My name is Yung Lee, one of the analysts on the US MedTech team. Really pleased to introduce Fred Hite, CFO and COO of OrthoPediatrics. He will give a presentation, 20 to 25 minutes, and I'll turn it over to Fred. Thank you for coming.
Thank you. Thank you for the introduction, and thank you, Jefferies, for having us attend. Very, very pleased to be here. OrthoPediatrics is the one and only orthopedic company that is solely focused on pediatrics. We do not do anything else on the adult side. It is strictly on pediatrics that we focus our entire company. Sorry, do we have a clicker up here?
We start all of our investor calls and all of our internal meetings with talking about how many kids we help. In total, cumulatively, we've helped 1.3 million kids. In 2025, we anticipate helping about 150,000 plus. Our CEO has set a goal, objective, to help 1 million kids a year. We are just getting started on our journey. The company is about 20 years old, and prior to us coming into the space, the main products that were being used were small adults. Children have very unique clinical conditions. Their bones are more than 30% curved compared to adults. In the past, it was only small-sized adults' implants that were McGyvered into procedures. The photograph you see on the page actually shows a screw going through the growth plate, and that can cause an additional deformity.
There's been really limited technology, new technologies launched into this space prior to our presence. There's no specialized salesforce and really no industry focused on education. We joined the space, as I said, about 20 years ago with a focus on new product development specifically designed for pediatric patients. Here's another example of a product that we produced early on that shows the screws not violating the growth plate and, again, avoiding a future deformity. The goal was to create the broadest pediatric-specific portfolio in the industry, and I'll talk to you about the advancements we've made in there, to deliver novel innovation to the space, which hadn't been done in many, many years, and to create the only global channel to serve this marketplace. We also wanted to help lead surgeon clinical education, and we'll talk about that as well. Innovation technology.
We have over 80 systems that we serve the market today, and we have a consistent cadence of new products that we're launching into the space. Some of those include enabling technologies, which we'll talk about. The commercial side, domestically in the U.S., we have over 230 sales agents that cover our customers, and we today sell in over 75 countries, and we estimate that there are more than 200 other individuals servicing those hospitals in those 75 countries. As I mentioned, we have a severe commitment to clinical education. Every year, we host over 300 individual training sessions for surgeons, clinicians, to help them continue to grow and expand their knowledge of the procedures.
We estimate that our global marketplace is about $6 billion, and you can see on the left-hand side how that breaks down: trauma and deformity, scoliosis, specialty bracing, as well as enabling technology. We have five key principles that have been in place for the last 15 years, and that is really a laser focus on children's hospitals. In the United States, there's roughly 300-400 children's hospitals, and that's the only place we call on. In the United States, there's about 4,000 adult hospitals. We do not call on those at all. We only focus on the catchment points where a lot of the pediatric procedures are done in these children's hospitals. We now have by far the broadest product portfolio, which I'll show you in a bit, and we continue to deploy more and more instrument and implant sets into the marketplace.
Think of that as additional inventory sitting on the shelf in the hospital, so more and more surgeons have access to our products. We are expanding our business both in R&D, as I mentioned, but also through several M&A acquisitions, which I will talk about. We have a goal to continue to train the next generation of pediatric orthopedic surgeons. We focus on our U.S. market, which is about $1.6 billion. This is now just the opportunity we have within the top 3 or 400 children's hospitals. You can see the trauma and deformity, which is the majority of our business. About 70% of our sales go into the trauma and deformity correction space. Scoliosis, which is about 20% of our business.
Specialty bracing, which we'll talk about a little bit more, and enabling technology, which is a new area that we've just entered in the last several years. This slide shows 17 products. These are the products that we offered when we went public in 2017. On the left-hand side, some pretty basic cannulated screws, some plates. It got a little bit more advanced on the right-hand side with a scoliosis system specifically designed for pediatric patients. Since 2017, we've accelerated the product introduction cycle quite a bit. This slide shows both the R&D as well as the acquisition products that we have now brought to the marketplace.
You can see as it moves across the page, it gets pretty busy as we've increased the pace of product introduction, as well as the complexity and the innovation of the products that we're now bringing to the overall marketplace. As I mentioned, not only are we focused on R&D, but we also have several acquisitions that we've completed and partnerships. On the left-hand side, FIREFLY is a navigation system specifically for scoliosis where we print 3D custom bracing guides that help implant the scoliosis system. In 2019, we purchased our first X-Frame system specifically designed for the pediatric space. In 2020, we purchased a product called Apifix, which is an internal brace. It's an implant, but it acts as an internal brace for scoliosis. In 2021, we partnered with OrthoFix, and we brought the 7D technology to the pediatric space.
We have the exclusive rights to bring that technology into the pediatric space in the United States. It's a zero-radiation navigation system that is very, very popular with all of our surgeons because it provides navigation with zero radiation for the patient. In 2022, we entered into the specialty bracing business, first with MDO, which is our number one market share clubfoot product in the world. We then purchased Pega Medical, which is known for their Fassier -Duval expandable nail for osteogenesis imperfecta, also known as brittle bone disease. In 2023, we partnered with Aura to bring their product to market, also purchased the RhinoBrace, as well as a company called MedTech, which I'll show you that product, which is a new enabling technology product that we're working on to bring to the marketplace. Our latest acquisition is Boston O&P.
Boston brings specialty braces as well as clinics surrounding the children's hospitals to continue to serve our pediatric orthopedic surgeons. Boston is about a $20 million business when we purchased it. They had about 26 clinics, and they produced a variety of specialty braces. If you know anything about scoliosis, the first treatment option for scoliosis is to brace the patient. So Boston O&P in the clinic will do a 3D scan of the patient, send that back to the manufacturing plant, will produce a custom brace for that patient. It'll be sent to our clinic and applied to the patient, teaching them how to use it. Typically, that brace will last for about one year, and then that patient will come back and get a new prescription for another brace. Typically, there's a three or four-brace cycle for that patient to be treated with scoliosis.
Hopefully, that cures the problem, but if not, the patient would then go on to skeletal maturity and eventually have our scoliosis fusion product, which would then fuse the rod if the bracing protocol does not work. The specialty bracing market is a big market for us. It's about $500 million within the pediatric 300-400 children's hospitals that we serve. There's lower limb extremities, there's scoliosis, and then there's specialty bracing. We're just getting started in this space, started in 2022, and then a big step forward in 2024. This is a big growth area for us, both in creating new specialty braces as well as adding more and more clinics to the portfolio. I mentioned MedTech, which was an acquisition that we did several years ago. They have a product called Playbook.
Playbook goes in the OR and is an enabling technology that helps with the workflow and the care optimization for the OR. It not only has surgeon preference cards embedded in it, but it also has the ability to hit a button, and you can then phone an expert if you want. There are cameras on this device, so the individual who calls in can see the X-rays, they can see the actual surgery, and they can help assist if there is an issue with the procedure that is happening real-time. The system also tracks each step in the workflow. Afterward, you can then measure each step in the workflow for that surgeon as compared to other surgeons in the hospital, as well as an average across all of the usage in the United States.
Brand new product for us, just being introduced recently with lots of excitement from surgeons. For us, it is just another way for us to assist the surgeon and try to improve the safety of surgery as well as improve the optimization or efficiency within the OR. I mentioned education. We are very proud of the money we spend and the hands-on training that we have in training, not only in the United States, but around the world. In Europe, in Brazil, we are by far the leading contributor to all of the societies, helping make sure that they have productive meetings and they have the funds they need to continue to support those meetings. During COVID, many of the large OEMs withdrew their funding for these societies because the societies were not having face-to-face meetings.
OP stepped up, continued our contributions to all of these societies, and enabled them to pivot to have online meetings that year and then to expand their meetings in the future to reach more and more surgeons. This is a big focus area for us. Again, similar to enabling technology where it's not only product-focused, we're trying to assist the pediatric surgeon in any way we can to make them more effective and to increase the safety of the procedures. New growth from technology. I showed you a slide that has all of the products that we've introduced historically. We're now up to over 80 systems as compared to the 17 that we offered back in 2017 when we completed our IPO. These are some of the more recent and upcoming products. We have the 3P HIP on the left-hand side.
We have the 3P Mini, and that product was just approved by the FDA. It'll be launching in 2026. The 3P Tibia and 3P Femur are in development. Those will be launching in late 2026 and early 2027. The cycle that I talked about earlier, which was increasing, is not slowing down. We continue to invest in new technologies to bring to the marketplace. That's on the trauma and deformity side. We also have many products on the scoliosis side. Several years ago, we introduced the first rib and pelvic system that has been very popular, followed by, in 2025, we just introduced what's called the VertiGlide system. This system is for very, very severe, what's called EOS, or early-onset scoliosis patients. Think about a five-year-old, six-year-old, seven-year-old child that has up to a 100 or 120-degree curve in their spine. Very, very severe.
It starts to, at some point, collapse their lungs and cause other problems if not corrected. This system attaches at the top and the bottom of their spine and actually slides in the middle, which allows the system to stay in place as the child continues to grow. A tremendous product just introduced into the marketplace with marvelous results. Very, very high-end product for us. The procedure is about a $40,000-plus procedure, which is a high-end product for us and doing very, very well in the marketplace. We have a new product coming, which is called eLLi. That will be launched late in 2026 and into 2027. This is a mechanical growing rod. This is put in the spine for, again, young children. It is attached at the top and the bottom again. That mechanical piece that you see in the middle actually expands as the child grows.
There is only one other system in the marketplace that does anything similar to this. We are confident that our launch in 2026 will bring new innovation and advancements to this space in the next several years. I mentioned OPSB or OP Specialty Bracing. This group includes our MDO, Clubfoot Bracing, as well as the Boston O&P system. It also includes a new product that we introduced in 2025, which is having tremendous success, called the DF2 Brace, which is for hip dysplasia. It is a strap around the waist, and it attaches down the leg to keep the hip intact. It replaces what historically has been a spica cast. A spica cast starts just below the nipple and goes all the way down to the knees. If you could think of a child having a cast that restrictive, it is very, very onerous on the parent.
This brace can be put on and taken off. It can assist in not only keeping the hip dysplasia in place, it can also be used, just recently approved for post-operative care. R&D is a big area of us in the middle, as you can see here, bringing new products to marketplace. We also have a goal to continue to expand the clinics. When we purchased this business, they had about 26 clinics. Since 2020, the beginning of 2024, we are now up to just under 40 clinics servicing the domestic marketplace. Very pleased to close our first international clinic acquisition in Ireland just a few months ago, servicing a big hospital over in Ireland, which has a tremendous amount of scoliosis procedures that we support.
Not only are we opening more clinics, bringing new products, we're also expanding our sales force and our sales channel in this marketplace to continue to grow this business. OPSB, the specialty bracing division within our business, is growing at over 20% per year, and we anticipate that continuing for the next three to five years as we continue to invest in this business. This shows you a historical revenue map for the company. As you can see, our first sales were back in 2008. Business has continued to grow over 20% every year except for COVID. The blue is the domestic or the United States revenue, and the green is the international revenue. You can see in 2024, the green bar is actually as big as our entire company was in 2017 when we went public. The growth in 2025 does slow down a bit.
Right now, the current guidance is at 14%, and that is growth both domestically as well as internationally. The business continues to expand. One thing that's a little unique about our business versus the larger OEMs is that in June, July, and August, when the kids are out of school, it's by far our largest sales months. You can see typically the third quarter is going to be the largest quarterly revenue for us across the time period. It's a little different pattern than most of the OEMs. It's important for us to educate everybody on this so they understand the time of our sales across the quarters. In 2025, our current guidance is $233.5 million-$234.5 million with adjusted EBITDA of $15 million-$17 million. That compares to about $8.5 million of EBITDA last year.
We generated $6 million of EBITDA in the third quarter and are on track for this $15 million -$17 million. We have talked about a significant step up in the overall EBITDA of the business for 2026. At the bottom, you can see revenue growth, 14%-15%, and about $15 million of set deployment. We are the only diversified company focused exclusively on pediatric orthopedics. We have a very large market that we serve, and we continue to expand that market with acquisitions and new technologies, a concentrated customer base with three or four hundred hospitals that we serve in the United States, and a broad product portfolio. As I mentioned, over 80 products that we now bring to the marketplace.
We are the only provider that is really committed to pediatric clinical education, dynamic award-winning corporate culture, and improving commercial execution and attractive financial profile. Historically, the business has used cash, as most companies our size do. In the third quarter, we used $3 million of free cash flow, down from $11 million in the third quarter of 2024. We have committed to generating positive free cash flow here in the fourth quarter of 2025 and getting to free cash flow break-even in 2026. That will be quite the accomplishment. Two years ago, the business used about $40 million of cash for free cash flow. This year, it will be about half of that. Getting to free cash flow break-even for us is a big deal as a company while we continue to grow the business.
I think several years ago, it was grow at all costs and limited focus on EBITDA or cash usage. In the last 18 months, as interest rates have gone up and investors have a little bit different attitude on what's important to them, we've modified our strategy a bit to continue to grow the business, maybe not as fast, but continue to grow the business aggressively, but aggressively improve adjusted EBITDA and make dramatic improvements on the overall free cash flow of the business. This will enable us to continue to support the independence of the business. We have about $60 million of cash on the balance sheet at the end of the third quarter, and that'll get us through the next 18 months where we'll start generating cash and then eventually building on that overall cash position.
Again, I'd like to thank the Jefferies team for inviting us to the conference. I appreciate your time and attention. After the presentation, I'll stick around for any questions that anybody may have. Thank you very much.