IART · Integra LifeSciences Holdings
Conviction · Low · more likely to lag the S&P 500 over the next three months
Wrong if: a daily close above $18.34
Note written ·
Price against the kill line
21.5% clear of its kill line on the 13 November 2026 close.
How to read this
This note expects the shares to lag the market, so its kill line sits above the price: a close above the red mark would prove the view wrong. Prices run from low on the left to high on the right. The dot is where the stock closed on 13 November 2026, left of the mark while it is below the line; a dot right of the mark has closed through it.
The scale is stretched near the line, so close calls are easy to see. More than 8% from the line, the stock reads well clear, with a hollow dot to show the figure is off the drawn scale.
The kill line is the research note's own test. The portfolio sells on business facts, not on a price. How the portfolio decides
Three months against the kill line
Daily closes, to . Red: the kill line, a daily close above $18.34, on record since 11 November 2026. The shares are down 18.5% since the close; the S&P 500 is down 2.1% over the same sessions. Figures in the note can cover a different window.
Kill line
A daily close above $18.34, which would put the shares back at their mid-August level and show them leading the S&P 500. Fourth-quarter adjusted EPS above the $0.71 top of the guide would also show the shares leading.
Research onlyNot in the portfolio.
Key figures from the filings · Health Care
Quarter to 30 September 2026, filed 23 October 2026; valuation at the 13 November 2026 close
- Revenue, latest quarter ($M)
- 411
- Revenue, change on a year (%)
- +2.3
- Gross margin (%)
- 51.0
- Operating margin (%)
- 4.6
- Free cash flow, four quarters ($M)
- 85.8
- Net cash, cash less debt ($M)
- −386
- Price to earnings (×)
- 86.1
- Enterprise value to sales (×)
- 0.9
All filed numbers
What Integra LifeSciences Holdings reports to the SEC in its quarterly and annual filings. Each group states its period and filing date once; a figure dated otherwise says so. Built from the filings known on .
| Quarter to | Revenue ($M) | On a year (%) | Gross margin (%) | Operating margin (%) |
|---|---|---|---|---|
| first filed | 411 | +2.3 | 51.0 | 4.6 |
| first filed | 419 | +0.8 | 52.5 | 4.6 |
| first filed | 392 | +2.4 | 55.4 | 2.9 |
| first filed | 435 | −1.7 | 50.8 | 5.3 |
| first filed | 402 | +5.6 | 51.5 | 2.9 |
| first filed | 416 | −0.6 | 50.4 | −123.4 |
| Pre-tax income ($M) | 15.7 |
| Net income ($M) four quarters: 13.0 | 14.9 |
| Diluted shares, change on a year (%) against the quarter to 30 September 2025 | +2.4 |
| Operating cash flow ($M) | 140 |
| Capital spending ($M) | 54.6 |
| Free cash flow ($M) | 85.8 |
| Cash and short-term investments ($M) | 312 |
| Debt ($M) long-term debt | 698 |
| Net cash, cash less debt ($M) | −386 |
| Deferred revenue ($M) −3.7% on a year | 21.5 |
| Backlog, orders not yet delivered ($M) | Not reported |
| Receivables ($M) | 249 |
| Inventory ($M) | 465 |
| Shareholders' equity ($M) | 1,067 |
| Market value ($M) | 1,120 |
| Enterprise value, market value plus net debt ($M) | 1,506 |
| Enterprise value to sales (×) | 0.9 |
| Enterprise value to operating income (×) | 20.7 |
| Price to earnings (×) | 86.1 |
| Price to book value (×) | 1.1 |
| Free-cash-flow yield (%) | 7.7 |
Short interest (FINRA, settled 15 October 2026, published 26 October 2026): 9.4% of shares outstanding sold short, 5.5 days of average trading to cover, +0.7% since the previous report.
| Window | Bought | Sold |
|---|---|---|
| 90 daysfrom | $0 | $0 |
| 12 monthsfrom | $0 | $0 |
The thesis
Integra LifeSciences' shares are more likely to lag the S&P 500 over the next three months. The 21 October 2026 report held full-year guidance but guided fourth-quarter earnings below analyst estimates. The SurgiMend relaunch, which management targets for the end of 2026, and the Cincinnati plant's return to full output in the second quarter of 2027 settle whether earnings recover.
The shares closed at $14.77 on 11 November 2026, up from $13.42 on 6 November 2026 and $14.82 on 4 November 2026. They remain 27.9% below the 52-week intraday high of $20.49 set on 28 July 2026, and the three-month change is −19.0%. Integra's chief financial officer presented at the UBS Global Healthcare Conference on 9 November 2026 (company announcement, 6 November 2026). Company news since 21 October 2026 contains no new results or guidance.
The market has priced in a partial recovery: the shares sit at or above most analyst targets set after the fourth-quarter guide, which run $13–$14 from UBS, Truist, Citigroup, BMO Capital, JP Morgan and Wells Fargo (22 October to 27 October 2026).
Bullish and bearish views on Integra LifeSciences Holdings Corporation
The bull case on Integra LifeSciences Holdings Corporation (IART), in brief: full-year guidance held. The bear case: fourth-quarter guidance is below estimates.
Bull case
- Full-year guidance held. Integra affirmed 2026 adjusted earnings per share of $2.30–$2.40 and revenue of $1.634–$1.654 billion on 21 October 2026. Both ranges match the cut made on 2 October 2026, so the flood did not trigger a second reduction.
- Neurosurgery is growing. Specialty Surgery revenue was $304.1 million in the third quarter, up 4.2% organically, with Neuro up 6.5% organically (company release, 21 October 2026). Integra presented neurosurgery products at the CNS 2026 annual meeting (company news, 30 October 2026).
- Cash generation is strong. Third-quarter operating cash flow was $96.0 million, and full-year operating cash flow is guided to about $190–$200 million (company release, 21 October 2026).
- Insurance covers part of the flood. Third-quarter flood charges were $0.8 million after insurance reimbursements, and the earnings guide includes business-interruption recoveries (company release, 21 October 2026).
- Refinancing removes near-term maturity risk. Integra closed a $2.1 billion refinancing on 19 October 2026, including $450 million of 9.5% senior secured notes due 2033. The maximum net leverage covenant was raised temporarily and steps down to 4.25 times in 2027.
Bear case
- Fourth-quarter guidance is below estimates. Integra guided fourth-quarter adjusted earnings per share to $0.61–$0.71 against a $0.76 analyst estimate, and revenue to $413–$433 million against $436.77 million (company news, 21 October 2026).
- Analysts keep lowering targets. UBS moved to $14 from $19 on 27 October 2026 and kept Neutral. Truist moved to $13 on 26 October 2026 and kept Hold. Citigroup, BMO Capital and JP Morgan stood at $14 and Wells Fargo at $13 as of 22 October 2026.
- Tissue Reconstruction is shrinking. Segment revenue was $107.1 million in the third quarter, down 2.2% organically (company release, 21 October 2026).
- Financing is more expensive. Integra expects its effective interest rate to rise near the high end of a 100–200 basis point range after the refinancing (company release, 21 October 2026). Net debt was $1,516.8 million and total leverage was 3.8 times.
- Earnings quality is thin. Third-quarter adjusted earnings per share were $0.59 against $0.19 on a GAAP (generally accepted accounting principles) basis (company release, 21 October 2026).
Price setup
The shares closed at $14.77 on 11 November 2026, above the 50-day average of $14.41 and the 200-day average of $14.15 (adjusted daily closes). The dip to $13.42 on 6 November 2026 recovered within two sessions, to $14.37 on 9 November 2026.
The 52-week closing low is $8.90 on 18 March 2026, and the 52-week intraday high is $20.49 on 28 July 2026. The 3-month reference close was $18.24 on 13 August 2026, so the shares have not regained their mid-August level. Analyst targets cluster at $13–$14, apart from Citizens at $22 (22 October 2026), so the shares trade near the sell-side centre.
SEC filings show a 10-Q filed on 23 October 2026. The latest Form 4, dated 4 September 2026, records 1,455 shares withheld for tax from the chief human resources officer at $16.62 on 1 September 2026. No open-market insider purchases appear in recent filings. The next earnings report, expected around February 2027, falls outside the next 30 days, and no confirmed company event falls inside that window.
Catalysts ahead
- ~31 December 2026 (est.): Management's target quarter-end for the SurgiMend relaunch. The remaining operating milestone for the turnaround; a later date would weaken the case for Tissue Reconstruction.
- ~February 2027 (est.): Fourth-quarter and full-year 2026 report. Tests the $0.61–$0.71 fourth-quarter adjusted EPS guide and the Cincinnati restart date.
What would change the view
A daily close above $18.34, which would put the shares back at their mid-August level and show them leading the S&P 500. Fourth-quarter adjusted EPS above the $0.71 top of the guide would also show the shares leading.
What it trades with
Integra trades with mid-cap medical-device and surgical-products companies, and with the health-care sector more broadly. Its earnings depend on its own plant recovery, so sector moves explain less of the share price than the company-specific milestones above. Rising interest rates matter more for Integra than for most peers because of its leverage and the 9.5% coupon on the new notes.
The evidence, claim by claim (8)
- Third-quarter 2026 revenue was $411.2 million, up 2.5% organically; adjusted EPS was $0.59 and GAAP EPS $0.19. Integra Q3 2026 earnings release (8-K) · as of
- Full-year 2026 guidance affirmed: revenue $1.634–$1.654 billion, adjusted EPS $2.30–$2.40, operating cash flow about $190–$200 million. Integra Q3 2026 earnings release (8-K) · as of
- Fourth-quarter 2026 guidance: revenue $413–$433 million and adjusted EPS $0.61–$0.71, against analyst estimates of $436.77 million and $0.76. Integra Q3 2026 earnings release; company news · as of
- Specialty Surgery revenue was $304.1 million, up 4.2% organically; Tissue Reconstruction was $107.1 million, down 2.2% organically. Integra Q3 2026 earnings release (8-K) · as of
- Net debt was $1,516.8 million and consolidated total leverage was 3.8 times; third-quarter operating cash flow was $96.0 million. Integra Q3 2026 earnings release (8-K) · as of
- UBS cut its price target to $14 from $19 and kept Neutral; Truist cut its target to $13 and kept Hold. Analyst notes reported in company news · as of
- Integra's chief financial officer was scheduled to present at the UBS Global Healthcare Conference on 9 November 2026 at 2:45 p.m. ET. Integra press release, 6 November 2026 · as of
- The shares closed at $14.77 on 11 November 2026, above the 50-day average of $14.41 and the 200-day average of $14.15; the three-month change was −19.0%. Split-adjusted daily closes · as of
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