a genetic disposition and it's almost always bilateral. These are the stages of the disease from normal cartilage wear, severe cartilage wear and so-called osteophytes, so deformation of the bone as a reaction. And then Stage 4, this is a bit of problem. Stage 4, this is the trapezium, the multangulus majus. So we not only have osteoarthritis on the base of the thumb, but we also have osteoarthritis in the wrist. So the next joint is affected as well. That's important in the discussion of the treatment options.

So what's unique? We all know that. Opposition is purely made by the CMC1 joint. So the thumb saddle joint makes the opposition. It's placing the thumb in the 3-dimensional space. That's why it has this unique anatomy. It looks like a Cardan joint, a double Cardan. It needs because of that shape, important ligamentous structures to hold it in place. That's one of the problems in osteoarthritis because they weaken down and it gives the so-called subluxation. So the joint dislocates out, gives even more forces on specific points in the joint and hurts even more.

That's very high contact stress. So if you press here 1 kilogram, we might measure 10 kilograms at the base of the thumb. So for a man, I'm pretty strong in my hands. I press 15 kilograms. So every time I press completely, I have 150 kilograms on that joint. That's a lot. What's the problem of Sina if we look at her. It was not that extreme in that particular cases. But these cases, we see quite often. We call it a chain reaction. You have this subluxation we call, so dislocation of the joint. The next joint is reacting, it's hyper extent.

And at the end, we call it the Z-deformity. This is a compensation of the missing movement at the base of the thumb, very difficult to correct. If they pinch these patients, it gets even exaggerated, and that's not an unusual case within our daily practice. So what's the outlook for the future for Sina when she's asking? Pain will remain very likely. She is rather young, very active. It becomes more and more unstable in her situation because she is subluxating already. And of course, she will lose a lot of function in her hands.

So what options do we offer? It's a pretty busy slide, but I break it down to 3 different possibilities. I call it the anatomical preservation solutions, giving basically injections. There's one surgical solution, which is called osteotomy, where you break the bone, you change the axis outside of the joint and then you unload the joint, which is below. It's called osteotomy. It doesn't work that well in the thumb A and B, most patients have a too advanced osteoarthritis that this option will make sense because you need some preserved cartilage where you can change the load to that area.

The next group is the so-called functional preservation. That's where all the implants are coming in, the TOUCH, there were implants or still implants on the market. So interposition discs, which separates the bone, the results are pretty mixed. So these are functional preservation options. And last but not least, I call it a joint destruction options. It's fusion, fuse the joint, I'll come back in a second or resect the joint, take it out.

So fusion, what does it mean? Imagine you have the base of the thumb fixed completely. You still have 2 other joints to move, but these joints are just doing flexion extension. So no way to put the thumb in the 3-dimensional space. That's fusion. It's a rare indication where it makes sense, especially in manual workers where they need a lot of power and a lot of strength. This might be an option. But there is a fear if we fuse that segment, there's more load on that segment and maybe there's more degeneration in the future. Resection, we already heard it from Marc as well, take the bone out, the trapezium goes away as whole bone.

And in order to give some stability, we put in a tendon graft in a different technique. There are many techniques which has been described, it is called resection, suspension, I suspend the metacarpal one bone and interposition. Coming back in a second to the details and the famous joint replacement. So fusion is not an option for Sina. We are talking about those 2 options to her and give her the perspective. What is it all about? The resection arthroplasty has been invented in the '70s. It's still considered as the gold standard in many markets. Why? Because it has been done for many, many years with quite constant result.

I don't say the results were hilarious, but they were not as bad as we could think about. There's a good pain relief. You have to be fair to that option, but there are significant deficits. You have seen this adduction contraction, we call it like that, very difficult to correct with such an option. So all the functional deficits which go along with the deformity basically remain after surgery. However, there's a low revision rate in our series, about 2% to 3% in 10 years. So the chance that the patient has a second intervention is pretty low.

However, if he needs one, it's very difficult. The bone is away, the soft tissue around, a lot of scars. There's not an easy and good solution to that problem. Arthroplasty, very interesting. We are talking about arthroplasty since many years. The big hype and the big wave of beginning of arthroplasty goes down to the '70s, started with the hip, knee, all the other joints, including the thumb base. The thing is somewhat cultural and interestingly enough, the big markets you have seen on the slide, French, Belgium, they were unique. They did their own thing. They had a high tradition in arthroplasty, but nobody took care about. We didn't even look at it. How can you trust a nation which hangs up the x-ray like that.

By the way, the French and the Belgium are the only one in the world hanging the x-ray like that because they say men are standing in that position and not in that position. The only in the world, if you are at the French Congress, you're all the time looking like that because we are not used to see the x-rays in that regard. So nobody trusted them. These were the first implants, and they had a pretty bad track record. This is a dislocation. So this belongs into here. It didn't hold. This is a so-called loosening. You see the bone around the implant is blacker than the bone around the wrist, which means you have a big hole inside.

So this track record, together with the fact that nothing was really published on it, made it that nobody took care about that. What changed? Changed a lot. I think we started to understand the biomechanics of that difficult Cardan joint more better and better. The big breakthrough was the so-called double mobility because the implant, you will have it, and I think it's touring around as a double mobility in terms of -- this is the polyethylene so-called liner, the head, and this is the metallic head inside. So you have 2 heads moving against each other.

And this double mobility enhances the circumference where the implant can move to a great amount. And this is one of the breakthroughs in that. We have better material, just the integration improved. Cup shape is different. We have 2 different cup shapes, which helps us to fix the implant much better here. The problematic zone is the trapezium. The fixation in the trapezium is the one which really is the difficult part. We have a stronger polyethylene Marc talked about it, cross-linking vitamin E. These are all things which improve the implant a lot. When we look at the results, just as an overview, looking at the different parameters, pain, pinch means strength, recovery time, durability, cost aesthetics complication. This is a resection.

It's cheap, reliable in pain reduction, but all the rest, our recovery time is almost endless, goes up to a year until patient really recover functionally. But again, it's quite durable. If we compare that with the implant arthroplasty, this is proven scientific given data. We see a much spectacular reduction of recovery time. The thumb looks normal again because I give that stability back, the deformity is corrected because we recenter the joint.

The problem is the complication, but I'm coming back to that, dislocation almost disappeared, but maybe loosening implant failure mechanical wise is an issue. It's a huge difference. This is a patient on one side, an arthroplasty on the other side, resection. You see the difference. This is the resection side. So functionally, again, it falls in that position. Here, there's much more stability and thus much more pinch strength in those patients. So what happened if it fails and both can fail. The resection can fail as well as the implant can fail. If the resection fails, sorry, there is no way back. The bone is away. Here was the space for the bone, it's completely missing.

If we have a problem here, a, we can change part of the implant, we can change the neck, we can change the cup. And in the extreme, we can go back to resection very easily. And this was one of the reasons to start that intervention that we knew we had a backup, which was still the gold standard in many markets. Again, comparison, what did we observe? And this is all published, spectacular fast reduction of pain. After 3 months, patients are basically almost pain-free. Spectacular regaining of key pinch strength going up, no chance to resection, our patients.

And last but not least, return to work much, much faster. And I almost never had an intervention where patients spontaneously said to me, doctor, I forgot I had surgery. It's really impressive. What about the cost? Very interesting and very important in many markets. If you look, return to work again, spectacular own data published. You had a chance to get access to data from the insurance companies. And what we see that however, the medical costs are a bit higher, RSIA is a resection. This is implant.

At the end, due to the fact that the return to work is much faster, it's highly cost effective. And I think this will be a driving force in many markets to persuade the insurance company like in Australia, like in the U.S. to approve that type of intervention. When you are looking at this typical hype cycle of new technologies with the start, the euphoria, the valley of disappointment and then we find out how to use it. I think in the CMC arthroplasty, we never had this valley of disappointment. Nobody who started to adopt the technology from my colleagues changed back to resection again, pretty impressive.

These are numbers from France. This is a resection, it's a flatliner. There is still resection on the market. There are indications, the stages of very severe deformity still need a resection arthroplasty. But what you see is the incredible growing in an already mature market like in France. So it's not a red ocean, it's a blue ocean. It means you enlarge the number of patients. Patients are confident. They see that there is an option to treat them very well, relatively easily for them in a fast time. And this increases the market.

So in our clinic, 2015, when you put in an implant any type, you have to explain and discuss that. Nowadays, we have to explain why we don't use an implant because the results are so much different. This is indeed my first patient I did together with a colleague from Geneva, who had more experience. He is a professional piano player, a boogie-woogie player, pretty famous in Switzerland. I saw him 2 weeks after surgery just by chance in the clinic. I said, how is it going? He said, spectacular. I already played piano again. I said this is not possible. No, no, I show you.

[Presentation]

There's another example from a friend of mine from Spain. He had -- fighter pilot with osteoarthritis at the base of the thumb and he had to go for a check flight again in order to get ready to fly and believe it or not, and I think military plane fighters much more on the control than even civil aviatic flying after 30 days of surgery. He got the approval to fly both hand, pretty impressive. There are tons of these examples.

This is by chance in a hotel in England, we had indeed a TOUCH course, and this was at the reception. I couldn't believe it. And it was confirmed that the company didn't die. So very interesting. So to sum it up, there is a silent revolution going on in that regard of a disease, which is extremely frequent, which needs a lot of patient treatment. And the standard now is going to shift from resection to implant arthroplasty. It is very convincing results, more and more publication saying all the same, fast rehab normal function and strength.

An interesting phenomenon is there's also clear pressure. Those colleagues who are not offering it, they lose patients. That's a classic. And they might not feel it now, but the word to mouth from patients to patients is much more powerful than we think. And I have never seen a new technique on the market, which was so quickly adopted by the general practitioners. Now after 1 year when we started that, I got the first referral saying, would this be a case for an implant arthroplasty from a general practitioner. So they realize things are going on, and this is very unusual. So -- and what they already said, nobody from my colleagues who started that technique changed back to the resection anymore. We still do it again. There is still a low number of patients which need that.

So I really can say after 30 years of hand surgeon, nothing has changed or a greater impact my practice more than this new implant on the thumb saddle joint. It's really nice to be on that journey. So coming back to Sina, indeed, she has chosen together with her surgeon, the CMC implant. There was a straightforward procedure. She had almost no pain postoperative. I think she took 2 pain pills on a low level, extremely quick recovery. She worked back again after 6 weeks, but she did everything after 2 weeks, and she is extremely happy and grateful. She is now 3 or 4 years out. By the way, it's my wife.

Just the last word. Lancet, very famous scientific journal said the operation of the century is a joint replacement of the hip. And I think they are basically right. In orthopedics, this is absolutely true. I think we might be in a phase to say at least it could be the operation of the decade, the CMC arthroplasty. We have the same phenomenon of collective enthusiasm. We have the same phenomenon that there is a real change of paradigm in terms of treatment. We are now working already, as Marc said, on revision strategies because patients are coming back. It's a mechanical device. It will fail sooner or later, and we must have strategies to solve that. And it's -- I'm very enthusiastic to be on that journey, and I'm very happy about that. Thank you very much. Looking forward to your questions.

Daniel, thank you very much. Is it working now? Peter? Yes. Daniel, thank you very much. And first of all, sorry, it's a Schulthess Klinik. As a Chairman, Schulthess is in our heads. This is a small thank you to you. And I think nobody better than him as a surgeon and with your wife as a patient, explaining the advantage because we could speak, yes, hours and hours about TOUCH, but not the same like you, you also showed a little bit the advantages, the disadvantages. I think there are a lot of questions. Let me say something before we start the Q&A. Medartis will not become a mono product company. I think at this point, and Daniel is not the only one who mentioned this invention of the decade, this change of orthopedics of a decade now like at the hip, it was -- it's now the TOUCH for the thumb. This will not mean that we will lose focus on our Medartis core business. I think this is very important to you know, this might become bigger than Medartis. Yes, we know, but we still have a focus on Medartis because we believe that hand-in-hand, this is working. So now I would like to...

I just want to confirm that. I think the TOUCH is a clear door opener. That's absolutely. And especially like in the U.S., it's the only implant which has been approved, you mentioned it. I think we will have an advantage of 5 to 7 years. Other companies, of course, we were aware of the success of that implant, which is going on because it's so enthusiastic. If you look at the program of the FESSH, the main subject, which is discussed is CMC1. It's interesting if you observe over the years what the subjects are, how they change, but CMC1 at the moment.

And I just got last week a mail from our most important journal, it's the Journal of Hand Surgery European Edition is the highest impact. We had 3 papers most cited last year, just about the subject of CMC arthroplasty. So also scientifically, it's just an enthusiasm there. We want to know how the patients are doing. We have in our clinic a prospective registry where all the patients are registered before the intervention and in typical intervals. So we gained a lot of insights. For a company, it's certainly a door opener.

So now I would like to ask for the Q&A. Peter, please, because I believe financial questions are coming anyway. Marc and Mario, so if you have a flash question, Mario, come, please. And this is Andreas Richter. He's working in Fabian's team. They are multiple purpose, our team members. Thanks a lot, Andreas. So questions.

There's one in the first row, Matthias.

We need to get the microphones up there. We need a second microphone. Just before we start, I haven't heard the presentation from Daniel Herren, who of you think that his wife, his partner, his husband should get CMC1 arthroplasty instead a TOUCH instead of suspensionplasty. Raise your hand, please.

I have a couple of socks -- TOUCH socks here.

The big difference after resection or implant is you can pull it up much faster than before.

Thomas, you believe in it as well. Good. So the first question...

My name is Michelle. I'm working with [indiscernible]. As you see, I'm already a big supporter. I'm wearing the socks. I actually have a question for you. I mean I think you convinced all of us that prosthesis is like a better solution now. What makes you choose the Medartis product instead of competitors' product?

Honestly, I've chosen KeriMedical. No, you think there were -- there's an evolution of that implant. And at the stage where we decided to step into that, one of the decisions was the double mobility because we have already seen first publication showing that the dislocation, so that the joint really dislocates and gets out was basically disappearing. We feared that because that's not a very pleasant complication.

So when they started to have that and then the first company offering that was the implant was called [ Movis ], but this was from the same engineering background. And then COVID came and [ Movis ] was sold to Stryker. Stryker didn't have an interest. There must be no mourning. And then Keri came with a kind of evolution of the movis with the double mobility. And at the moment, the double mobility was -- the only implant was available was that one. Meanwhile, there are 2 implants on the market with double mobility. As you know, the one the MAÃA prosthesis from the Groupe Lépine and they look very, very similar. But the advantage of the Keri, and this is really neutral, they have 2 different cups. So we have 2 different shapes of cups. So surgical-wise, you still can choose the ideal solution for that specific patient, which the MAÃA doesn't offer. So that's why I've chosen that implant.

[indiscernible] Will help. please. No, it's okay. Yes, women's first.

Sandra from Octavian. I have also 2 questions on KOL TOUCH. So the first is on the payer side, you mentioned, Matthias, that kind of the pre-approval process from the payers is a hurdle to adoption. So can you elaborate a little bit more on that? Or how -- what's the percentage of cases that is being approved? Or is it more a problem of the time for the -- to get the preapproval -- or are payers pushing back to lower cost restruction treatments? How is it in the U.S. currently?

We expected at the beginning, much more rejection, much more pushback from the insurance companies. We are still early in the process. I would say, we see the first cases rejected, but much less than we expected. To put this in numbers, I would say, at the moment, 90% is going through, 10% is pushed back and needs a discussion and our team stepping in, we have a team and we have an agency helping us on this. But we have to observe this. If this number goes a little bit higher, it depends also on the institution. And it also depends on the -- and the surgeon, he has a very important role. He can have some influence as more the surgeon is explaining the benefits and the faster recovery and less OR time for TOUCH. I think, Daniel, you did not mention how long it takes to you -- how long it takes to put a TOUCH. On average.

The shortest was 28 minutes.

28 minutes. So this is a much shorter procedure time than with the sector with.

Trapeziectomy.

Trapeziectomy, so 10% roundabout.

I may add maybe because with the discussions, I just came back from Atlanta from a training scores, and we had a lot of discussion. This reimbursement issue, obviously, is a problem or a discussion point. In the U.S., a lot of surgeons are partners of outpatient surgical center. So -- and it's a question of volume and negotiation with the insurance company, how much they get from that. So it's a completely different market compare what we know from Switzerland or in other European countries. So it highly depends on the negotiation from one to one company. It's amazing. And again, it's different if you do it in a hospital or you do it in an outpatient surgical center.

Second thing is Jonathan T. Ting, he was probably the first contact we had with him was here in Basel. He was sitting in the front row like that. And he has Viking roots. I thought he will kill me immediately. He was so critical about that implant we could demonstrate here in the lab. And now he's the one who is really pushing these things forward and gives lectures and it comes into the TV. He got it that way. He's a high-volume surgeon for that Rush hospital in Chicago. So the hospital realized the manager, okay, at the moment, this might be a deficit. But for purposes of public recognition and everything is important and he's a high-volume surgeon, that's why he gets all the approvals for that. So it's very local and very individual. But it will come.

I think to add this, the Rush Institute, from heating in Chicago, they were supporting the first implants end of last year free. There was no reimbursement in place. They bought -- they paid it out of pocket from the hospital. So just to make the media and the marketing because they believe in a huge opportunity for the future.

And I have a question for Peter on profitability by when or which revenue level is needed in the U.S. from KOL TOUCH to make that business breakeven on a fully loaded cost, including the investments in Florida and the field experience, et cetera.

Well, we -- I'm not sure -- yes, we are not building a completely separate infrastructure up with a completely separate organization to distribute and sell TOUCH in the U.S. So we can also leverage our existing distribution channels that we have, either the direct ones or the indirect ones. What we are building up is a team of specialists, so-called field specialists that are supporting on the one hand, our salespeople or our partners, but we are also supporting and consulting the surgeons in the operating room at the end of the day. But I would expect profitability for the U.S. business itself of TOUCH in next year.

Andrea, you have to be careful not to forget him. He was the first who raised the hand.

Yes. So I have 2 questions. One is you mentioned a run rate for TOUCH of 150 for the first time in the month of May. So if I keep this going for 8 months, you're already at the 1,200 cases that you targeted for the year. So maybe can you frame your guidance? What's baked into the upper end of the guidance? And is there, I guess, upside potential?

This is the reason why we are so careful. Each single number you give, they are already extrapolating and calculating and Matthias, you are too cautious. Yes, you are right with your calculation. Yes, I'm cautious. I think in August, we have then also June and July run rate. I said it was the first month of above 150, which is good. So we have no doubts to reach the 1,200 this year. Let's see. But I think the positive message I wanted to give is that the acceptance in the U.S. is there. This is the first thing that we have top surgeons in the U.S. who got educated, Daniel, for example, who is now in Atlanta, who's taking this knowledge from Europe. And this is the second thing. And the third is that we are now starting to prepare U.S. surgeons. Well, you said it once in an interview, Daniel, how many surgeries a surgeon should have done before he could teach others?

We published on that scientifically. And we had -- it needed about 30 cases to get a stable proficiency in terms of produce the intervention on a standard level. This is in accordance to other joints like the shoulder or the knee. It's always a question of time, of course, if you do 10, 30 years, it's not the issue, but in a given time. The thing is the challenge is, and I've never seen a program of being involved in a program which invests so much into education. We can do -- it's not a difficult intervention, but it's not an easy intervention too. There are tips and tricks like everything in life, which changes, and we are still a learning system. So I think the rolling out of the education is key here also for the numbers. And personally, as a surgeon, I'm pretty proud also of the company in terms of they take their responsibility.

They could have trained already 10x more surgeons. But we already realized now at the moment that we are probably leveling up. We have the top U.S. surgeons at the beginning. And now don't take it wrong, we are probably already approaching the second league, and we see that on the table when we instruct. They need more support. They need more supervision. And I think that's extremely important that the company is investing in that also in the future. Other than that, you can [indiscernible] a really good implant if people are just using it wrong.

Correct. And this is important, what you asked before is we are building -- we are building Florida education not only because of TOUCH. This will be an IBRA center and it's not only TOUCH. But the education is so important. And let me explain you one thing. We have at the moment around 70 surgeons, 70 trained in the U.S. on TOUCH. But we have only around 49 using TOUCH already. Why? Because hospitals are delayed in the contract or the hospitals are delayed with the reimbursement getting in. And those surgeons, we are training again before they do their first TOUCH cases. It's very important. And we are only training surgeons where we believe they can do at least 2 TOUCH cases per month.

So they should do around 24 to 25 a year. And this is very important to maintain the practice. Of course, I said it because it's already published, you will not find all journals and teachings who are doing 100 in 5 months. This is not the standard. This is a little bit heavy users. We have them also in Germany. We have them all over, but this is not the standard. The standard should be a user who's doing 2 touch per month, at least, who's keeping traction. And as Daniel said, if you figure out, and therefore, our field specialists are so important, if you figure out that there is a surgeon who has done nothing in 6 months, we have to be careful because today in social media times, the worst thing, even if it's not a failure of the prosthesis is negative image on social media, patient complaining because the problems and it's a surgical mistake. Did I answer your question?

Yes.

I still have to do some math.

And then my second question was on the rest of the Bertis portfolio, which I think is also key for the growth story. You mentioned Keri being the door opener in the U.S. get into contracts. Can you maybe talk about some evidence you've seen of this? Or are we still in the early stages here?

We are -- we have a super sales excellence team in the U.S. We have a person already before we started all this. Ted is already a long time in the organization. So we have a lot of data, and we are using more and more of this data to drive also our commercial team. I can tell you that we have already gained 28 out of all the trained surgeons became new Medartis users already. And then there are only a few. I mentioned 68 were trained, 49 use touch already, but 28 of them are already using also for the first time the Medartis hand or wrist portfolio. They have not used because we got into the hospital. Is this now an indication that the 28 will continue with all the train, but we see a positive impact, and we have to stick on this.

We are also now more flexible in our own training centers to speak about Medartis. For example, I spoke yesterday with Daniel coming back from Atlanta. I asked him, I said, was Medartis touched really he said, no, there was not enough time because if we have rented training center cadavers, they are so expensive that there is sometimes no time to speak about Medartis. So the Medartis products are only showcase. But in the future, we will have this also as a part of the education. We will speak about TOUCH. The trainer who is there will teach TOUCH, but we will speak about Medartis and the risk portfolio. So we are intensifying this.

[Indiscernible] Probably my question goes also to Mr. Herren. You showed this slide with -- against the resection -- and at computation and durability, it was still a little bit behind with the implants. So do you think this could change over the time with increasing experience of the surgeons with this procedure? Or you think this is really a

disadvantage?

No, absolutely. I mean it's much more -- taking just a bone and put a little bit tendon in, I mean, it sounds easier than it is. But it has a lot of room in terms of surgical techniques. You cannot do a lot of mistakes. So the complications come from the from the nature of the procedure itself. The bone subsides, takes contact with the next bone is rubbing aid in, pain again. This is a typical complication we see in resection arthroplasty. If you -- the moment you put in something which is more complex like an implant, the likelihood of a complication is higher. I have to talk this afternoon about our complications in implant arthroplasty, the vast majorities are simple complications.

So we have to put that in a perspective. When I say here complication potential is higher, this includes every type of complication. We define a complication is an event after the intervention, which you might expect that happens and needs further treatment. So a lot of these complications are treated by an injection. It's the tendinitis and inflammation of the tendon, which is the -- we have 3% of tendinitis after touch. This is by far the highest complication we have. Dislocation is down to 0.7%. So the real complication associated to the implant itself is lower than what I was talking about. But again, it's a mechanical implant. So the likelihood something happens to that mechanical device is naturally higher.

I would have a second question, I think more to the company, health economic study, specifically for the U.S. How important is that? And what are you planning in this direction for the, sorry, for the TOUCH implant.

You mean How important the TOUCH sales in the U.S. are for the economics [indiscernible].

Not the economic study. I think we saw something also from Mr. Herren on European data, I guess.

It's shoulder clinic data. It's our own patients.

Yes, with data from insurance company like Hana and CFS. So these are real data comparing those 2 procedures in a working age population. So completely comparable, sex and age matched. These were the data.

And how important would this be that you show something similar in the U.S. for longer-term ramp-up of this procedure?

We are doing this. We started immediately. First of all, we have one study, which we are obliged to do from the FDA. This is really to control each touch placed on a long-term success rate. And if there are no complications, it is one thing. The other thing is we are now doing in the U.S. with the U.S. surgeons from TOUCH 1 in the U.S., really a follow-up, also getting the patient input to show afterwards data, how fast the recovery is, how fast the people are back to work, how much money you can save. Daniel mentioned it, how much physiotherapy you have to take out with another procedure, how long it takes to be back really mobile. So all this, you can figure out in numbers and in figures to show the insurance companies the benefit of a higher-priced procedure, but on the long run, it's cheaper.

And I think the the patient feeling and back to life and this happiness of the patient, you cannot pay money. This is something you cannot put in the study. Unfortunately, there are some patients also in the U.S., they are not willing to be fast back at work, but you have this also in Europe. But this is another problem, but we are doing this study.

And not only in the U.S., we're also looking into other markets like Germany and other markets to do these type of studies.

Daniel Jelovcan from [Indiscernible] Also to Dr. Herren as you are already here and one of the top surgeons. We have the possibility to talk to you. So first one is, I guess, your penetration of touch in short must be very high, 80%, 90% of all procedures. Is that the correct assumption?

No. Unlike the hip guys and the knees in our clinic, we have a much wider variation of interventions we are doing. We do a lot of -- we increased the number of treated CMC joints, yes, indeed. We almost double it because word of mouth, again, GPs who are sending us patients. But it's -- in joint replacement, it's by far the most often performed procedure at our clinic. We were the first started in the Swiss German-speaking part. We published after 1 year on the Congress of the Swiss Society, our first impression and results -- and from then on, it just ramped up. It was extremely impressive. I was proud to see that people had confidence in us. We have a scientific board, which was completely independent from us. So we don't do the measurements. The measurements of these patients data are all done by professionals out of us with standardized measurements.

Our registry file was the file, which was approved by the FDA for the FDA approval of the implant in the U.S. So we had to send all the raw data of our patients registry to the U.S. and U.S. statistician analyzed it again, and they proved that, obviously, we didn't do a lot of [indiscernible], which is for us a measure of quality of the data we are collecting.

But the number of TOUCH procedures versus fusion versus the other one [indiscernible].

But you've done a lot of trapeziectomies before the [indiscernible].

We published -- joint replacement is our core business from the clinic and the history of the clinic. And we published already a lot about the some the resection arthroplasty. So this was our field of competence. So that's why we can now compare our patients before with the old technique with the new technique now. And again, the difference is rare to do a resection arthroplasty. And honestly, I liked the resection arthroplasty because we mastered it at the end in a way that it was an easy procedure for us. I meanwhile hate it. It's technically such a difference to replace a joint instead of just taking a bone out, which is a very brutal intervention at the end of the day.

But maybe let me -- I know where your question is going on, Daniel. I think it's also important that Switzerland, unfortunately, is not a direct market for us. So it's not our team or my region selling Switzerland. We have a distributor taking over from Keri Medical, a long-time partner of Keri Medical. I think we could do more in Switzerland if it would be in our hands, very honestly. It's now it's also not the biggest market. They get a good service, but it's around 3,000 TOUCH per year in Switzerland. I think it could be a little bit more because you can also have some demographics, how much people living in the country and how much TOUCH by age and whatever, around 3,000.

Okay. My question was then more, I'm sure you talk to your other colleagues in other countries, obviously. And so your colleagues in Spain or in the U.K., which is only 5% of your sales in touch. and you are more or less the only one, where does it go in other countries? So the penetration must be very low

Exactly the same. It's increasing. But as we already discussed, the reimbursement is a big issue. There are laws. I'll just give you an example in Scotland, so far, it was not allowed to put in an implant in a patient which is older than 65 and not working. Believe it or not, that's -- it's no longer part of Europe, but unbelievable. But I just learned 2 days ago on a dinner from a colleague from Scotland that they are changing the policy. So the government realized we are missing an opportunity to bring back people earlier to work and the quality of life is increasing dramatically faster. So there's pressure from different sites. It's amazing. So you cannot compare that market to that. So the driver of the markets are sometimes out of the medical indication.

And last question, a stupid question maybe for you, but what about the other fingers? I mean the index finger is also quite important with -- together with the [indiscernible] sorry, but.

The first finger I would let me amputate is the index finger.

True, it's completely overrated. If you have something on the index finger, you can compensate with the other fingers. So that's MCP, just short, I don't know if we have time.

Yes, We have still have an hour.

MCP joint, this joint here, this was the classical joint patients suffering rheumatoid arthritis. We did tons of that. Since the new medication was introduced about 20 years ago, the numbers are almost to 0. So we rarely implant an MCP joint anymore. DIPs go to the other end, these joints here, we tend to fuse them. We did a series of silicon implants here. It is certainly not good in the index and in the middle finger because we are pinching with the thumb. So there is a lot of deviation forces. So an implant is not a good solution. So we do fuse these joints here. Their fusion is a good option. And then we are on the PIP joint market, and there are 2 implants on the market, which are in used, but the PIP joint is a more delicate and a more difficult joint to treat it with a bit more unpredictable results than the CMC.

We always compare it, this is the knee and this is the hip and not only looking because if you look at the PIP joint, the 2-component PIP joint, it looks like a knee joint. If you look at the CMC here, it looks like a little hip. I always talk about the Barbie hip to the patients, they love it. Since the Barbie movie, we can do that. So this is -- and then we have the risk and the risk is, I say, personally an unsolved problem. There are implants, but it's heavily debated, very complex joint.

Ed Hall from Stifel. Apologizing on behalf of the English, Scottish NHS system. A couple of questions on The majority on touch. I mean, I think you talked about it being a Barbie hip and obviously, replacement rates in the hips are there. I mean, from your experience, is there a certain replacement rate when it comes to the touch prosthesis? That would be my first question.

I didn't get it completely.

So. In terms of certain hip operations, there are replacements that need to go on. From your experience, is there a certain or a similar, let's say, replacement rates with hip with touch or not the case?

I definitely think so. The numbers are suggesting that. Again, what I said, it's not a red, it's a blue ocean, which means we are increasing the market. patients, if you talk to a patient and tell him, I take out the phone and stabilize it with their own tendon, that's what we do. They are afraid of that intervention. And then they hear from a neighbor, it took me a year. It's fine. The pain is away, but you know I have no power in my hands, blah, blah, blah. And that's a completely different ball game. So I think we're really increasing the market, definitely.

That makes sense. And maybe just on the other side, obviously, similar sort of question just on sort of bone infection. How significant is bone infection within the some joint compared to maybe other larger joints and sort of bacterial infections and what are the current methods in which you would treat that?

Infection is an implant arthroplasty disaster. We hate it, and you take it personally if you have an infection. What is the infection rate to put it in a perspective. The international numbers for hip and knee infections primary implantation are around 3.5% to 4%. In our clinic, it's also approval from the registry, 0.8%. So there's room for improvement. And honestly, the rate is among the highest in the U.S. the most costly health care system has the highest infection rate. So the first question I got in Atlanta is where was from the colleagues, how many infections did you have? So I was together with the colleagues from the Netherlands. He overlooks 500, we overlook almost 900 implants. And both of us said spontaneously independent 0 because we had 0 infections.

In the hand, the hand is not very prone to get an infection. Usually, it's in very complex situation, trauma, whatever. So that's not -- and resection arthroplasty, we have 0 infection as well. So it's -- that's not the issue. So we don't even think about infection.

Perfect. And then final question would just be on reimbursement. The CAT 3 code in place. And I guess, I'd be curious to hear your thoughts on what is required to convert that to a Cat 1 code and sort of the time lines of how we should expect that?

Well, we have now, let's say, we need our studies for this also. We have now a EM peace of mind. We discussed it an average 6,500. This is also -- we calculated it in our estimations and our fundamental analysis and our plans with a lower reimbursement code. So we are cautious. But if the studies confirm all the information which we have delivered before we got the reimbursement code, it will be prolonged. It will continue. And there is no reason on what Daniel also said that the studies in the U.S. show the same results we have in Europe since 10 years. So all fine. But there is -- you can imagine there is a team working on this. This is not a one-win show in the U.S. There is really a professional team.

Our own team together with agency teams working on this because as higher the reimbursement code remains as more attractive it is. But also, I'll tell you, with 4,500 reimbursement would be also attractive because the reimbursement in Switzerland or a multiple down.

Yes, we are about 2,500, but...

In Switzerland.

Yes. France and Germany are much lower. So Switzerland is still kind of within Europe and attractive market. But yes. will be interesting. Japan is interesting in reimbursement, Australia.

Yes, Australia as well, but not even coming close to the U.S.

No, we are talking about 8,000 to 10,000 in the U.S.

So it's also attractive for the money the hospitals get for the treatment. And I think what is important, and we cannot answer, but even if you would know it, what we don't know is the overall potential, this blue ocean. And coming back to what we said last year, we said we know that 150,000 surgeries are taking place in a year, we would catch with this CMC 1 procedure, 10%, 15,000 case. But honestly, we have no clue. It could be multiple hundred thousands of cases possible.

Yes. Maybe one question on the product road map presented by Mark. So on the CMX, can you please maybe tell us why are larger players leaving this market? And also, what are the economics on the new solution, patient-specific and scalability of that?

What do you mean by leaving this market?

Big players are not playing anymore. That's what [indiscernible].

Yes, what I said is that Stryker is going out of some of the markets, but not -- they're not pushing back from all their patient-specific or CMX solutions. So it's really kind of in some markets, they're stepping out because of reimbursement. I mean scalability, we think it's really heavily scalable since with all the automation, a lot of the planning can be done just by the computer. I mean Andreas elaborated a little bit on that one. We're working with bots doing the planning, and there's a high level of automation already done by the team. So we can scale the cases also by doing kind of automated segmentation and all that stuff. So it's really scalable.

And in terms of manufacturing, the team of Mario has a huge experience in scaling manufacturing processes. So also there, we're pretty confident that we can scale the business and regionalize it also because that's important, right? Keeping lead times low in patient matched or custom-made services is really important because the surgeon doesn't want to wait like 4, 5, 6 weeks on a case. They want to have it, as Andreas said, in like 4 to 5 days being ready, especially in these tumor cases where the tumor couldn't grow. So you need to be very fast in delivering the products.

So on the production side, this is done with 3D titanium printers?

We have several options of manufacturing. So some of the implants we're printing now with CADskills. Other ones we're milling kind of conventionally because we have trick in it.

So we anyhow need to go on a milling machine. So there are several options of manufacturing the implants depending on what type of implant it is.

But maybe, Mario, you can just say a word, I think this 3D printing of titanium that also with CADskills, we have still to install a milling machine. It's not coming out of a printer and that it's ready to use. Maybe in a few words, this process, how this work?

So yes. So here in Basel, we are still milling out of the blanks. This is our process, and we can -- the cases that you saw before, they are milled here in Basel. So they are not 3D printed. CADskills print from 3D. But we are planning to also add some milling capabilities there for locking features.

So we are extending also our capabilities in CADskills. Here is what was mentioned before, we are planning to scale this technology also globally to address additional markets.

I just can add, we are talking about 2 different things. The numbers of these procedures will always remain low. it will remain a niche special indications. I don't know in the CMF, but it's not a thing we would like to roll out like an implant arthroplasty. It will be dedicated to a few centers who do a significant case load, but it's not like a thing which will popularize everybody does it. So I think -- but what it is, definitely, it is, it's -- that's the classical door opener. We surgeons like that. And when I thought back how I did the corrections 20 years ago and now, I mean, I would never step back again. It's like having a horse or a Ferrari, it's completely different ball game.

Exactly.

And I think this is -- therefore, Medartis is so well known and also so respective that we are -- we have this specialty and we are taking the time to offer the best solution for the patient and for the surgeon. Where others, when I mentioned they are stepping out, they are trying to divest a little bit in this area, they are too big to fail. They are selling so much hip and knee that is for them, it's not important to have this specific patient approach, which we do. And yes, we believe also it's part of our future. It's part of our DNA.

And probably another comment. I mean, we see other competitors coming in the patient-specific market. It's very important to provide all these services in the indications where we're active because otherwise, other comes in. And as I said, it's a door opening, right?

So they try to sneak in then their standard portfolio. So it's very important to provide these services to the customer to also protect and grow our legacy business.

And by the way, to end that, you're collecting data, which are extreme because you always do CT scan from both sides. So you take the reference of the healthy side. So you're collecting a huge amount of data of healthy bones in the hand, which further helps to develop new implants and find new solutions. So I think it's always the side effects, which needs to be also taken into consideration.

And that's an important point. It also helps us for all these digital services like Puma AI because we then have the data to base on all these services. So.

So before Matthias closes down, maybe a word also -- thank you also. I don't know if you can see in the camera. I would also thank the people that have participated online. And before I hand it back to Matthias for the closing remarks, so we have food prepared for your drinks. The experts are still around, and then we would leave at 12:15 with a bus, which is departing over there. Also the ones who have signed up for the factory tour that will start at the reception at 12:15. And the ones who have a yellow sign are -- have signed up for the Congress, the ones with black and white are for the company tour, if at all. Thank you very much. And Matthias, closing.

Okay. Now from my side, thank you very much. Also the online attendance, I forgot that we have a camera upfront. Hope we involved you a little bit. Thank you for joining here. And yes, thanks for your interest in Medartis and we see each other latest, I think it's the 18th of August for our half year. I don't know if we see each other or we speak each other, Fabian, what is planned. I love to see you, but okay. And yes, enjoy FASH, nice congress, and you see a little bit where the orthopedics is coming from when I say where we are coming from, where we are heading to.

Thank you very much.

So we'll start. Good morning, ladies and gentlemen, whether you made it to [ strictly ] to Basel here by train or by car or if you're watching us behind the screen, thank you for being here to listen to our Medartis 2025 Full Year Results story.

A few practical questions before we get started. The presentation slide deck is our compass for today's meeting that was published this morning as alongside the annual report, the integrated annual report as well as the press release on 6:30 this morning. I encourage you, especially for the annual report to explore them if you have the time.

Now a brief important legal disclaimer on Slide 2, you see the forward-looking statements that I'd also like you to take note of it. For today's program, we have 2 speakers lined up. You see them here on your right-hand side, Matthias Schupp, our CEO, who will open the strategic highlights of the year, what has been, in my opinion, a transformational year for the Medartis Group. And then we have Peter Hackel, a very familiar face to many of you. He will then take us through the numbers behind the story. Once both have finished, the floor is yours. We very welcome your questions for an interactive session simply by requesting the microphone here in the room. The ones who are listening through Microsoft teams, I would like you to raise your hand by clicking on the hand symbol.

But first things first, Matthias, the stage is yours.

Thank you very much. Yes, good morning to everybody here in Basel and also dialing in from outside and listening via video conference. It's every time nice to see you face-to-face. I prefer this much time more than having a video conference. And also welcome to our brand-new auditorium. I'm happy that we have the white chart gone. It's becoming very hot with white chart. 2025 was not only my first year as the CEO of Medartis, it was also a real transformational year. And I'm very happy, but also proud of my team. This is not a one-man show. This is a team behind the results. And what this team worldwide has achieved in 2025 was yes, in my view, outstanding.

We had 2 acquisitions, the NeoOrtho acquisition back in March last year and then the full KeriMedical acquisition in August, the 100% takeover. We had leadership changes. So throughout the year, I built the team for the future, also for the future growth of Medartis, and we had a substantial change in our strategy, especially in the U.S. If we look back to the U.S. from 2024 to 2025 -- and I told it 2 weeks ago in a town hall in the U.S., this is like day and night.

We have not only changed 50% of our distributors in the U.S., we are focusing now on upper extremities, especially in hand and wrist. We have now exclusive distribution partners in the U.S. for hand and wrist, which we never had before. We prepared the TOUCH launch in the U.S. throughout 2025 because we were never sure which month it will kick in. Finally, we achieved the FDA regulation in August, and we were ready. And the team also managed an unforeseen -- yes, it's like a roller coaster distributor change in Florida, and I will come back to this later, which was a really heavy impact for us to manage, but it was agility and quick decision-taking to make this possible.

And very important for me, and I mentioned it to you in March when we met for the first time last year, and I repeated it in August, we deliver what we promised. And I think with our 2025 results, we delivered on our promises. The culture, and you will see it again and again and again throughout my presentations in the upcoming years. This is so essential. This is the basis of everything. And the culture is driven by myself, together with my EMB and then with the EMG through the whole organization.

We did important inroads. We have done more than 25 cultural workshops with our teams. And if you ask me, if I compare Medartis today, when I'm coming also here in Basel to the office and I see our employees and I see this communication, I call it this vibe and this happiness and this fun that people have to work for Medartis, this is quite a change. And then in the middle of everything, it is our customer centricity. Whatever we do, we need to focus on our customers.

And our customers, our hospitals, our surgeons, our insurance companies, but a lot of departments, they have internal customers, also an internal customer, if you work, for example, in the IT or in the finance department. In 2025, Medartis became the Medartis Group. We have now 3 group brands, the Medartis brand, the KeriMedical brand and the NeoOrtho brand. And I'm asked every time in interviews or in meetings, Matthias, why you are maintaining those brands within a group and not just integrating? And I'm repeating every time the same.

We are maintaining the entrepreneurial mindset of those companies. We are maintaining the innovation power and the innovation stream of those companies. We maintain also this cultural top spin. The underlying culture is the same, but the top spin is different, in Keri it's different, in NeoOrtho. And we have also a kind of challenge between the brands. So one brand is pushing the other and nobody would like to stand behind.

And for me, my personal opinion is it would be too easy to think that only because we are sitting in Basel that the Eiffel Tower is in Basel, and we know the best what to do. We see it, and we have seen it throughout 2025 that this is the right setup. With this setup, we are now 1,360 employees, and we are growing not only because of the acquisitions, but also because we are expanding production. We are hiring new talents. We also started a talent program with our HR department. So Medartis, not only from a group perspective, but also worldwide is on a growth path.

The group revenues, you have seen it in the press release today in the morning. We achieved CHF 269.3 million total revenue with organic revenue growth of 15.7%. This means we are at the upper end of our guidance when I say we deliver what we promise. And we know we had some headwinds, only speaking about tariffs or FX exchange rates, we delivered an EBITDA margin of 18.4% in 2025. If you look to the Medartis world, this is a mixed picture, but a very positive picture.

There is not one single region not growing at least double digit. Let's start on the right side with the APAC region. The APAC region is coming from a negative growth, single-digit negative growth in 2024, and we are back to growth with 13.3%. This is mainly driven by Australia and Japan and some distributors in the APAC region. We then move to another region, which was double-digit negative in 2024 and 2023.

Now coming back with 10.4% growth is our Latin American region with our Latin America regional office in Brazil, but also with our subsidiary in Mexico and some distributors in the other countries, and I will come later back to Latin America when we speak about the value segment. Then in the U.S., I will touch it later. We have achieved a 13.4% growth. We would have achieved 18% growth if you would not have had the impact in the second half with our Florida distributors. Quite happy with the performance of the U.S. and the floor is prepared for the future.

And an outstanding result of EMEA, our leading region. And what it shows is that also when you have in markets in big markets like Germany, above 35% or 40% market share, that is not a stop signal. And what I said also last year, even if you have 50% market share, you can gain additional market share. And our fantastic EMEA team is showing this month by month.

As I said, in the U.S., we had this impact starting June. We had to exchange our distributor in Florida. And let me explain, this was one distributor covering the whole Florida region. And therefore, so important for our business, around 10% of our annual business in the U.S. done by them and also a long-standing distributor with over 17 years. Located in West Palm Beach near Miami, I'm telling you this because this means that the focus was really on the southern part of Florida.

The team in the U.S. reacted very quickly. we identified very soon additional distributors, and we decided strategically to not leave it in one hand to divide it into 5 different distributors throughout the region of Florida, especially focusing also on the northern part. If you ask me, we have an analysis and gap analysis month by month, and we are closing this gap, and we are closing this gap, especially very quickly in the northern part. As I said, Orlando, Tampa, the northern part of Florida, there are some states where we -- some cities where we are already better than before, but we are still suffering on the southern part. And I expect that by mid of this year, this transition is done, and we are full on speed.

The other news, and I announced this already in March last year is that we -- out of 57 distributors, we changed 50% more or less to get exclusivity in upper extremities. We have a new North Star in the U.S. It's not any longer lower extremities, this old NSI portfolio, which Medartis had after the acquisition. It is now the upper portfolio, and this fits exactly with KeriMedical TOUCH because this goes also into the hand. This was a very smooth transition, I have to say, and also a big effort again from my U.S. team.

TOUCH, let's touch TOUCH. And TOUCH is the overwhelming story whenever I'm on roadshow, whenever I'm meeting you, whenever I'm meeting journalists, and I have to be very careful to not only speak about TOUCH because you can expect an acceleration of Medartis as well. So we have a Medartis-based portfolio, which we are tracking totally in separate. And then we have our growth accelerator, TOUCH. TOUCH finally was launched in the U.S. We got the first products in September 2025 in the market. And as you know, we had already 45 key opinion leaders trained in Europe before we launched TOUCH.

I explained to you this, that we used the European facilities of KeriMedical, but also together with some clinics like the Schulthess clinic in Zurich, for example, to train 45 surgeons coming to Europe throughout '25. So they were ready. And you can imagine, the first TOUCH prosthesis' arrived end of September into the market of the U.S. And there were some surgeons like Jonathan Tueting on this photo who could not wait to place the first TOUCH because everybody of this 45 wanted to be the first to place TOUCH in the U.S.

It was Jonathan, who placed in Chicago the first TOUCH in this lady, she has her own bakery. So she is very active with her hands, with both hands. She's doing beautiful cakes, delicious. She is only 40 years, 48 years of age. So a TOUCH prosthesis is not only for patients of 60, 70 or 80 years. She felt arthritis in her thumb. She had difficulties to prepare the cakes and she visited Jonathan. And Jonathan reserved her since mid of the year only waiting for TOUCH.

Believe me or not, this month, she got the second TOUCH on the right hand. This is, of course, a unique case. But she was so happy, and you can also see it and maybe Fabian, you can share, we have some CBN interviews on the U.S. news TV channels where she got interviewed, and therefore, we are also allowed to show her picture because normally, we cannot show patients. She speaks highly about TOUCH.

So the rollout started already in October. This was not planned. So we had the first surgeons like Jonathan placing some TOUCH in October, but the official launch was in January. Throughout the last year, we had already built up our initial launch team for KeriMedical with 10 exclusive field experts. Those field experts, let me explain. When we train surgeons, then the surgeons throughout the first 10 cases, they are together with the field expert. We are very close to the surgeons. This is not only to support and help the surgeons, but this is also to make sure that we have no complications in the first TOUCH surgeries.

We know from our international clinical data that after 10 surgeries, they are fine, they can go alone. We plan to train this year another 300 surgeons in the U.S. So we are doing a careful approach. We are not training 500 or 600. We are training another 300. And we have more or less 3,000 hand surgeons interested.

So at the moment, we have this unique situation that we can select which surgeons we invite for trainings. And we are not depending that surgeons are registering by themselves. We did also our first U.S. training already end of December, just before Christmas last year, which was also not planned, but the vibe was so big in the U.S. that we had to start. And I'm also very happy that we are now in the construction phase. And by end of the year, it will be ready of our own education center in Orlando. Orlando, Florida, Sunshine State, a lot of future patients also for TOUCH, and we use the Orlando location also in the future to train international surgeons.

Maybe interesting for you that in the moment, those trainings in the U.S. are still held by our European surgeons. But starting with the second half of the year, these trainings will be taken over by our U.S. surgeons, and Jonathan will be one of them doing TOUCH in the future. This is my EMB. This is my dream team. And I've learned one thing. Each leader deserves the team she or he has. And I think I'm a very happy guy that I have this team working with me.

What is new on this chart. On the upper left part from your view that Dougal and Bernard, the 2 founders of KeriMedical are connected to the company. They are forming together with me an advisory board. They are still very active, very motivated. Bernard is running the whole innovation and R&D side, and we are working on new innovations outside TOUCH, but also on the next generation of TOUCH. And Dougal is, yes, our face to the market also in the U.S., but also still leading the direct countries of KeriMedical, which held in France and Belgium, for example, and handing this over throughout this year to our commercial head, Loic, who is taking care of KeriMedical commercial in the future.

And another new phase, but not really new to you, but a new phase in my EMB is Peter Hackel. And I think about Peter, I don't need to speak a lot or not need to explain a lot. We know each other for 18 years. We never lost the contact, thanks God, when he left Straumann. And this was maybe one of the reasons why I got the jackpot to bring him back, and I'm very happy that he joined the team now 1st of January, but actually, he already onboarded throughout December last year.

And with this, Peter, the financial review, the figures are yours.

Thank you very much, Matthias, and a warm good morning also from my side. When I'm looking to the audience, I see quite some familiar faces from previous time, and I'm very happy and excited to be back in Basel to be back in medtech as well and especially also excited to be back in such a great company as Medartis with such a great future ahead of us.

So let's deep dive a little bit into the financials, and you see that some time has passed by. That's a sign I need to remove my glasses. Otherwise, I can't see the figures anymore here on the chart. Let's dive into the financial figures. Matthias has already elaborated on the growth of the regions, all the regions, double-digit organic growth, group organic growth at 15.7%.

And let me shortly explain the definition of the organic growth. On the one hand, it's a growth rate based on current exchange rates, on stable exchange rates and constant exchange rates. On the other hand, we have also included the organic part of the acquired business, the organic growth of the 2 acquired business on a pro rata basis throughout '25. So that lifted the organic growth rate a little bit. And if you would exclude that, organic growth would be at the same level as in the first half for the second half as well.

You see on the right side, total sales stand at CHF 269 million, a difference of CHF 3 million to core sales. And this CHF 3 million are basically caused by 2 business activities. On the one hand, in the first months after the acquisition of NeoOrtho, we still had the hip business in our books. We divested that business. So that is contributing a little bit. And the other contributor is the contract manufacturing business that we still have in Warsaw in our U.S. plant to better utilize our fixed cost and capacity that we have there. That is scheduled to be phased out once we need that capacity for the production of our own products.

Then moving in the chart to the left side, you see the M&A sales impact of CHF 18 million. That is caused by NeoOrtho that we consolidate since May '25 for 8 months and is contributing about 1/3 to the CHF 18 million and the other 2/3 are coming from KeriMedical that we are consolidating since July '25 in our books. And on the very left side, you see the headwind from the FX side, mainly caused by the U.S. dollar, you see a negative impact of almost CHF 8 million versus previous year. And that's also a theme that you see throughout the whole presentation, that FX headwind also on the margin side.

So let's move on one chart and look at the product sales from a different perspective from the product perspective. The larger upper extremities are contributing almost 70% of the shares with a growth of 16%. And there are basically 3 main product groups really driving that growth. On the one hand, TOUCH sales, not in the U.S. because we launched TOUCH in the U.S. only this year, but mainly in the European regions where we have been acting as a distributor already before the increase and full acquisition of KeriMedical during last year. The second driving factor are 2 product launches in the dorsal olecranon area and the clavicle portfolio that we also launched partly in '25.

The third growth factor is the hand nail portfolio that is used to treat finger fractures contributing very nicely also to the growth of the upper extremities. Lower extremities, posting the highest growth with 18%, but at a low share of 15% contribution overall. And CMF and others craniomaxillofacial and others is posting a 17% share with 15% growth driving basically by 3 different factors. On the one hand, mid-phase solutions were lifting growth there. The orthognathics area contributed to growth and especially the cannulated compression screws, which are used as an alternative bone fixation method also contributed nicely to growth.

That's -- and CMX digital and customized solutions were expanded to cover all the different product ranges, upper and lower extremities as well as craniomaxillofacial. And that's also an area that we strengthened significantly with the CADskills acquisition that Matthias will elaborate a little bit later in the presentation.

So let's move on one chart coming to U.S. tariffs and the impact of the U.S. tariffs. But before we go into the details, let me reflect a little bit how these are recorded in our financial books. When we import a product to the U.S. or to any other country with tariffs, the tariffs are added to the product costs. Then we put the product on the inventory in the local stock, and it stays there for a couple of months. And only when we ship that product from our local stock to the customer, tariffs will impact our P&L. So there's a certain delay of something like 6 to 10 months between importing a product in the U.S. and seeing the impact of the tariffs in our P&L.

So in '25, we faced a burden of about 90 basis points on the gross margin or an absolute impact of around CHF 3 million. In '26, I expect a slightly higher impact of around CHF 4 million, especially in the first half year because of that delay that I just mentioned. You see that from August to November, we imported products with a 39% tariff. Currently, we import around 10% tariffs impact on a blended rate. But you see that 39% burden from last year will impact also especially the first month of this year with the tariffs.

However, what are we doing to mitigate that impact? We already decided late in '24 to shift part of the production for the U.S. market from Basel to our Warsaw manufacturing plant. Obviously, the tariff discussion did accelerate that shift. And we plan now to produce about 70% of our U.S. volume by the end of this year in the Warsaw manufacturing site and by the end of next year, around 80% of the U.S. domestic sold volume.

That is not only mitigating the U.S. tariff impact, that is also diversifying our production footprint and easing or helping us to better naturally hedge the impact of the U.S. dollars and the continuous weakening of the U.S. dollars that we have seen over the last couple of years.

Moving on now to a reconciliation from the IFRS figures to the core figures. It's a little bit busy and number heavy chart. You see the impacts of the different noncore and alternative performance measurements on the right side in the comments. But let's start with the table on the left side. You see there the IFRS reported figures. And then we have 3 columns where we took out either onetime exceptionals or M&A accounting effects to come from IFRS and reported to the core figures.

Let me go through the different columns. M&A impact, overall, we reversed a gain of CHF 13.6 million at the EBITDA level coming from 3 effects. The amortization of the fair value step-up from the KeriMedical acquisition of the inventory, adding a charge of CHF 8.8 million. Then in the operating expenses, we have 2 impacts there. On the one hand, a revaluation gain of the initial KeriMedical stake at the point of the acquisition -- time point of the acquisition. On the other hand, we also have a reversal of a contingent liability from the former NSI transaction adding to the CHF 13.6 million reversal of gain.

In the middle, we have taken out the noncore businesses that I have already explained on the top line. And on the right side, in the column other, we have eliminated costs of CHF 10.2 million coming from -- mainly from 2 different effects. On the one hand, scrapping costs for the former NSI inventory of around CHF 3 million. And on the other hand, from past service pension costs because we changed our pension model in Switzerland from an insurance-based model to a collective foundation, which led to some past service costs that we eliminated in core.

And on the right side, you see the core results '25 and the comparative base for '24 as well.

In the following charts, I'm going only into the details of the core results and not the reported results. So let's start with the gross margin. Overall, core gross margin, we posted 81%. You see the negative burden of 90 basis points from the U.S. tariffs and eliminating or excluding that headwind from the U.S. tariffs, core margin -- gross margin almost stayed stable around 82%, posting 81.9%, a slight decline of 20 basis points.

We were facing a certain negative product and country mix effect. However, with efficiency increases in the production sites that was more than overcompensated KeriMedical, the full consolidation of the margin of KeriMedical since the acquisition lifted gross margin as well. And we saw an unfavorable impact from the NeoOrtho acquisition as expected. NeoOrtho is coming in with a lower gross margin. However, on the EBITDA line, it is margin and absolute EBITDA accretive as expected. And NeoOrtho shows the typical P&L structure of a Latin American value player.

On the left side, you also see the FX impact on the gross margin, 60 basis points unfavorable FX impact. If we move on to the EBITDA margin, we were able to increase despite several headwinds and despite also significant investments in growth opportunities, such as, for example, also the preparation of the TOUCH launch this year in the U.S. to increase the EBITDA margin by 60 basis points to 18.4%.

We see gross margin negative impact of 110 basis points. That was overcompensated by a strict cost management and a reduced OpEx ratio with 140 -- 150 basis points associates results and others slightly also lifted gross margin. On the left side, you see the FX impact of minus 120 basis points on the EBITDA margin. So coming to the bottom line of the P&L to the net result. And despite the increase in absolute core EBIT of CHF 4 million, net result from -- in an absolute point of view, decreased by roughly CHF 5 million, on the one hand, driven by unrealized FX losses and on the other hand, also by slightly higher financing costs.

So let me start with the FX result. Financial result was negative CHF 13 million or CHF 8 million more negative than in the previous year. FX results was negative of CHF 5.6 million, mainly driven by the weakening of the U.S. dollars versus the Swiss francs and hence, respective unrealized FX losses in our intergroup financing structure. However, these FX losses are noncash relevant. Interest result stands at CHF 8 million, including a noncash accretive interest charge on debt -- I'm sorry for that -- on -- so interest result stands at almost CHF 8 million, including a noncash accretive interest charge on debt components of the convertible bond as well as contingent liabilities, mainly milestone payments from the former acquisitions of roughly together CHF 3 million.

And please bear also in mind that the convertible bond was issued in April '24, and we have recorded in '25 for the first year full 12-month interest charge for that loan. In summary, roughly CHF 4 million of the finance result are cash relevant. The other part is not cash relevant. You also see other operating result positive contribution of CHF 2 million on net result that is mainly coming from an innovation grant that we received from the Canton here in Basel.

Now let's move on to the free cash flow overview and the development of the cash balance in '25. Obviously, the debt development of the cash balance reflects the acquisitions of NeoOrtho and KeriMedical that I have already commented. Operating cash flow contributes CHF 35 million. CapEx increased to CHF 25 million, significantly higher than last year, around CHF 30 million higher than last year. And going forward, I also expected the CapEx level at that level, mainly because of investment in production expansion sites. We have expanded the production for KeriMedical in [ Ars-sur ] near Geneva. We will invest this year and next year also in the expansion of KeriMedical in [ Tuchbresis ] in Burson. We have -- are just moving into a new manufacturing site in Curitiba for NeoOrtho, and we are shifting the production from -- part of the production from Basel to Warsaw for the U.S. domestic market.

So these are all investments in this year and next year in growth expansion and growth strategies. That brings free cash flow to CHF 9 million for the full year and the cash balance at the end of the year to CHF 33 million. And with these comments on the cash, I will hand back to Matthias for the strategic outlook and update.

Thank you very much, Peter. Yes, our strategic update, the future looks bright. And I think it is important we have, since last year, a clear North Star and our teams around the world, they know it. They know where the strategy is going, and we are really focusing also on transparent communication with the teams.

From head to toe is our strategy, literally from head to toe, and we have 6 strategic priorities, and those are also not changing year-by-year. They remain the same. And we have one EMB member at least responsible directly for each priority. And of course, for our team, we have those broken down in action steps. We still continue to accelerate the U.S. When I speak about our Medartis-based portfolio, we are getting some inroads now. I said 2025 was a transformation year, but with a market share in upper extremities of around about 2%, you are nowhere.

So we have huge, huge focus on growing the volume, but also gaining market share in the U.S. And on the other side, the TOUCH launch will accelerate this growth. But again, we should not forget about the Medartis-based business. And we have also made sure for our sales agents that they have an incentive to focus on the Medartis business and separate on the TOUCH business so that you cannot go with your commission only based on TOUCH.

The second topic, the second priority is KeriMedical. The KeriMedical further expansion. We are speaking about the U.S. We are registering KeriMedical currently in other big markets around the world. We have still huge opportunities also in some of our European countries where we are in the process for only 4 to 5 layers like Germany, like the U.K., Austria. We have also in Asia Pacific opportunities for Keri, TOUCH, and this is one of the reasons what Peter managed that we are really expanding the production.

The third pillar is our value strategy. I think we are the first global orthopedic player stepping into the value segment. And we are doing this very clear that there is an increasing value market, not only in Latin America. I will come back to this, but also in other regions of the world.

So expanding NeoOrtho internationally is one of those strategic priorities. Regional share gains. And here, I have all my regional heads as leaders of this pillar. This is clear and valid for all regions. I mentioned the example of EMEA, where we have already very good market shares, but still continuing to gain additional market share. Innovation, digitalization, CADskills, I will come back later to this is one of those transformational acquisitions we did, we are announcing today, which is really technology going into innovation and digitalization, but also a new technology when it comes to manufacturing. But also a big focus for the team of Merck to focus on our innovation stream for Medartis products. You see a few, which we will launch this year, but we have some other very interesting products in the pipeline for the upcoming years.

And last but not least, Peter, this is your pillar, improving the cash flow because nothing has changed. It is a focus growing top line, but as well profitability of this company. Where we are operating. The total orthopedic worldwide market, you see it on the left side is a CHF 50 billion market. This is dominated. You see this on the right side, by the big knee, hip, spine business where we are not active.

So if we address this down, what is our serviceable addressable market, we are speaking about a CHF 4 billion to CHF 5 billion market worldwide we can address at Medartis. And there are some very nice and not small niches like the CMF part, the blue ones here, like extremities, when I speak about upper extremities, hand, wrist, elbow, shoulder, but also trauma. But -- and I said this last year as well, -- it cannot be our goal to be just the number in this market. The number X. We need to focus where we can really become a world market leader. And I said it, and after 1 year in the company, I repeat it. In hand and wrist, we have everything to become the #1 in the world in the future. And this is something we are focusing, and this is also the reason why we are not playing with the sharks in these hips, knee and spine area.

Again, the TOUCH. Here a little bit the growth momentum over the last years. And I'm including this chart because I was asked several times from a few of you, why we are so confident with TOUCH. TOUCH is a prosthesis, some prosthesis which is already over 9 years in the market, especially in the French and Belgium market. So we have clinical data over 9 years. We know how successful TOUCH is. And what is the interesting part is that even in a market where TOUCH in the meanwhile has over 80% market share, we are growing 18% still. And we continue to grow double digit in France and Belgium, where you would say, but this is already overpenetrated.

But why we are growing. Because this is the first product in our portfolio where we can do patient awareness activities, patient campaigns. It's not a typical B2C business because we are not speaking openly about TOUCH. We are not mentioning Medartis, we are not mentioning KeriMedical. This is really educating the patients in sport events, in their daily activities that pain in the thumb is something normal that this is something you can treat. You can back -- you can gain back the strength of your hand. And I also learned that opening a bottle of water, it depends on your thumb, the whole strength in your hand or playing golf keeping the golf club fixed in your hands. It's all about the sum. So when you lose the strength in your thumb, you will feel a direct impact in your daily life.

And then knowing that there is a solution, guiding interested patients to an Internet page where they can find doctors. And of course, those doctors are working with TOUCH in their region, in their country. And we started these campaigns now in other countries of Europe, and we are preparing after the launch phase to do this as well in the U.S.

Now Cold Fusion. We call this project Cold Fusion. Cold Fusion was bringing the Medartis Sao Paulo organization of Brazil into the NeoOrtho organization of Curitiba moving into our new production facilities, gaining synergies, starting producing in the new facility, but having also one back-office functions together and only have a differentiated marketing and sales approach. And I would say that this was really in record time. In 12 months, this new production facility is ready. The people started to move in last week. And next week, we will celebrate the internal opening.

The teams are now together. This Cold Fusion project for us started only in March, and it was finished in only 10 months. The teams are now together. The synergies are getting in and NeoOrtho is ready for the new stage. But also Medartis in Latin America is now ready for the new stage. And with this, in 2025, when I spoke about a transformational year, we also are coming from 1 production facility to 5. This is quite a big step, and I promise you it will not happen each year.

But we have now on one hand side, our -- we are sitting here our Swiss-based main production facility for Medartis, and nothing will change. Our home is Basel, and we will stay in Basel. And by the way, we just renovated for another 12 years, our contract here in Stucki Park. So we stay also here at this location, and we are expanding here with our production. But as Peter mentioned, and not only because of the tariffs because we had a wonderful production acquired in 2022 in Warsaw, Indiana, with capable people, we are translating now.

And this project is called Flash. And it's running and our COO is sitting here. Mario, it's running like flash. I would say it's running faster than flash. This production transfer to the U.S. producing 70% of our needs for the U.S. already this year in the U.S. Then we have 2 production facilities for KeriMedical, the one in [ Archon ], which is just 2 kilometers behind the border after Geneva, where we are in an expansion phase now.

And the second production facility, which was actually the first one where KeriMedical started in [ Besson ], where we will invest this year in a new facility as well. We are focusing on to the next 10 years or 7 years, and we are doubling our production volume for KeriMedical. And last but not least, on the lower part of this chart, our new beautiful production facility in Curitiba, Brazil.

The value segment is fully underway. As I said, we have now the back-office functions consolidated. We are in the process of doing this. The move started a week ago. We are addressing now an additional value market segment of around CHF 450 million only in Latin America. We know that only in Brazil, 85% of the market is value where you have absolutely no chance with the premium product. If you're going to the public hospitals in Brazil, you even do not need to knock the door with Medartis because you are totally outpriced. This is opening now new access, and this is the same in Argentina. This is the same in Colombia, and this is the same in Chile and in Mexico.

In Mexico, we started to launch NeoOrtho through our Medartis subsidiary already beginning of March. We are in the process of rolling it out. Colombia, Argentina and Chile are following this year for the rollout. At the same time, we already started a project with the expansion committee of NeoOrtho, both in Curitiba, but also here in the headquarter to analyze some interesting European markets where we would like to launch in 2028.

And you know for this, we need MDR. So we started now the process of getting registration of the NeoOrtho portfolio also with MDR registrations, and this is coming around in 2 years from now. And in parallel, we are also analyzing some countries in Asia Pacific or in Saudi Arabia. This is running in parallel, but this is a process step by step. And before you ask me afterwards, the U.S. is not a focus at the moment.

First of all, we have a lot on the plate to do in the U.S. And the other side, the U.S. market is still a premium dominated market.

CADskills. Very happy with the team. They made it through. This is a truly innovative technology acquisition, but also a production acquisition with a new technology of titanium printing. This is a step into personalized implants. Personalized implants in orthopedics are becoming more and more important. It started in the phase with reconstruction for 2 more patients. Those are surgeries you can plan. Those are surgeries you can digitally plan. And then the products, the plates are produced individually for each patient.

We have more and more also extremity cases, for example, in hand and wrist, where you have patient-specific products. One thing is the planning. So we are getting now with CADskills, a high talented team of planners who are doing the cases for the surgeons, but we are also getting a team who is then producing it in Belgium on their own titanium printing device, a huge machine. And this is Class III approved. Just to give you an idea, Class III means that you are also allowed to sterilize and to deliver directly to the OR.

So basically, in Europe, we are ready to deliver in 48 to 72 hours, the plates now to the OR. This is a technology we were looking in for quite a while because I mentioned to you that this is high on our innovation list looking to digitalization and innovation. And we also analyzed this in -- with the partnership of the University Hospital in Basel, where they are doing this already in the hospital, but only for this specific hospital. So it was quite a learning process for us. And if you see what these products can do for the patients in the face, this is really mind walking.

And yes, you see teeth again on this chart. There is a connection with our sister company on the other side. And of course, where we will produce those products to replace upper and lower jaws, you have the implant abutments already connected and those might be in the future, Straumann or Neodent is clear. But you see what's possible also on the mandibular with these joints, printed joints from CADskills.

So very happy that we have them on board, and this is a technology we can scale. This is a technology we are analyzing now to bring to Latin America because NeoOrtho is printing the personalized products currently in Argentina, but now we can source this in-house because you need those planning and those services in each region in the future. You cannot do it in Europe for the world, for the U.S. or for example, for Latin America.

So -- and this brings me to the outlook. As I told you, we have interesting launches in our pipeline for 2026. We are continuing to launch. We have the fibula nail, which is a lower extremity product going a little bit into lower extremity trauma. We have custom-made plate for the CMX service, but this time also with our TriLock locking connection. So we are able not only to personalize, to produce those plates in the future, but also with our patented locking system.

We have, when it comes to the shoulder, our clavicle hook plates, a little bit the hook plates, which we also launched this system in hand, and now it's becoming bigger and also going to the clavicle hook. We are launching our Titan nail system from Medartis this year. very unique, very modern system. And for the Humerus system, we are coming now with the PentaLock 3.5, which is a bigger locking, a bigger screw to give even more stability. And the PentaLock system is something we will further expand also in our portfolio for our surgeons in the future. And this was really a wish from many of the surgeons where we are listening to and where we are executing.

This brings me to our outlook 2026. We expect the organic growth from 16% to 18% on core sales. And our core EBITDA margin will improve, will continue to improve, and we expect to be in the high teens for 2026. And now Fabian, I'm handing over to you for the Q&A.

So we will start with the Q&A session. We try to juggle different channels at a time, but we will start with the room participants, go around. And please, if you could state your name and maybe the company you represent so that people will not see you on the screen are able to identify who's asking the smart question.

Congratulations on today's results. I'm [ Tanja hanslik ] from UBS. So I have 2 questions, if I may. First one for the 2026 guidance of 16% to 18% sales growth, it's a slight acceleration from the, I think, 15.7% in 2025. Can you tell us what your assumptions are for the U.S. launch of Keri that are baked into the guide. And I understand Florida will also have an impact. Is there an upside case as well. That was the first question.

Should I go one by one or...

Yes, it's okay. Yes, should I answer the first question. Okay. Yes, thank you very much. Interesting question. I was expecting this question. But as I said earlier, we promised what we can deliver, and I'm very confident to deliver on this guidance again. The U.S., the TOUCH launch is an ongoing process. This is not just kicking in, in 1 month. This is starting slowly because more and more surgeons are starting to work now with TOUCH.

I told you that we had trained 45 surgeons in the U.S., 33 of them already use TOUCH in the meantime. So there are still from this group, 12 missing to start, and this depends also on the contracts for the hospitals because the surgeons normally like to immediately place the TOUCH, but they need also clearance from their administration in the hospital to get the contract. This is a process with a 3 months delay, depends on the impact of the surgeon.

So slowly start. In the U.S., I clearly expect that our Medartis-based business is moving towards a 20% growth. And then, of course, as I said, for 2026, the TOUCH business will slowly kick in. And you know I was open with this that we plan for this year, 1,200 TOUCH cases in the U.S., and I'm very confident that we will reach this.

Okay. And then for my second question, maybe more for Peter. How will you finance the growth strategy. You have a net cash position of CHF 33 million and CapEx, I think you mentioned similar to this year, plus I think you have an earn-out for Keri and obviously, the investments for the U.S. launch.

Yes. Thank you very much for that question. I expected that as well. Obviously, we have a comfortable cash balance of CHF 33 million at the end of year. We have only used about 1/4 of our existing credit lines. And based on discussions with the different banks, we are very comfortable and sure we can increase further our credit lines. So that will be increased by increasing -- financed by increasing the credit lines.

The next question from Sandra.

This is Sandra Dietschy from Octavian. I have a quick follow-up to the previous question on the U.S. You mentioned that you would expect the base business to accelerate to 20% growth. Now is it fair to assume that in 2025, like a high single-digit percentage point was coming -- of the growth was coming from price increases. So what is -- the 20% seems like a significant acceleration on volume growth compared to last year. So what gives you that confidence that you can really accelerate the base business that significantly?

Good question, Sandra. Look, I said close to 20% for our Medartis-based business. Of course, we see now the acceleration to close the gap in Florida. And when I say that we would have grown 18% last year without the impact of Florida, this is not calculating any growth into Florida. It was just flat. So I expect that especially we will see this only in the second half because we had still some rest sales of the former distributor in June and July. So the impact really happened end of July, beginning of August. So that will also help us to grow with a lower baseline. And the other thing is that we are now getting new contracts. I explained last year in August that getting new contracts in hospital, this is really a hard work, and it depends sometimes up to 6, 9 months to get a new contract.

So we started with our distributor change in the U.S. moving to upper extremities to hand and wrist. We had to open new hospitals, new contracts. We were focused mainly on lower extremities. And having a contract with lower doesn't mean that you go in with your upper extremity portfolio. The other thing is, Sandra, and I think we also spoke about it last year that Keri throughout this year will open new doors as a TOUCH. There will be surgeons interested to place TOUCH who are maybe today working with another hand system of a U.S. competitor of us, and then we have now opportunities to really become more prominent in those hospitals. But again, we need contracts. So this will kick in. So I see the growth more kicking in, in the second half of this year.

Okay. Great. Fair enough. And then a second one on the lower extremities segment. So what is there the long-term ambition? Is it kind of simply grow in line with the underlying market, which I would assume is some high single-digit growth? Or do you see scope for an outperformance also in that segment?

Yes. So the lower extremity market is growing between 5% to 6%. It is the fastest-growing segment in the U.S. this is a little bit what we are doing in line. We are getting some portfolio -- additional portfolio products in the future also for lower extremities. It is very clear for me to say that we are not stepping out totally of lower extremities. We are maintaining from head to toe also lower extremities in the U.S. But for the moment, our clear focus is the upper extremities here, hand and wrist. And as I said, we need to focus in the U.S. We are not in a place or in a size of a company where we can do everything together.

Sibylle Bischofberger?

Sibylle Bischofberger from Bank Vontobel. I have a follow-up on the outlook. We talked about organic growth in 2026, but obviously, you have also acquisition effects. If you could quantify that with NeoOrtho, Keri and now the new acquisition you made. And maybe also if the currency remains as they are at the moment, how much would be the currency effect? And then I have another question on the EBITDA margin outlook.

So you mentioned it with the growth without the acquisitions.

Yes. The organic part of the growth in '25 lift the growth rate a little bit from the first half to the second half, you see that difference. I'm not sure what you mean with the acquisition impact. You mean the M&A impact, the organic impact, what that is. So I think if you take the CHF 18 million and if you divide it by 1/3 comes from NeoOrtho for 8 months and 2/3 are coming from KeriMedical for the remaining 6 months, then you can come back to -- and you adjust that for the pro rata contribution in '26, then you see the M&A impact for '26. On the margin -- and the FX impact on the margins, that's obviously a very difficult question to answer given the current volatile environment and situation that we see.

However, if we take the '25 results and recalculate it with current spot rates as of today, then we are facing a margin impact of almost 1 percentage point, 90 to 100 basis points, given current 2-day spot rate basically.

And your core EBITDA margin outlook for this year, can I understand it that you expect a margin improvement? Or could it also be a margin decrease?

Well, the goal, obviously, is always to improve the margins also on a currency or on a constant exchange rate basis, that's important to realize. However, we also need to be aware that we are facing further headwind in '26 on the tariff space. I mentioned it's about CHF 1 million to CHF 2 million more tariffs. I have not assumed any positive impact from a repayment of the tariffs that needs to be seen when and if that will happen. But on the margin side, obviously, especially in the first half year, I see a certain burden on the margin in the second half year with what Matthias also said with the growth and the acceleration of the growth, I see some further tailwind in the second half year compared to the first half year.

Before we move to the next question, I just want to remind people online joining us remotely, you have to click on the hand surgeon -- on the hand symbol in order to indicate that you would like to ask a question, and we continue with Daniel Jelovcan from ZKB.

Thanks, Fabian. So a very quick one, TOUCH plus 60%. You mentioned the growth, 60%. That's the organic -- that's not including Keri markup distribution and so on and so on. That's the pure organic growth of the TOUCH prosthesis you mentioned in the slide.

60%, yes. We mentioned.

Maybe I can clarify. That's the Medartis contribution in the 5 channels or 5 markets, that's Germany, the U.K., Austria, Australia has started.

Correct. Daniel, these were the markets where we had already our TOUCH own distribution before we acquired Keri, correct, our direct markets. And yes, they are all in the ramp-up phase, yes, 60%, correct.

Organic unit growth, so to say.

Yes. Yes.

But that was always in the numbers also in '25 and '24 and '23.

And then on the CADskills acquisition, how easy is it to leverage this business model, especially in terms of margins because it's -- in the end, it's tailor-made. And on the other hand, it's 3D print. So maybe I lack a bit the skills to figure that out.

This is tailor-made. This is high reimbursed, especially in Europe, high priced and printed. We have already a CMX division, a patient-specific planning division since a few years in-house. So this division now combined with CADskills is really leveraging the technology. CADskills, just to give you an idea, CADskills had also revenue in the past. CADskills without any commercial activity, without not one single salesperson, they sold for EUR 1 million products last year. but this was not their main focus. This only happened because surgeons, doctors knew the founder, Professor Maurice, and they asked him for products. So of course, through our sales force, through our markets, especially in Europe, we have a huge leverage. But we did not buy CADskills or we did not acquire CADskills because of the commercial performance. We acquired them because of technology and stepping into titanium printing now.

Okay. Great. And the last question. In the past, you said that the TOUCH on average, a surgeon in Europe uses or makes 30 to 40 treatments per year on average. Is the U.S. higher than that? I mean, I could imagine, but -- or is that a similar number? And then the selling through the increase of share of wallet within the new surgeons you gain in the U.S. when they use other, as you mentioned, plate and screws for the hand. Is that easy to take away from the big guys because the big guys offer plate and screws all over the body, right? So I struggle to see how you can separate that?

2 questions in one, Daniel. So the first one, it's too early to say for the U.S., how many TOUCH each surgeon will do per year. We have to observe -- we may get some hard users who really place it every day. We might have some who are doing 1 per month. On average, for our long-term business case, we calculated an average of 15 to 20 TOUCH per surgeon per year in the U.S., but we have to see this.

Your second question is a good one. Yes, those are the big fishes in the U.S. who are attending those surgeons today. I will not name any names, but they are not as specialized and I would say, as good in hand and wrist as we are. This is clearly also seen by the surgeons. What we have now is the situation that those surgeons would like to get trained on TOUCH. And it's at the moment, it's difficult to find a spot for a training this year. So we invite them, and then there is a kind of agreement to say, okay, but we would like to attend you with our whole portfolio and we do TOUCH training with you, and then you get TOUCH, but you get also the Medartis hand portfolio because the agent, the person who takes care is already in the OR. So he will bring in the Medartis products.

And honestly, for the company they are working today with, and those are the big ones in the world, this is digestible because their volume is on other products and not necessarily on hand and wrist, even if they are in some hospitals exclusive. And this is also a thing very interesting. We are only getting the door open in those hospitals because we bring a product nobody has. If one of our competitors has a contract with a hospital with a huge hospital in Tampa, for example, you have no chance to negotiate during the running time of the contract.

The doors are opening now because they are asking for something which is unique in the market and then you can negotiate with Medartis' hand because the sum is part of the hand and then we are getting in.

Good. The next question is from Leon [ Nixian ] from UBS.

Three for me, please. I'll start with the first one on current trading. Maybe can you give a bit of color how you've started into the year into the different regions, products in terms of upper and lower, something you want to flag here and also, Keri, is this continuing as strong as in the fourth quarter?

Okay. Thank you. I'm happy with the year, how it started, not only in Germany because of ice and snow. And this is also something I would like to say thank you to the team in our supply chain and logistics. We really ramped up our stocks, and we could serve all those accidents, and I'm never happy when a patient has to go to a hospital. But in January and end of December, it helped us a lot. But this is not the only reason because we are not selling less when summer comes. So very happy, a good team in all regions. And you can imagine that also the regions where we had negative growth in the past in '24, '23, I mentioned APAC and Latin America, that those teams are now motivated.

And we have teams that did not get any sales bonus over the last 2 years. And finally, in 2025, it kicked in. So you feel an excitement also on the markets and the team. And yes, this counts also for the U.S. So yes, we are quite okay. The year started, but it's only 2 months. It's a little bit like observing the share price each hour, but we're on a good move.

And maybe just one follow-up on to this. How many additional surgeons have you trained since the start of the year?

We have, in the meantime, 100 surgeons trained, yes, nearly 90 something, 93 surgeons trained in the U.S., also including the 45 we trained -- and the rest is already programmed throughout the year. It's not so easy to find education centers with Cadaver Labs in the U.S. who are available for those training. We are training around about 25 to -- we are doing 30 courses this year in the U.S. and therefore, we are also expecting to use more of our own education center in the future.

Okay. Then 2 more detailed questions for Peter. Just housekeeping ones on tax rate and net working -- sorry. Net working capital effects and tax rate, just some housekeeping questions for you, Peter. What do you expect? Can we expect tax rate in terms of like between 19%, 20%. And will net working capital effect alleviate the free cash flow trajectory or rather not?

Yes. Thank you for these 2 questions. Yes, tax rate. Underlying tax rate is around 18% to 19%. So your assumption is maybe a little bit higher than what I expect on the underlying tax rate. Net working capital, we saw a cash inflow from net working capital this year, mainly by managing receivables and bringing down the DSO. So the teams have done a good job there in that respect. Going forward, I see -- and Matthias also mentioned that, especially on the inventory side, it's also somehow supporting growth. And I have not planned to drastically reduce net working capital.

I would see it stable or slightly increasing with the sales increase that we are going to push in the next coming years. And focus is definitely on increasing sales, on increasing growth, supporting growth, be it on the net working capital side, but also be it on the margin side with the investments in TOUCH launch in the U.S. for example, as well.

Okay. And then last one. Just to clarify the understanding of organic growth. Is it that you assume that the organic growth rate from the second half only refers to the Medartis core business? Or does it also include the Keri and the NeoOrtho organic growth. This was not really clear...

On a pro rata basis, it includes the organic growth of KeriMedical and NeoOrtho for the time where we have consolidated these businesses. And as I said, it lifted the organic growth slightly. If you would exclude that, the growth of the Medartis portfolio will be at the same level as in the first half roughly.

And Matthias, maybe you can -- you mentioned that in the second half of the year, the U.S. surgeons will take over the train the trainer. What we haven't mentioned is the new training facility in Florida. Can you mention also a word on that, please? On the local training center in the U.S.

I mentioned it when I started that we have in Orlando, our local training center, especially for TOUCH trainings, but also for international trainings in the future. But this will kick in only 2027.

Okay. Then we continue with Michel from ZKB.

Michel from ZKB. There's a trend in the U.S. towards ambulatory surgery centers. Do you see a trend there as well for your products? Does it make sense for trauma, even I'm not sure if you can treat trauma in ASCs. And also is TOUCH gaining traction in ASCs?

Absolutely. So we see a trend of the ASCs in the U.S. This is, of course, also for TOUCH the case. You know that touch is an ambulant surgery. The surgeon normally does the surgery in 40 minutes. Patient is then going out. So yes, we see this, but not exclusively in the ASCs. We are also well presented in the big orthopedic hospitals also with TOUCH and the rest of our portfolio.

And we have a follow-up question by Sandra Dietschy.

So you mentioned during the presentation, your ambition to become #1 player in the upper extremities. Do you have any time line for that in mind you can share with us? And then also more specifically, is the ambition to become a leader across the whole upper extremity segment or just specifically hand and wrist I would estimate this is a market of CHF 1.5 billion roughly.

Correct. I think exactly it's hand and wrist. I mentioned hand and wrist where we can become a world market leader. To become a world market leader, you need a significant market share in the U.S. I think we are already showing that market leadership is possible in many of our European countries. This gives us the confidence. What gives us also the confidence is that in the U.S., for example, but also in other markets where surgeons never used hand or wrist portfolio for Medartis, everybody knows it. and it's world-class products and everybody is open to try it and to start to use it.

This is quite a way to achieve. So we are not announcing midterm targets, but we have a strategy until 2030 to further expand our market shares in markets outside EMEA. But in 2030, we will not be yet the world market leader. It will take a little bit longer, but we will have a significant market share in hand and wrist in the U.S., definitely.

Perfect. And then another follow-up question on Keri TOUCH, which you also introduced in Australia, and I understand you still don't have reimbursement there. So it's still out of -- fully out of pocket. So maybe you can comment on the commercial and clinical update there so far and lessons learned, which you maybe also can apply to the launch in the U.S.

Yes. We are waiting now for the final reimbursement in Australia. But as you said, if you place over nearly 200 TOUCH in Australia over the time and all the patients are paying out of the pocket, this shows how well received this product is when a patient understands that this will improve the quality of life. And I think this is a big learning for us. And it shows us again in the U.S. now. The patient we saw the lady doing the left hand thumb and 2 months later doing the right hand, this is something Dr. Tueting was not speaking her into this surgery. She decided to do it because she was so excited.

And this is something which gives us a lot of confidence.

So we have Ed Hall from Stifel. He raised his hand. I don't know if his question was already asked. If not, please raise your hand again, and Leon has a follow-up question.

Just one more detailed question on this Keri reevaluation that you did. Can you explain what the context of this was? And was this a positive or negative effect. On the slide, you had those 3 numbers, just to understand which ones were actually supportive or not supportive?

The revaluation impact of the initial Keri stake of 47 was done at the time when we increased to our full ownership. And that was on the reported figure, a gain of CHF 14.5 million that we excluded from the core figures. And obviously, that went into the PPA then the purchase price allocation of the acquisition.

Then a question from Sibylle Bischofberger from Vontobel.

Thank you, Fabian. Cranio-maxillofacial is only 16% of total sales. But anyway, it's a historical part of your business. We didn't talk too much about CMF, but what are the goals for 2026 and furthermore?

To further grow it, we had in 2025, a refocus on CMF, which was a little bit lost throughout the years. But again, we had also a change in our motor system in many countries. So therefore, the growth rate in '25 to '24 is not one-on-one comparable. We had a lot of sell-in also throughout the change in 2024. We have huge opportunities. It's a small market segment, a very specialized market segment, and there are only a few players. There are other big companies stepping out because they do not have this heritage and legacy in this product portfolio, all what we have -- we have a motivated team here.

We have engineers working for more than 20 years with Medartis and everything started with CMF. So I see huge opportunities and especially because we are adapting very fast on those patient-specific implants, new design patient-specific design and now CADskills also moves into this. So we are broadening a little bit the opportunities for CMF.

So it remains key in your business.

Yes. Yes.

So the person stepped back from his questions. So if there are no further questions, I just look around the room. It was an interactive session. Thank you very much for everybody participating.

So before I kick it back to Matthias, just a demonstration of our annual report. So you see a little bit how it looks like. There's a creative team behind it that created this. And of course, you see Jonathan again and other great people from NeoOrtho as well as from KeriMedical. And with that, Matthias, you have still one big thing left for today.

Yes, one big thing. FESSH. FESSH is the European biggest hand congress. I would say the world's biggest hand congress. Every time I'm saying FESSH is coming home to Basel, to Switzerland. It was last year in Helsinki, and now we are hosting the FESSH. And we are hosting for you media and investor event on the 3rd and 4th of June, where you can also listen to some very prominent hand surgeons like Daniel Herren, for example, from the Schulthess clinic in Zurich, giving a very nice presentation, what really TOUCH means and how it is placed and how the patients are reacting.

You can have the opportunity to visit our booth. It's the first time that we are appearing and in the future, it will be ever like this, KeriMedical and Medartis together and getting a little bit of feeling also about our main competitors. And of course, we will also socialize together. So it would be very happy to welcome you here in Basel again, and it will be summertime. So hopefully, see you.

Good. And Ed just came back. So Ed, can we also open the line for Ed Hall from Stifel because he could not attend us today in person. We can hear you well.

Very good. Back on TOUCH, I think you mentioned the 300 surgeons trained in '26 or looking to train these 300 surgeons. I'm curious as to what your assumptions are for the midterm. And then also, if we think about the patients for touch, how many are you assuming are going to be having multiple placements. So obviously, 2 thumb joints?

Good. Look, the 300 surgeons trained per year, this is forward going as well. We believe we should not train more to really have a controlled approach. So it will be next year as well, 300. We will end up the year 2026 with slightly above 300 surgeons trained because we have the one carrying over, which already received training throughout 2025. And then the fact that there is a patient who has done 2 thumbs, I would not generalize this. This would be wonderful. We know that we have estimated our market potential on 15,000 cases in 2030. Out of the 150,000 treated 3 cases in thumb in the U.S. For the moment, I'm sticking to this number. We will see how fast it goes. But also what is very important for the next 3 years, we are alone. There is no other competitor in the market because there is no other competitor with the FDA. And this is a unique opportunity for us.

And yes, let's see. Hopefully, I have some more news in August when we have 7.5 months already running into the year, how many TOUCH we placed. For the moment, all fine, all good.

Ed, do you have a follow-up question or...

Yes. Just one quickly on I think it was asked, if we look at other regions, it really has been a headwind for a number of years. Is this still the case?

I didn't understand the last part of the question.

Just on pricing for APAC -- Australia.

Pricing for APAC for Australia. Yes. Look, for the moment, we have no further price reductions from the government. We don't know if -- we hope this stays like this. We had still an impact a little bit in the first half year, but this is over for the moment.

And then as you carefully read in the press release, we also opting for reimbursement in Australia. Today, it's more or less paid out of the pocket. So it always creates a little bit of volatility there, but we also are optimistic that in the second half of the year, we will reach also a greater reimbursement for that more patients can opt for the treatment that are in need for it.

There is a question coming electronically. I just read it out. So there is someone asking, so based on the approval by the FDA, we were also asked to submit post-approval study data so that people are safe to get treated by TOUCH. Is there any news flow for the public that they can know what the news flow is, how good the results or how bad the results are. And -- or is this just taken between Medartis or KeriMedical and the FDA?

The study started immediately. This was one of the obligations from the FDA. The results are very good, but we are not publishing those results yet. They are not different to the results in Europe. So -- and we do not expect to have other results in the U.S. than in Europe. Very successful. We have 9-year clinical data. And this clinical data we are using, but we cannot use the clinical data from Europe in the U.S. So we will use this once we are 1 year into the data, 2 years into the data. I think it makes no sense to use data, which we have only gained over the last 2 to 3 months.

Good. I think this is very important that the clinical data are good. That's why we also take a careful approach. We have to train the trainer. Matthias mentioned that 10 surgeons have to be followed by the field specialists in order that we also get great results out that people remain confident in the product.

I think it's fair to say that when you speak also with the specialists and the clinical team of KeriMedical and throughout all the years, we have never seen a big failure in the prosthesis. When there is a problem, it's sometimes because the patient is not careful enough. They are hard working and not waiting at least 3, 4 weeks to get to some movement again. And they are drilling holes into the wall and then it's getting vibration. It really happened or in a very few cases, a wrong positioning throughout the surgery. But everything is not a big damage and it's repairable.

Okay. That's one more reason why you should join the June event because Dr. Herren as mentioned by Matthias, he's one of the biggest user, long-term user, and he also has a registrar from his clinic to surgeons that have operated many over -- more than 100 patients. And somewhere, I also invite you to come join us as you're close by our head office here.

With that, I would like to close out this session. It was very interactive, 90 minutes. That's probably the longest session we ever had. There was some good news flow, but we don't stop here. There's also a complete IR activity program outlined on Slide 39 of the deck. If we haven't seen you here in person, make sure you sign up for one of these trips, and we're happy to give you the full story and answer all the questions you might have.

Otherwise, you can also reach out to us through [email protected] or [email protected]. And we have to -- we are glad to assist in any way. And with that, I hand back to Matthias maybe for some closing remarks you might have.

Thank you. No, again, thank you very much for joining. For me, I don't know for you, Peter. For me, this is really a joy seeing you face-to-face and not only listening to a conference call. And yes, and thank you for your interest in Medartis. And see you very soon, hopefully, on the 3rd of June, and let's rock it together. Thank you.

Good morning, and welcome to Medartis Half Year Results Conference. Thank you for joining us today on a busy day. We will be referencing the presentation slides published this morning on our website. I would equally encourage you to review our comprehensive half year report, which contains the complete financial statements as well as additional details on recent business combinations.

I'm pleased to introduce Matthias Schupp, our CEO, who is presenting for the second time results and is the first time on his own guidance. And Dirk Kirsten, who is familiar to most of you from previous calls.

Before we begin, please note 2 important points. First, as always, we would like to draw your attention to the disclaimer, which you see on Slide 2 here, especially for forward-looking statements. And then we would also encourage you to submit questions. You can do -- either do that in writing via the Q&A field that should be available to everyone on the desktop, the ones who are using Android, but not the ones who use mobile iPhone. And then as alternative, raise your hand, then we will call you up. And once it's your turn, we would then appreciate if you could unmute yourself. And if preferred, you can also activate your camera on.

And with this, I would like to hand over to our CEO for his opening remarks and the highlights both the first half. Matthias, please.

Yes. Good morning also from my side, from sunny Basel. This time a Teams' call. I really hope we see each other next year in March again face-to-face. I enjoy this much more. I think the sunshine corresponds with our results. I'm very happy with the performance. We show an organic revenue growth of 15.3%. Our total sales in the first half reached CHF 123 million, including already May and June, NeoOrtho, which we consolidate since May. And Brazil, strong with the value segment, I come to this later. Organic growth exceeded expectations and the upper end of the guidance range.

And this is confirming what I said to you in March that when you ask me about the guidance, that we would like to deliver on what we promised. NeoOrtho integration is on plan. I'm very happy how this, we call it, Cold Fusion project, is running in Brazil. I'm there next week, and we will take already the first structural changes to bring the teams together, so everything on track to move end of January next year, beginning of February into the new facilities.

We will have a back office consolidation and then in the new facility also, our new production site for NeoOrtho in Curitiba. Curitiba is at the south of Brazil, an hour away from Sao Paulo, an hour from Rio de Janeiro. It is also important, and I would like to reconfirm this, that with the value and premium segment in the future, we will have 2 focuses in Brazil and in Latin America where we maintain a commercial team focused on premium Medartis and a separate commercial team focused on value. But whatever is behind the scenes, back office, of course, we have a lot of synergies.

Just coming back from a town hall yesterday with the KeriMedical team. We finished now. We closed the acquisition last Friday. This is not part of our first half year, but it's very important that we are now with the FDA readiness, with the FDA approval, ready to launch in the U.S. We acquired the remaining 53% and we are now preparing the market entry in the U.S., means our team is already in place. Our dedicated Keri team for the TOUCH launch this year. We mainly focus starting end of September on education activities, continue education activities.

And then I expect the real launch and the real first sales beginning of next year. The guidance for the rest of this year, for the second half, we raised to 14% to 16% based on what we have achieved in the first half, but also based on how July and August is coming in. I think we are seeing a satisfying positive trend. And we maintain our EBITDA items unchanged despite the U.S. tariffs. And now the tariffs, this is the buzzword over the last few weeks, especially.

Let me give you some clarity on this, and I would like to be as transparent as possible with you because the question will come later anyway. We did not expect 39%. I think nobody expected this. On the other hand, it is what it is. And me and my team, we only can act on what is happening, what we have in our hands. We will have for 2026, a high single-digit million impact when it comes to the tariffs to the U.S. And I would like to divide this in 3 parts.

1/3, we will mitigate with price increases, which we have already started beginning of this year in the U.S. You know that in the U.S., you have contracts with hospitals, with insurance companies. So around 60% of our business in the U.S. is under contracts. We had a huge opportunity with the change in the U.S., having now more focused in upper extremities that we got new contracts, so we established already new prices. And this is ongoing for 2026 because those contracts normally have a run time of 2 to 3 years.

1/3 is our production ramp-up in the U.S. You maybe remember in March, I already explained to you that we took the decision already end of last year to use our Warsaw facility without knowing yet the tariff impact to produce in the future in the U.S. for the U.S. demand. This was at the end, the good decision. And what we are doing currently is we are speeding up with this ramp-up of the production. I estimate that by beginning of 2027, let's say, in the first half of 2027, 80% of the U.S. demand will be produced in the U.S.

By end of 2026, we will already produce 60% of our U.S. demand. A side note, Keri TOUCH is coming from France, produced in France. So it's not applying the 39% tariffs, only 15% tariff. And the third part of the impact, especially for next year, we will have a general cost mitigation in headquarter in other regions. But here also, it is very important that when we speak about cost mitigation, we will not stop the positive credit in our regions. We will further invest in our sales teams. We will further invest in expansion when it comes now to the TOUCH loans in the U.S. We will not kill this momentum.

The impact for this year, for the remaining 4.5 months, since the 39% are in place, Dirk will explain later. But you can imagine, as we maintain unchanged our EBITDA guidance, we are in a position to manage this impact for this year as well. People are important. Human capital is important, and I'm very happy to announce 2 important EMB changes. One is Marc Ammann, already 17 years with a company appointed EVP and R&D and innovation. He is an internal successor. This is also very important that somebody stepped up in the EMB.

And I'm totally happy, especially with this agility, knowing the orthopedic industry, giving our innovation a new drive, focusing on digitalization, Marc now part of my EMB. And normally, it's ladies first. Now it's the second part is Caroline because she's a newcomer. She joined us as the Chief Human Resource Officer, our CHRO, bringing over 2 decades of experience coming from one of the top banks. But before long years, the CHRO of Google, Switzerland. Before this GE. So she brings everything to drive also together with my EMB, our culture forward, and I'm very happy that my EMB is now completed.

And this -- I speak about the one team approach, a team make dreams reality. You see in this chart as well how KeriMedical is incorporated in this management. You know that, that I will come back later to this. We maintain KeriMedical as a stand-alone company inside the Medartis Group. But the 2 founders, Dougal and Bernard, they maintained their seats in the Board of KeriMedical, and they are now forming an Advisory Board, very close with me. I have the General Manager of KeriMedical, Julie reporting to me, my [ EMG ]. This is the level below the EMB and also our VP, who is responsible for the commercial activities of Keri worldwide, former team member of Medartis, sitting here in Basel is also part of the EMG.

So you see here, my team is complete. And also on the chart, you see that as I told you already in March, yes, I'm taking care about our value expansion in Latin America because this is very close to my heart, and I know NeoOrtho very well. But the daily work is done by Frederico, he is our transition manager and reporting to me for the NeoOrtho transition and our Cold Fusion project.

When we look -- and Dirk will go in a little bit to the detailed figures, but let me focus on the growth of our regions. EMEA continues a strong momentum with 16% growth, very, very good. I'm very happy with the team. Those are very mature markets, especially in Germany and Switzerland, and we continue to grow. Also fueled in Germany, in Switzerland, in Austria, and in the U.K. by Keri TOUCH, but very strong sales. I'm absolutely pleased with the U.S. performance with a 16.2% growth. Well, remember, we changed in the first 5 months, 20 out of 57 distributors in the U.S. We are now finished. There is one change ongoing in Florida, in southern part of Florida, in the Miami area, but this is not a huge impact.

But having 20 distributors changed out of 57, growing 16.2%, yes, I could not be more happy, honestly. And now we see the team is complete. The distributors are complete. We have a clear focus on Upper Extremities. We are focusing on what matters, and I see this continuing. And yes, I can tell you, expectation for the U.S. in the future is, of course, growing close or over 20%. So we are on a good way, very well done.

APAC region, back to growth. You might remember our biggest country in Asia, Australia had some price cut impacts. We still suffered a little bit from it in the first half year. But despite this together with the Japanese business, we are growing 14.9%. Japan coming in better, especially in CMF, fantastic growth, but also in our lower extremity business. We are still a little bit suffering in Japan in our upper extremity business. This is not good, and this will be attacked.

But also to be very honest and transparent with you, my head space in the first 9 months was not necessarily Japan. It was U.S., it was Brazil, it was EMEA and KeriMedical. And now I'm very close to our Japanese team. We will tackle this. We have more opportunities in the future. But overall, APAC, Australia and the rest of the business in Japan, very well on track.

Latin America. If you see the figure here, not on track yet, better than last year, but this is not good enough. Working on this, especially our premium business, the Medartis business. If you would include NeoOrtho, it's clearly double-digit growth, more than double-digit growth in Lat Am, but it's for Medartis, not good enough. We had some problems, especially in Brazil with some insurance companies ongoing.

We are solving this. We have new entries also to those partners through our NeoOrtho partnership. They are much better established in Brazil. And we had some distributor changes in Mexico. So revamping this again, so a lot better than last year but not good enough to get this together. But overall, very happy with the first half year and I told my teams it's also a moment to celebrate with them.

When we look into our segments, the Upper Extremities, and this is the main focus, especially hand and wrist, driven by TOUCH, but as well with dorsal olecranon, this elbow implant, with product launches, with strong growth in mature market, but also driven by strong growth with Upper Extremities in the U.S., our biggest business. Then we have our TOUCH now, especially in the markets in Europe, what I already mentioned to you. We have the NX Nail. This is a product we are distributing in the U.S. with strong growth. Our screws portfolio, our unique screws with very dynamic growth. We have a stand-alone future in the market.

Our CMX is digital personalized solution business, is becoming stronger and stronger, and we are expanding in this area, and we are also analyzing to have CMX planners outside Basel. It's becoming bigger. You cannot do this only in Basel. We need to see also next steps if we will start to have a CMX business and the planning business in the U.S. And CMF, our strategy from head to toe, CMF that had our legacy. You might say 10.3%, this is not very much, but this is based on a very strong MODUS 2 launch last year in the same period of first half year, where we sold a lot of sets. So this had an impact. So I see the CMF business, which much more growth momentum coming in, in the second half and especially next year.

And with this, I would like to hand over to my CFO, Dirk, and he will provide you with the financial details, and I come back later. Dirk, please.

Thank you, Matthias, and good morning also from my side. I'm going to lead you through the financial slides right now. Starting with Page 11. We summarize the key P&L items for the first half of the year, we reported a core gross margin of almost 81% with a 17.8% core EBITDA margin. And for those of you who are interested also a core EBIT margin of 8.5%. Now while the gross margin came slightly down versus previous year, the EBITDA margin slightly increased, and that was despite FX and also what I call the Trump customs or the Trump tariffs, mainly due to operating leverage and also continued cost consciousness.

Our cash flow was flat for the first 6 months of the year, and the group carried about CHF 121 million cash at the end of June with that one also being well prepared for the upcoming KeriMedical acquisition, which we then announced just a couple of weeks later and which now is going through the cash flow.

I'm moving to Page 12. And here, you see the gross margin. And the first impact factor, first of all, was FX. We're just talking a little bit about FX because I know that is a huge interest for all of you. The impact on top line was more than 300 basis points. The impact on gross margin was 50 basis points. And when you come down to EBITDA and to EBIT, the impact is even 140, 150 basis points.

So you see that the impact from FX in the first 6 months, especially after the Trump announcement, the tariff announcement, which also weakened the market, the U.S. dollar coming down, Australian dollar coming down, some other currencies coming down, had a huge impact on our P&L. The good news is that we were able to compensate that on an EBITDA level. I'm going to show you in a couple of minutes.

Now what is important is that the factors which we can drive, the U.S. -- where the U.S. tariffs, we cannot really drive, but they had an impact of 0.5%, I'm coming to that later again. Our business mix includes KeriMedical, and I need to explain that to you currently or in the past, we were selling KeriMedical as a distributor. So as a distributor, normally you have lower margins. In the future, this will change and we can consolidate the entire margin of KeriMedical into our own P&L.

So the impact which you see here of 80 basis points negative reflects an enormous growth of KeriMedical in the first half of the year, the dilution which comes from that on a gross margin basis, but you will also see that on an EBITDA margin, it is different. It's even accretive. But in the gross margin here, we have to report it. There were a couple of other factors important for you. Our core gross margin is still 81%, which we believe we can also hold and we are taking measures, especially also on the tariffs to protect it as much as possible.

Now talking about the tariffs, I think Matthias -- Page 13, by the way. Matthias has already spoken about that. So I'm not going into the details. But of course, what we've done, we reviewed our transfer pricing very, very short term, that was already in May. Matthias mentioned that we are looking at price increases wherever they are possible on a selected basis and that without killing the momentum, very important for us, and also to remain competitive. And of course, we look at our cost basis, be it in manufacturing, be it through the entire organization.

But also, as Matthias has said, we're not killing the growth. So very selectively, we look at -- we focus the spending along where the biggest growth areas is, especially on Keri, we have a dedicated growth investments. Now to support the launch in the U.S. of TOUCH and there we will not make any compromises. Overall, we believe that we can compensate some of that impact from Trump. We've calculated it for the second half of the year. We believe the impact will be gross about 120 basis points, which is on top of the 50, which I mentioned before.

But we also benefit from the positive effect now from the 2 acquisitions, both KeriMedical and also NeoOrtho, have an EBITDA margin, which is accretive to our own. And when you look at that, there is the positive impact, which comes from the full acquisition of KeriMedical, also the gross margin, which I mentioned before, plus also the EBITDA impact, which is positive. So we hope that we can compensate most of the negative Trump impact by the measures, which we've mentioned.

And of course, what Matthias has said, in the midterm, we are ramping up. It's already starting right now. We're ramping up the manufacturing in the U.S. We had planned that anyway, will be now faster. And with that one, we can reduce the volume which we're shipping from Switzerland into the U.S. and with that one, also the tariffs, which we have to pay for Mr. Trump. So this is at least the short term and the midterm strategy, and we hope that we can compensate most of it with a combination of the measures.

Now talking about the EBITDA on Page 14, you see the positive -- the negative gross margin effect, but you see also the positive OpEx ratio effect. And let me just come on this one because there have been many questions in the past. With increasing size, and we're now going above -- clearly above CHF 200 million sales for the full year, that should also be the operating leverage. And we have always said that, and we see it also coming. We're trying to manage our costs tightly. But also, as Matthias has said, we continue investing into where the growth is.

So when you look at the allocation of the increase of the OpEx, most of that has been done in the regions. There has been also additional spending for training and education for R&D, which all drives the growth. And with all other functions, we're trying to remain as flattish as possible. I mentioned here NeoOrtho is accretive. Now you will understand that for consolidating it only for 2 months' time, it is not material at this point of time. But what I would expect is that when we come back for the full year reporting, there is a positive impact from NeoOrtho and also from KeriMedical, which so far was an associated risk item, which will now be fully compensated into our P&L.

Now the message here also should be 140 basis points up on a CER basis, but a hit of FX or from FX of 140 basis points. So what it says is that, in fact, in the first half of the year, we fully compensated FX on that level, the FX impact as we also compensated with the cost savings, especially the Trump effect. This is what we're proud of.

Now moving ahead, I've seen it already in the press, a big surprise on the finance side. I need to explain it to you. We had more than CHF 5.2 million unrealized losses, that's very important, unrealized noncash losses in FX. This came from the Australian dollar. This came from the U.S. dollar, most importantly in some other currencies. Where does it come from? When we sell products into the organization, we normally have a loan or an accounts receivable, which is in our books.

And if I have $100, which go into the U.S. and the dollar comes down 12%, this is what it did or the Australian dollar even 20% almost in the worst time, then I have to revalue these internal loans and that creates an FX loss, which is unrealized. It can also revert. We're managing this carefully, but we are putting cash impacts over P&L impacts. Otherwise, we could hedge it, but then we have a cash outcome outflow. And for that reason, we remain it as it is with the potential also that there will be an upside potential in the second half of the year.

The result is a slightly negative net income. I wouldn't overemphasize this too much on an EPS basis, it is surprising for you, but it comes mainly from the FX and then also additional financing costs, which we have since the convertible last year, which is about CHF 3 million.

Now last page will then be on cash. Cash was flattish versus last year. When you look at the absolute figures in the report, we've been very disciplined in managing some of the working capital position, the inventory, excluding the acquired inventory from the ortho, but our own business has been managed very tight. The same thing is also due for accounts receivables. We had a swing in accounts payables, if you want to look at the details, but overall, it was more or less flattish.

At the end of June, we carried CHF 121 million -- almost CHF 121 million in our balance sheet. That money is now being used for KeriMedical. In fact, it has already been partially used for KeriMedical. But we remain our financial flexibility because we've renegotiated some bank loans; with that one, have additional financial headroom, which is about CHF 50 million going forward. And with that one, we're very confident we can finance everything, which is the ongoing business. And by the way, we also expect that our own cash flow is increasing and getting stronger. So as a result of that, we are extremely confident with the cash level, which we have, including the bank loans.

That being said, I hand back to Matthias. Thank you.

Yes. Thank you very much, Dirk. Now a little bit some follow-ups on the strategy and on our strategic priorities. It remains unchanged since beginning of the year, literally from head to toe. But let's start with the Medartis Group to bring in our newly acquired businesses. And this is one of my biggest learnings in my professional career. Never change a winning team, never try to change their culture, maintain the spirit and the innovation drive of those teams and let them do and let them continue to work independently and not try to include this in your company by dividing the areas and establishing reporting lines.

And therefore, I maintain KeriMedical totally, and I said it already, separate as part of the Medartis Group, and this will give us the innovation power. This will maintain the agility of this company and this go-to-market and this very good marketing and education approach. The same, of course, we will do with NeoOrtho and even further in NeoOrtho, we will integrate our Medartis organization because we only can win with the benefits we are getting together.

Now our 6 strategic priorities are unchanged. I see a very solid and good progress over the first, yes, 7 months. They are in place now. We see now in the next chart some examples and some highlights how we are continuing and each of this strategy priorities has their own owner. But please allow me 30 seconds to come back on this customers centricity. Everything and now my organization understood it worldwide, all what we do, we have to do for our customers.

If we do not act and what our customers are expecting from us, it sounds simple, but it is not as simple. We have no right to win. And this is supported by a fundamental high-performance culture, and we are doing good inroads now with our high-performance cultural workshops with our cultural learnings. And I'm very happy to welcome 100 of our top leaders worldwide in September for the first time for our Medartis management meeting and the whole meeting, which will be our kickoff of the budget process 2026, but at the same time, will be embedded in our culture so that we have live -- to have to live this culture together.

Let's start with the first priority, our U.S. growth progressing to plan. The figures demonstrate this. Very happy, as I said. I think the underperforming and nonexclusive distribution partners are exchanged. There was one big surprise. This was the change in Florida, which was not planned, but happened. And sometimes when doors are closing, new doors are opening and you see new opportunities. And what we figured out in the last 2 months is that we have a huge opportunity to grow much faster and much more focused in the Florida region than what we have done in the past with only 1 distributor. We now changed to 4 distributors in this big Florida territory.

We are focusing on training and education. This is very important. This is especially important for the Keri launch. And we have now created together with our new U.S. President, our sixth sales region to have a focused approach. And especially when we speak about Florida, again, this is one of our top regions and has now their own regional sales manager because Florida, and you might recall this from my -- from the March call, is one of the key regions also for the TOUCH launch.

Speaking about TOUCH, we have a controlled rollout plan defined. We will focus on education. This education process has already started beginning of the year when 45 surgeons from the U.S. were trained by KeriMedical in their infrastructure in Europe, in France, but also together with some universities in Switzerland and in Belgium. So we will continue. We will retrain those key opinion leaders and prepare everything for an education-based launch in the U.S. We need to be very careful, and you might call it slow, but we are very careful that we are selling TOUCH in the first moment only to train surgeons to get the positive momentum into the U.S.

The reimbursement study started. We will have our first reimbursement code by end of the year, beginning in January to start selling the TOUCH prosthesis in January to the market. The sales this year, the TOUCH prosthesis is now shipped to the U.S., will arrive in September out of customs. So we will start with education approach in October. The sales this year are not very, very big. So we are really focusing on education. And we will also use the Keri facilities for onboarding of new key opinion leaders, but planning to have our own education center next year also in the Florida region to not travel every time with the surgeons over to Europe.

So U.S., I would say, promising, confirming the trust we showed in them and confirming this speed, this agility, this bold thinking from the new management in the U.S. KeriMedical, I spoke a lot about it. The growth momentum continues, especially in the EMEA region. You will ask me every time for detailed figures. I give you one figure that maybe in the most mature market, which is France, where KeriMedical is already many, many years in the market, we still see high double teens growth. This shows how dynamic this opportunity is; of course, much accelerated in countries where we have a new launch like the U.K., but like Germany really accelerating and this will -- this momentum will further continue.

Just discussed it yesterday because we leave the team in place, which was so successful over the last years. And this means also that we have dedicated Keri teams field expert, but also sales for the Keri TOUCH prosthesis and not mixing this up in a Russian salad with the rest of our teams, really focusing and getting most out of it. On the other hand, yes, we know that the prosthesis is a new procedure in the U.S.. And therefore, we are dedicating -- analyzing our future key opinion leaders in the U.S., driving it by new surgeons, young generation of surgeons, well established in the U.S.

And therefore, we are so optimistic with the Keri continued growth in our countries where we are in EMEA, but also the new launch. We are also in parallel starting registration processes. So Keri TOUCH will come to Brazil and will come to Japan as well. We estimate 1 year more or less for registration. So the U.S. and Australian market launches are underway. I already spoke about this. Nothing new on this chart. I don't need to read the chart for you, and I already spoke about the 45 KOLs.

Maybe one word to our key opinion leaders. When we started the training, we decided together with KeriMedical to train 45 KOLs to have at least 25 KOLs active afterwards in the market. And the big surprise was that the 45 KOLs are totally flashed, all of them bought in Keri, all of them are waiting now for the TOUCH prosthesis arriving in the U.S. and doing the first cases. So we have 30 U.S. reference centers now in some 2 surgeons, 2 KOLs are working to start the first surgeries.

So on one hand, you can say, yes, those surgeons have already patients waiting to get the prosthesis. But then again, when they do the first touch prosthesis, you have a ramp-up phase. And we are calculating with this ramp-up. So it will start with the first prosthesis this year. And then next year, we will start continuous training. And we are planning to train around 300 surgeons per year in the U.S.

NeoOrtho acquisition, this is our value segment completed in May and the integration on plan. The integration is our Cold Fusion project. I think I explained already most of this. HR strategy is clearly focusing on maintaining our key talents out of both companies, aligning leadership structures. We will also continue -- already continue with this. The production facility is on time. It's very fast advancing. We are also lucky with the weather in Curitiba currently. It's winter time, but not as much rain as in the past. So we are totally in time that the facility is ready in December, and we can move in, in February.

We see also that NeoOrtho has an accelerated sales momentum much faster than Medartis. This shows again how promising this value strategy is; and especially in CMF, the growth was outstanding in the first half year. This team is really doing a great job. The premium and value brand positioning maintained -- will be maintained separately. Our focus when it comes to the sales channel is separate. We will not give, for example, NeoOrtho and Medartis together to one distributor because then they are mixing up everything, and we will lose the momentum.

Value is not cheap and premium has an additional service to offer. So we separate this, but everything back, not visible to the customers in the backseats, back office, marketing, education. Here, we have HR, finance team, production, we are working with one team. Closing important portfolio gaps. I mentioned already the dorsal olecranon system for the elbow. This is a new launch, which happened throughout the first half of this year for elbow, very well accepted.

We have in the U.S. for the elbow, the Avenger radial head system, which provides the U.S. surgeons interoperative flexibility between arthroplasty and blade fixation. We see an increasing momentum. I was not quite sure, honestly, how Avenger radial head will really move and push our Medartis portfolio for the elbow, but we see that now the surgeon has the full solutions on the table when it goes to the ER, OR and this helps. So both launches, very successful, combined with our Hand 2 launch.

Yes, our outlook for 2025, let's say, for the second half or for the remaining of 2025. We are raising our guidance to core sales of growth of 14% to 16%. Again, remember, we deliver on what we promise, and we maintain our high teens rate when it comes to core EBITDA margin. And I think Dirk gave already the explanations to you.

And now we are happy and curious to take your questions. And with this, I hand over to Fabian. Thank you very much.

Excellent, Matthias. With that optimistic outlook, we will go seamlessly into the Q&A session. We welcome your active participation. [Operator Instructions] And with that, we will start with the first person, Sandra Dietschy from Octavian.

I have 3. So the first one is on the U.S. market. You reported very solid growth in the first half, showing that the optimization of the distributor networks works well. So what impact do you expect from this to have on the U.S. growth rate in the second half and maybe also in 2026? You mentioned your ambition of U.S. growing more than 20%. I assume this is rather a midterm target and not an ambition for the second half, but clarification there would be helpful.

And then second question on the gross margin. Could you clarify what's the expected gross margin of KeriMedical? I recognize that converting the distributor margin to a full manufacturing margin is a tailwind. But should we expect that the KeriMedical underlying gross margin is still dilutive and maybe could also the touch manufacturing ramp-up in the U.S. weigh on the margin. So I just try to better understand how we should think about the consolidated gross margin once NeoOrtho and KeriMedical are fully integrated?

And if I may, a third one, it's on KeriMedical acquisition. Here, I would be eager to hear some more details on the earn-out structure, specifically what performance metrics the earnouts are tied to. I assume that at least one is linked to commercial sales. And also what revenue potential you see for Keri TOUCH in the U.S. during the initial years, i.e., 2026 and 2027. That would be all very helpful.

Yes, Sandra. Thank you very much for your question, and we will answer the 3 questions. No worries. Let me start with the U.S. market, solid growth. Yes, the 20% and then above 20%, this was a target I already gave in March. This is more for starting 2026. I would expect the U.S. growth above 16%, clearly 16%, continuing growing faster than the second half. We have seen this already in July and August. I'm cautious because I mentioned Florida is the biggest region. We had one distributor for 17 years working in the Florida region, so -- and it was not expected. It was not our plan to change him, but it happened.

So no problem because we need exclusivity, the main reason. And then this had an impact over the last 2 months. But overall, we are heading towards the 20%. And U.S. is part of my -- of raising my guidance or our guidance now because very, very well underway. Before I hand over to Dirk regarding the gross margin to Keri, just to clarify, we are not planning yet to produce TOUCH in the U.S. I understood that you mentioned TOUCH production in the U.S. Anyway, TOUCH is produced in France. We have only 15% tariff. It's not so easy to produce the TOUCH prosthesis.

So we are really focusing now in the ramp-up to the U.S., our Medartis portfolio. And before I hand over to Dirk, just the earn-out. Yes, there is one earn-out based on the next 2 years, '26, '27 sales performance in the U.S. Though this has to happen, there was another earnout is with the study, with the reimbursement study. This is really well underway. And of course, there was another earn-out, and this is the one we already mentioned, which is fulfilled, which is identification and training of the key opinion leaders. And now for the rest of the answers, I hand over to Dirk.

Just on the gross margin, I meant that there might be a dilution from the ramp-up of the touch for the U.S., not that you manufacture in the U.S., but maybe that's within the question on the gross margin for Dirk.

Sandra, first of all, currently, the gross margin is accretive to our business. We are currently doing the IFRS conversion. The numbers which we know, which we've also looked at in the due diligence earlier was clearly an indication that it's accretive to our own margin with and without the Trump effect here. Also here, we can work a little bit with transfer pricing and other things. But here, you should expect that the margin is accretive. It looks slightly different when you talk about NeoOrtho. Remember, this is the value strategy. So the value strategy you sell at much lower prices, which it's normal that we start with a lower gross margin.

What is -- however, the fact is that when you put it down on an EBITDA level, the cost structure is much leaner than our cost structure is, which is also typical for a value player. And that means that the EBITDA margin is accretive. But you're right, we are talking about 65% gross margin for NeoOrtho and the more NeoOrtho we do, of course, there is an impact. If you look at it on a relative size basis; however, it's still a small company. And for that reason, we've been also confident to hold our guidance.

Sandra, I forgot one answer to you. You asked the expectation of Keri sales.

Exactly.

This is a very tricky question, and I've read already some projections from your side. You are getting close. Let me explain you over the next 5 years because we have a 5 years plan. We have around -- in the U.S., we have around 150,000 procedures. We expect that we can catch at least 10% of these, 15,000 procedures in 2030. It is a slower ramp-up because education takes time, and we need to be very careful as it is a new procedure in the U.S. to get a momentum and positive comments from the surgeons. Therefore, we spend time on education and not just pushing the cases through, especially 2026.

And then for us, the example is Europe, example is France, Belgium, Germany, how this ramp-up works. And there is a math behind. We plan to train at least 300 surgeons a year on the TOUCH. And then you know exactly they are doing 1, 2 cases and they wait another month, they are doing the next 2, 3 cases. And so it's coming up, and in the meantime, we have surgeons, they are doing 10 cases per week. So this is a little bit what we are expecting over the next 5 years with TOUCH in the U.S., but 10% should be absolutely possible.

Very clear, Matthias. I hope Sandra, you're happy with the answer. We move to Daniel Jelovcan from Zürcher Kantonalbank.

So 3 questions from my side as well. The first one, looking at Asia Pacific, I don't really understand the composite of that growth. Because in Australia, you had the 2% sales growth because of the expected price cut. In Japan, you said you had some issues in the -- not your upper extremities, but you still recorded a very -- quite a strong decent 15% organic growth. So I wonder, I mean, and there are not that many countries left in the region to my knowledge. So just to get a bit more flesh on the bone. Maybe I just ask one by the other.

Okay, Daniel. Yes, I can answer you. Look, APAC, it depends a little bit how you look at it, growing on a low base. Japan, super growth with CMF. We doubled the business in the first half year with CMF. We have a separate distribution business in Japan, only focused on CMF. We are very strong on Lower Extremities. Also to recall, Lower Extremities started already 2 years ago to go direct in Japan before we moved from the upper extremity distributor also to direct. We are suffering at the same time in Japan with our upper extremity business because our former distributor became now a competitor to us. It is what it is, but the rest is growing very strong.

Australia, super effort. Surprised us a bit. We saw that the first half year will be a bit more impacted by the price cuts still. And then, Daniel, remember, we have also distributors in other countries in the APAC area. We have a distribution management sitting in Singapore, but the direct countries with the Medartis organization is Japan and Australia. And this explains a little bit the growth momentum for our APAC region. But still work to do. There is more in, especially if we get Japan under control fully.

Okay. Good to hear. Second question, just thinking about the Keri TOUCH in France, where it's, as you said, probably the most mature -- I mean, mature in [ epistrophe ], of course, market. How about the penetration just of the TOUCH prostheses in France, just to get an idea about the further upside versus current methodologies?

Yes, Daniel, good question. In France, this is the most mature market for TOUCH. This is their home market. This is their home game. They are rugby players, the Keri team. They have 85% of market share. And even in -- with 85% of market share in the high teens growing still. And this growth is continuing month by month this year because they are really doing patient activities. There is a strong momentum in acquiring new patients, patients asking for it.

We have seen in France because it's a showcase, a good learning base for us. We have seen in France, patients, they get the right sum done. And then 5 months later, they come back to the doctor and say, I need my left sum as well done. So it's really the standard and dominating the market.

And maybe, Daniel, if I can add from my side, we showed in the past, we haven't updated that slide for this presentation, but I'm sure we will in the future as well. So we showed you a penetration chart for the main countries where Keri is active. And France is about at 60% level, depending a little bit on what kind of data, how you take into consideration. That's about 3x higher than Germany is as of end of 2024, and it's about 30x higher than the one of the U.K. So in the U.K., we are only at the beginning. Germany, some leeway. And as Matthias mentioned also in France, the Keri TOUCH becomes more and more the gold standard in the treatment protocol.

Yes. And just to add, Daniel, this shows us also that it needs time. In Germany, now 2 years in the market, France over 10 years in the market, you see this difference. And once you have your surgeon network working and then it's really advancing fast.

Then maybe your third question.

Yes, Fabian and Matthias. And the third question is probably I haven't understood it correctly before I had some issues, but the tariffs, you said in '26, 1/3 is mitigated with price increases, 1/3 with the production setup in the U.S. And the other 1/3, I wasn't sure what it was.

Dani, I'll take this, Dirk speaking. Yes, it's true. Matthias also spoke about the ramp-up in the U.S., which is now accelerating. We had planned it anyway. You're absolutely right with the price increases, which we're doing on an ongoing basis, where we have opportunities and where new contracts are coming up. What he did not mention was the cost side on the one hand. We are very cost disciplined. We've looked but also on structuring it, on transfer pricing, these things.

And then I said also earlier during the presentation that with the acquisition of NeoOrtho and Keri in the second half of the year, we have 2 companies, which are accretive on an EBITDA level at least, and that should also work to hold the margin for the second half of the year. So it's not so much a gross margin comment, it's more a comment on EBITDA margin.

And the EBITDA margin in '26, everything should be recovered from tariffs? Or didn't you comment on that? I'm not sure.

I'm not saying everything, I have to manage your expectation yet, but we are very ambitious to compensate for as much as possible. And that's the reason why we also reconfirmed the margin guidance in the high teens.

Good. Perfect. Then Daniel, I mean you can always rejoin the queue if you want. The next question is from [indiscernible] from UBS.

First one would be around exit rates that you saw in July, August. Maybe you can comment a bit about that. Did -- continue equally strong? What about the U.S.? And particularly in the U.S., did you see any pullback maybe once the 39% of tariff were announced?

Okay. if I understood you well, [ Leone ], it is July, August. Well, happy, it continued. So it was definitely not a push to have a good half year closing in June. The momentum continued in July, a strong July, a good August. We are now mid-month, so still not finished. So I'm happy, yes, confirmed that we had to raise the guidance. No problem on this. And then in the U.S., what was the question again, please?

Also, how did you see exit rates there? How was the dynamic? Was it like some particular dynamic change once the tariffs were announced.

No.

Yes, I understand. Okay.

Honestly, not. I think in the U.S., we see the momentum gaining speed month by month, very positive. And as stronger as the team becomes because in many regions, we have a new team, so there are only -- also a few months in the market. And no reaction, I think seen any impact in the U.S. after the tariffs were announced, no.

Okay. And then another tariff-related question would be, we heard some other orthopedic companies talking about the Nairobi protocol and saying that they could leverage that to get exemptions for their exports into the U.S. Is that also something that you could possibly do? Or is that something that does not apply to your particular import?

I can hand it over to Dirk, but we are not doing those [indiscernible] strategies. I think very transparent way forward. There are protocols and whatever. We have to face it, and it's not planned to adapt it here. Dirk?

No, we can't apply. It doesn't apply for us. They double check those. From a legal perspective, it's just not possible to apply for us at the moment.

Yes. Okay. And then one last question around the guidance that you raised. Can you explain again, I just missed that. Why did you stick to your EBITDA guidance and left it unchanged, mostly because of tariffs and FX? Or is there another rationale that we should understand?

Exactly. It's a nice try. No, exactly, exactly. This is the reason. First of all, and Dirk will answer you based on figures, but deliver what you promise. This counts also in the second half. And we might have some further FX impact. And also, of course, we are trying to mitigate fully the tariffs. But imagine, it just happened. We have the 39% impacting 4.5 years, and our ramp-up is only speeding up now, not yet.

Yes. Leone, I don't know whether you recall, I presented earlier 120 basis points, which we expect to come for the second half of the year on top of the 50, which we've seen. We're confident we can compensate through the measures, which have been mentioned various times. We have -- we're a little bit lucky that now at the right time, the 2 acquisitions come in and to get accretion from those and through the full P&L. And we were also doing a little bit of structuring. We couldn't do the Nairobi, but we weren't just sitting there. In May, we also reviewed our transfer prices and tried to optimize it within the limits which we have.

So putting that all together, -- now I know that you have this implicit question what's going on with FX in the second half of the year. Our assumption was just that it's not getting worse, but it's not getting much better. Currently, we're seeing even though it's getting a little bit better, just wanted to not just -- so if we are a little bit lucky, we can hold that also from an FX perspective.

Just as a reminder, our guidance on EBITDA is on a constant exchange rate level. That doesn't mean that we don't manage currencies, but it's not included in the official value. The next question will be from Dylan van Haaften from Stifel.

So just another one on the touch rollout. So -- can you just reflect and tell us how we should think about year 1 volumes? Should we think about the targeted doctors doing double-digit amounts of cases? And maybe also can we reflect on when coding should come in? Is there existing coding you can be using? And what's kind of the price level we should be thinking out relative to Europe?

And maybe one additional one to that. Is there any data releases planned around the Keri launch in the U.S.? Because I know there's a -- I think there's a hand conference or there was one recently. Is there any conference activities planned for the next 12 months where we could also maybe see launch -- yes, talks about the launch.

Yes, Dylan, how are you doing? Well, yes, TOUCH, yes, we are going to all the bigger congresses. We have now upcoming in November ASH this time in Canada, not in the U.S. TOUCH will be there. But again, TOUCH is this education-based approach. So you can speak about it in a conference, you can speak about it in the Congress, but still you catch the conscience more in your education center and in your [indiscernible]. The volumes for the first year, this is a very good question.

Look, I told you, we have already 45 surgeons trained. We will train another 300 next year throughout the year. So let's say, we have 2, 3 courses, education courses per month. So this is coming in step by step. Yes, then you can calculate a little bit. So those surgeons who are already trained, they will do a first 1, 2, 3 TOUCH prosthesis. Then normally, they wait a few weeks and they do the next 3, 4 touch prosthesis. So this is how this ramps up. Fabian, what would you say?

No, you're absolutely right. I mean, in communication, you're tempted to give you high numbers. In Investor Relations, you're tempted to be realistic in order to get that -- you get your forecast right. We've seen in Germany, especially people that have -- that work on a private basis, and I would refer now to the U.S. context to the ASCs. They also see this as a differentiating factor to normal hospitals and to have a pull-in of patients. And so the 200 is clearly the iceberg.

200 what?

The 200 cases per year per surgeon.

Yes, I would say. Roughly above -- I give you -- I should you know a number, roughly above 1,000 TOUCH prosthesis next year, more or less. But it can be more, it can be less. It depends how we start. And the price -- it's also a good question. We are finally -- I'm doing all my calculations based on around USD 4,000. But we are still waiting for the final reimbursement code 4, 5, which we receive by end of this year, beginning January. So -- but my assumptions are 4,000, 4,500 more or less.

Perfect. And maybe one follow-up just on the penetration numbers you mentioned, Matthias. I think -- are we thinking about this as a replacement of LRTI? Because I had a chance to speak to one of the docs that uses it. And I think he's basically said that dual articulating is basically something that's changed the market and people are doing LRTI less and using a prosthetic approach more. And I think you said a number of 150,000 and then targeting around 50,000 in 5 years, something like that. That is a replacement right now. That is not from the market.

This is a replacement. Yes, definitely. It's a new procedure. It is much better. I'm not a surgeon, but it's much better for the patient. I spoke with surgeons and patients in Europe. And patient recovery time is much faster. Patients are back to normal speed after 6 weeks, whereas with the existing method, you are running around for months to recover. So it's a change in the procedure, and this makes it so challenging in the U.S. And this makes it also clear where our focus is on the young generation, young surgeons, to get them in into this because not very -- I'm not very optimistic that the old ones will change their procedure.

They are working for over 15, 20 years with. And then once the TOUCH prosthesis, this is what we see in France now, is established in the market after a few years, you get this mouth to mouth, you get the patient's voice and you get really patients asking for it. And then you start also to really doing some patient campaigns. But this is kicking in, in the U.S. only after a few years, not at the beginning. At the beginning, full focus is on surgeon training.

And we have a follow-up question from Sandra Dietschy from Octavian.

Yes I have 2 other questions. So the first one is on the portfolio. Regarding your CMF portfolio, is the U.S. launch still on track for the end of this year? And how do you see your growth prospects in this segment? Maybe you can also comment on potential gaps you have in that portfolio? And then I have another one on the U.S. and on access to hospital systems. Like there are many large hospital networks, as you know, in the U.S. How would you assess your access to these networks? Has that also improved over the last months?

Yes, Sandra, good question on the portfolio CMF. We are waiting for FDA clearance by end of this year for the U.S. We will not launch in 2026 because we need to focus on Keri. I mentioned this already in March. This is maybe one of the big learnings in the U.S. from the past, really do the things right and focus on it and do not get distracted. Therefore, it's also not part of our planning for the U.S. We reserve a launch for maybe later. We will see this. Our CMF portfolio is getting some innovations, is quite advancing, especially on the digital side, we are competitive.

We did a good analysis, especially with MODUS 2. We have a good system. And this is also shown in countries like Japan or in Europe, very, very, very good, but not yet a focus in the U.S. I would overwhelm the organization there. This is not possible. And U.S. hospitals access, yes, this is becoming better and better. I mentioned it at the beginning. We have already 62% of our sales are under contracts. We will get new contracts for bigger corporations when we launch TOUCH now, it's very interesting for them. We got better inroads once we had focused access with our upper extremities.

Remember, in the past, we were defocused. We focused on foot, and we let a little bit go on the upper extremities. So all this changed and will further change into the future. And do not forget, Sandra, also a very important group in the U.S. is the ambulance centers. And this is growing more and more, not the big hospitals, but the ambulance centers. And this is important for us for TOUCH, as TOUCH is a typical ambulant procedure where patients are stepping in, getting the procedure half an hour and going home.

Good. Perfect. With that, we're going to close this out for today. Thank you very much for your excellent question and your interest in Medartis. This is not over. The Medartis story continues, and it also continues on the road. So on Slide 28, you see our IR activities for the remainder of the year. You also see the brokers' name. So if you're interested to meet us, please call your sales representative, and we're happy to arrange a meeting with you guys.

And with that, yes, hope to see you again, and we wish you an excellent day and the rest of the day.

Yes, super. Thank you very much.

Thank you.