Thanks, Lily. Good morning, everyone, and thanks for joining us today. It's great to be here at the J.P. Morgan Healthcare Conference and talk a little bit about Treace Medical. Since our IPO in 2021, we continue to execute on our strategic plans, resulting in strong U.S. revenue growth and encouraging Adjusted EBITDA progress. With continued gains across our key operating metrics and a rapid expansion of our bunion-focused product lines, reaffirming we have the right strategies in place to expand market penetration with our differentiated technologies. Our safe harbor disclosures are here. Please refer to our SEC filings available on our website. Non-GAAP reconciliations are available at the end of this presentation on our website. So, Treace Medical is a high-growth medtech company focused on improving surgical outcomes for patients suffering from painful, lifestyle-limiting bunions and related midfoot deformities.
We pioneered and patented the Lapiplasty 3D Bunion Correction Procedure to bring surgeons a better solution so they can deliver better outcomes for their patients. The surgical treatment of bunions has been our specialty since day one, and we have sizable market to tap. Our flagship product, Lapiplasty, is backed by strong IP, compelling clinical data sets, and is marketed by the industry's only bunion-focused sales force. Our Lapiplasty solution has attracted over 3,100 surgeon users in 2024 and has established Treace Medical as the largest dollar share player in the rapidly evolving and highly attractive U.S. bunion market. Our growth has been strategic, focused on continuous improvements to our flagship Lapiplasty system while also introducing complementary procedures and technologies, and now we're delivering a significantly expanded portfolio of new bunion-focused solutions to our large, established customer base, which we believe will speed our penetration into the market.
As a high-growth company with high gross margins, targeting a large market with a rapidly expanding product portfolio, with improving profitability all coming together here in 2025, we believe Treace Medical presents a compelling opportunity for investors. Our disruptive Lapiplasty procedure and expanding bunion portfolio target a $5 billion-plus addressable market in the U.S., with continued high interest from surgeons and in the surgical foot and ankle community. With one in four adults affected by bunion deformities, we believe the bunion market represents one of the most compelling opportunities in medtech today. Bunions are hereditary and progressive in nature and result in about 4.5 million Americans seeking medical attention for their bunion pain each year, and we estimate about 25% of those patients are symptomatic surgical candidates, and it's this group of just over a million patients that represents our $5 billion-plus U.S. TAM.
That said, less than half of these candidates are opting to have surgery, and we believe that this is largely due to deficiencies of conventional surgical treatments, resulting in patient reluctance to receive surgical relief. So, there's a misconception that a bunion is just a painful growth of bone on the side of the big toe. In actuality, bunions are complex three-plane deformities caused by an unstable joint in the middle of the foot. And it's this unstable joint that allows the long metatarsal bone to shift outward, creating the visible and painful bump. There are three planes involved in the bunion, as shown in the illustrations on the right-hand side of this slide.
Modern research demonstrates how important correcting the third, or frontal plane, is on surgical outcomes, as failure to properly correct it can result in a 10 to 12 times greater risk that the patient's bunion will return. It's this third frontal, or rotational plane, that's been historically unrecognized and unaddressed in conventional surgical treatments until our company and surgeon advisors targeted and developed a solution over nine years ago. Here we have the two conventional, two-dimensional surgical approaches that are currently used for most bunion procedures today. The metatarsal osteotomy accounts for roughly 70% of cases. This procedure targets the bump itself, cutting the metatarsal bone below the bump and shifting the bump inward.
On the positive, it's a relatively straightforward procedure for the surgeon, and the patient can begin to bear weight on the operative foot in a few days to a couple of weeks following surgery. But because it does not address the third frontal plane or the unstable joint, it's associated with some of the higher recurrence rates in the clinical literature, some as high as 63%-78%. The traditional 2D Lapidus fusion is the alternative procedure, and because it does secure the unstable joint, it is generally associated with lower recurrence rates than osteotomies. But since Lapidus is a more challenging freehand operation for the surgeon and requires a much longer and restrictive recovery for the patient, it's typically reserved for the most severe bunions, those that an osteotomy cannot address.
So, with Lapiplasty, surgeons and patients have an option that offers a 3D fix for their 3D problem, and one that addresses the root cause of the bunion by fusing the unstable joint in the middle of the foot, and one that allows patients to start weight-bearing in a matter of days post-surgery in a surgical boot. As these illustrations show, Lapiplasty offers proprietary instrumentation and surgical method that allows the surgeon to confidently and reproducibly correct all three planes of the bunion in four straightforward steps. Without the patented Lapiplasty tools and method, this is a very challenging procedure for surgeons to perform freehand. So, what we've effectively done is given surgeons a paint-by-numbers approach to three-plane Lapidus bunion correction. And in doing so, we've enabled our Lapiplasty procedure to be adopted by the broad foot and ankle surgeon community and usable across a broad spectrum of bunion patients.
Lapiplasty is supported by leading clinical evidence and a large number of clinical data sets and publications. In fact, we believe that we are the only industry participant with this level of clinical data on a surgical bunion technology. Last September, at the annual AOFAS Conference, we presented our four-year primary endpoint data from our flagship ALIGN3D clinical study. ALIGN3D is a robust 7-center, 13-surgeon study with 173 enrolled patients. ALIGN3D is demonstrating sustained significant improvements in pain, radiographic correction, and validated patient-reported outcome scores in patients treated with the Lapiplasty procedure. We believe the positive data coming from our differentiated Lapiplasty study resonates with surgeons and patient communities and is reinforcing market adoption of the Lapiplasty procedure. With respect to reimbursement, last year in November, CMS announced significant reimbursement changes for hospital outpatient and ASC settings, which went into effect January 1st of this year.
The final rule is the reassignment of CPT code 28297, a primary code used for Lapidus fusion and one usually used for the Lapiplasty procedure reimbursement, to APC code 5115, with a hospital outpatient payment rate increase of 89% over 2024. And in the ASC setting, the payment rate was an increase of 100% over 2024. We're pleased that this final rule recognizes the value that Lapidus fusion offers patients suffering from these painful, lifestyle-limiting bunion deformities. And we're just getting started. So, now that we've established a powerful, direct bunion-focused sales team and a growing base of over 3,100 surgeon customers, we're advancing our leadership position in the market from being a Lapiplasty company to a comprehensive bunion solutions company. In 2018, our Surgeon Advisory Board published a peer-reviewed paper describing four classes of bunion deformities.
As a business, we initially focused our efforts on advancing a single standard of care across this full spectrum of bunion repair with our patented Lapiplasty system, and many of our surgeon customers have adopted Lapiplasty instrumentation and implants across all four of these classes as they mastered the technique and experienced great patient outcomes. This approach has been very successful to the point that we are the dollar share leader in the U.S. bunion market today, and it's been our strategy all along to address all four of these large market subsegments with additional disruptive solutions, giving a broader range of surgeons more options to address the evolving needs of their patients, so I'd like to take a moment to explain in greater detail the new technologies we have designed to give more surgeons a broader range of specialized options for these different bunion classes.
At a high level, our product innovation strategy is focused on making bunion procedures less invasive, which we believe translates to less pain and quicker recovery for the patients, and not only makes our procedure more attractive today, but we believe over time can expand our reach up funnel and appeal to a larger portion of the 4.5 million Americans seeking treatment for their bunion pain each year. When it comes to addressing bunions across a broad spectrum of severity, our patented Lapiplasty system continues to lead the way in market position and innovation with over 120,000 patients treated since late 2015. We've innovated our flagship Lapiplasty instrumentation and implant technology three times now over the last several years, and today, our Lapiplasty procedure can be performed through a discreet 2-centimeter incision with our latest Micro-Lapiplasty option.
And in late 2021, we launched Adductoplasty, the first and only instrumented solution for bunions with a concomitant midfoot deformity, which presents in up to 30% of bunion patients. And in our drive to allow less invasive approaches for patients and expand surgeon interest, we recently introduced Mini-Adductoplasty, which allows our procedure to be performed through a 3.5-4 cm incision, leveraging our SpeedPlate implant technology. For the milder classes of bunions, while Lapiplasty is used by many of our surgeon customers as their go-to procedure of choice, there are many surgeons who prefer metatarsal osteotomies to treat most of the patients within this class. And for these surgeons, minimally invasive osteotomies represent the fastest-growing subsegment of these 300,000 procedures as osteotomies. So, to broaden our procedure solutions and appeal to the preferences of surgeons and their patients, we're introducing two new differentiated osteotomy systems.
For background, we estimate around 10%-15% of all metatarsal osteotomies today are being performed with minimally invasive, or MIS, techniques. And we believe the biggest rate limiter to broader adoption is the technical difficulty and steep learning curves associated with the conventional freehand MIS techniques. For example, surgeons that train on these techniques will talk about a 40-50-case learning curve before a surgeon can become proficient in doing them. We see this as a tremendous opportunity for Treace to change the landscape and allow MIS surgeries to be performed by a broader base of surgeons with control and confidence, effectively democratizing these once-challenging operations, just like we have done and we continue to do with Lapiplasty.
Our approach to MIS osteotomies is consistent with our core philosophy of anatomic three-plane bunion correction in order to support best patient outcomes, and also offering user-friendly instrumentation to make these complex procedures controlled and reproducible for the surgeon. Our two new 3D MIS procedures are both performed through small, cosmetically appealing incisions, which we believe results in less pain and quicker recovery for the patient. Our first system, Nanoplasty, offers a controlled instrumented three-plane procedure and utilizes the familiar powered saw to cut the bone as opposed to a powered cutting burr, which is used today in most traditional MIS osteotomies. So, no new cutting techniques have to be learned by the surgeon to perform the procedure. For fixation, Nanoplasty utilizes a titanium intramedullary implant with locking screws to provide stability during healing.
Our second MIS platform, Percuplasty, is designed to be a new standard for surgeons who already use a conventional approach to MIS osteotomies, namely powered cutting burrs and screws for fixation. As with Nanoplasty, Percuplasty delivers elegant instrumentation to provide greater confidence and control to allow the surgeon to dial in that important three-plane correction. For fixation, Percuplasty uses two specialized titanium screws to secure the bones during healing, and we round out this comprehensive portfolio with a new and innovative option for a sizable segment of the bunion market, and these are patients with arthritic great toe joints. This class of bunion is treated at the toe joint itself, typically by fusing that joint. Our innovative solution here, SpeedMTP, leverages our market-leading SpeedPlate fixation implant technology. We're experiencing very positive early responses on these four technologies from both existing and new Treace customers.
We expect to ramp availability of these new offerings progressively through the first half of this year and see more material impact on the top line in the back half of the year as we build supply chain and train more surgeons. We believe this robust portfolio of best-in-class instrumented solutions targeting all four classes of bunions marketed by the industry's only bunion-focused sales force puts Treace in a unique and powerful position to extend our market leadership and speed our penetration into the bunion and related midfoot markets. In addition to our four classes of procedure solutions, we also have enabling technology platforms that we use to drive our innovation pipeline. We couldn't be more excited about our IntelliGuide PSI platform, industry's first and only pre-op planning and cut guide system for bunion and midfoot deformities.
Our acquired RedPoint Medical technology and processes have been integrated into Treace and are positively impacting patients' lives with personalized surgical treatment, and during Q4 last year, we announced expanded surgeon access of our IntelliGuide PSI technology for both Lapiplasty and Adductoplasty applications. With IntelliGuide, we can take a patient CT scan and, using proprietary software, manipulate the bones virtually in three planes to the desired corrected state and produce a preoperative plan and a patient-specific cutting guide for the surgeon. Not only can IntelliGuide streamline surgical procedures, reducing steps and instrumentation, but importantly, it gives surgeons greater confidence and control, particularly in more challenging and revisional operations. We look forward to continuing to advance our work with IntelliGuide across our procedure spectrum and continuing to scale our availability of this important technology to benefit more doctors and patients through 2025 and beyond.
Our enabling SpeedPlate technology platform has been another exciting first and only from Treace Medical and has been embraced with enthusiasm by our customers for Lapiplasty, Adductoplasty, and a variety of other bone fusion procedures throughout the foot. As mentioned a moment ago, we've just introduced our SpeedMTP, which is a specialized solution for patients with arthritic toe joints. SpeedPlate offers the strength and stability of a titanium lock plate with a dynamic compression and insertion speed of a nitinol staple. This is a very attractive combination for surgeons to the degree that within just 12 months on the market, SpeedPlate kits make up the majority of our overall fixation kit sales, and not only does SpeedPlate offer broader versatility, but as our premium technology also commands a premium price point, so it helps in building our average bundled selling price per case.
You can see by the release dates on these different designs that we've been very active applying this differentiated platform to meet the needs of our customers to the benefit of their patients, and we continue to have a robust pipeline of additional procedure-specific designs utilizing this technology in the works as we continue to expand our footprints strategically across the foot and ankle market. Our focused business model allows us to expand in a very capital-efficient manner. While traditional ortho extremity companies grow with a very inventory-intensive model, some offering 10,000 or more sellable products, we currently have about 50 sellable SKUs supporting our over $200 million in revenue, and the five new products and technologies discussed today will only add about 80 sellable SKUs to the mix.
This focus not only allows us to deploy less capital for inventory, but also rapidly innovate our products to drive deeper into the bunion market and defend our market positions. On the left is an assortment of our reusable instrument trays. These trays are small and lightweight and low cost, and they're easy for our sales reps to transport and for facilities to process, which is important for our outpatient and ASC customer setting. On the right-hand side are our high-margin sterile implant kits. These are the items we actually sell, and the economics here are such that the margin from just one surgical case covers the capital cost of the instrument tray, and each tray can service 30 or more procedures per year.
So this unique model and the positive margin it generates has allowed us to capitalize on our opportunities and will allow us to continue to efficiently scale our business as we expand our comprehensive bunion solutions portfolio. Speaking a little bit to our go-to-market strategy, as the pioneer in the treatment of surgical correction of bunions as three-plane deformities, our medical education efforts are aimed at training surgeons how to best correct these 3D deformities with our differentiated technologies. As we continue to advance into a comprehensive bunion solutions company, we've modified our surgeon training curriculum to address management of all four of these classes of bunions in a comprehensive educational event that we've actually branded Bunion Masters.
In these events, attending surgeons committed to being experts in bunion surgery will engage with our experienced faculty and learn how to properly use our best-in-class suite of 3D product solutions, from Lapiplasty to Adductoplasty, Nanoplasty, Percuplasty, SpeedMTP, and more. These comprehensive events not only educate our existing customers on the safe and effective use of our new offerings, but they're also integral to continued onboarding of new surgeons and ensuring they are properly trained as well. As a result, as a baseline, we estimate adding 200 or so more additional surgeons to our base annually going forward as a baseline. Our intent is to educate patients and have them ask for our surgical treatments by name.
We utilize targeted patient outreach initiatives, directing patients to our website where they can become educated on our technologies and connect with qualified surgeons in their area who perform our procedure and schedule a consultation. Our direct-to-patient efforts have resulted in hundreds of thousands of patients visiting our website every month on average to educate themselves about our technologies and tens of thousands of patients searching for surgeons using Treace technologies. Our established bunion-focused sales channel is poised and ready to introduce this expanded portfolio to our growing base of over 3,100 surgeon customers. Our direct channel has been an area of significant investment over the past five years and today represents over 82% of our revenue mix. We have established a large and experienced sales team. When you include our senior and associate sales representatives, clinical specialists, and sales managers, our field fleet today totals approximately 330.
Now that we have this large commercial organization in place, we expect to see leverage of this maturing team on the P&L during 2025 and beyond, while still being able to add sales personnel to ensure our customers receive best-in-class support as we rapidly expand our product portfolio. Our goal is to increase our rate of penetration into the bunion market while expanding wallet share per surgeon customer. We'll do this by introducing several new technologies, comprehensively addressing all four classes of bunions to our large and expanding base of surgeon users. We've made significant progress towards this goal by increasing our surgeon customer base from 997 active surgeons back in 2019 to over 3,100 active surgeons in 2024 for a 26% CAGR in surgeon user growth over the past five years.
Our surgeon customer base, on average, uses more and more of our products each year as they choose to treat more of their patients with our growing portfolio of best-in-class procedure solutions and technologies. Average annual revenue per surgeon has grown to nearly $67,000 in 2024, a 48% increase over the past four years. We grew our top line at 12% in 2024, which we believe to be approximately two times market growth for foot and ankle, as we continue to penetrate across a broad spectrum of bunions with our Lapiplasty and Adductoplasty systems, as well as sustained market adoption of our SpeedPlate technology and other complementary products. That said, with just 7% of the overall bunion market penetrated, we have an incredible opportunity to accelerate our share across all bunion classes with these new targeted solutions. We've also made significant progress on our pathway to profitability.
During 2024, we said we would right-size our P&L. In Q3, we improved our adjusted EBITDA by 40% compared to the prior year. We'll have significantly more positive adjusted EBITDA in Q4, our seasonally strongest quarter compared to Q4 of 2023. We expect operating leverage to continue to improve in coming quarters and expect break-even adjusted EBITDA for the full year 2025 and break-even cash flow for 2026. As a leader in this large dynamic subsegment of the foot and ankle market, we're advancing our company from a single technology player to a diversified and comprehensive 3D bunion solutions company with several new product offerings and technology launches already underway targeting large subsegments of the bunion patient population.
We have a robust R&D pipeline behind this, plus multiple additional drivers we expect to continue to fuel our growth while generating break-even Adjusted EBITDA in 2025 and break-even cash flow in 2026. With that, thank you for your time.
All right. You pre-announced good fourth-quarter results, so maybe we could start there. Revenues came in a few million above expectations. So what sort of trends did you see in fourth quarter, and what would you attribute that strength and upside to?
Yeah, thanks, Lily. I'll start with that one. Yeah, fourth quarter is always our seasonally strongest quarter of the year. We've seen that year after year. And so a lot of the same dynamics that we had anticipated, a large uptick in volumes happened again this year. And we feel really good about the strength that we saw, and it came in really as anticipated.
Great. I know there's been a lot of moving pieces over the last few quarters as competition from some of your ortho peers has started to ramp, and docs have shown an interest in MIS osteotomy solutions. So how have you seen competitive dynamics evolve over the last few months, and are you seeing physicians come back to Lapiplasty at all after initially trialing some of these competitive solutions?
Yeah, Lily, great question. We definitely felt some of those pressures over the summer months, and whether that was ball competition or some other dynamics that other larger companies have cited in softness. Irrespective of that, in the fourth quarter, at the end of the third quarter and into the fourth quarter, it feels like it's abated a bit, it's sort of stabilized, and as surgeons get into their active busy season, they want to go with the companies and the products that they trust. And it's a very high-volume time for them. And we found a lot of these surgeons that were dabbling over the summer months with competitive or new entries into the marketplace came back to Lapiplasty when it was time to really have to perform game time for them. So we were pleased with seeing that. We think it's sort of leveled out.
As we've introduced four new limited market releases of these exciting technologies, we've been training a lot of doctors on these for the past several months, getting them ready for the launch. We're seeing that enthusiasm for Treace Medical in our MedEd events. Our sales force morale is extremely high, and they're really ready to take these into the market. They feel like they're going to be going on a pretty heavy offense once we get this product flowing.
I guess on the topic of these new products, I know you're still pretty early in the launch of Nanoplasty and Percuplasty, but maybe you could share some early feedback and receptivity that you've been seeing in the limited launch?
Sure. And we've had a number of training events, and it's exciting to be able to see the doctors respond to these. A lot of the doctors we're bringing in are surgeons that maybe have not been our customers before, and they're either using or experimenting with MIS osteotomy solutions. And they get in the lab, and they see the way Nanoplasty performs, and they'll just tell you, "There's nothing like this on the market. This is totally different. And I want to, how soon can I use this?" So we're just seeing a tremendous amount of enthusiasm. Saturday, we had a big lab in Orlando, and a doctor was there that had done five Nanoplasties over the past several weeks and was actually so excited about it. He was training one of the doctors there. I thought he was faculty.
But he said, "Yeah, I used to use the Arthrex two-screw technique, and I'm converted to this. This is so much faster, so much easier, and I'm very pleased with what I'm seeing." So those are the types of responses we're seeing. Our SpeedMTP, very early on, but a lot of excitement over that. The first time that Treace Medical's really had a specific offering for that pretty significant segment of bunion patients, we were missing. Patients would learn about Lapiplasty online and go in to see a doctor, and they'd find out, well, the doctor was saying, "Well, you've got an arthritic toe joint. I have to fix your bunion in a different location at the toe joint." And they wouldn't use a Treace product. Well, now we're handing them a Treace product, so we can capture that now.
So we're hitting these 300,000 procedures in an osteotomy segment with targeted strikes that are very exciting. And we're also hitting this other end with the arthritic toe that we've never really approached before. So these are incremental new opportunities for us to penetrate this market deeper.
How do Nanoplasty and Percuplasty compare to some of the other MIS osteotomy solutions that are available right now?
Yeah, great question, so I think this is a situation where Treace is in a really great position being a little later to the market, and when I say late, it's no later than when we introduced Lapiplasty to the market, Lapidus was about 10% of surgeries, so minimally invasive osteotomies are still a pretty minimal part of that 300,000 osteotomy base, so what we're bringing to the front here is three-plane correction, that philosophy. There hasn't been a lot of focus on that third plane of correction in most of the conventional MIS techniques. Number two, really elegant, refined instrumentation that makes these procedures super approachable and extremely doable in the OR the day after they get trained in a cadaver, and we typically send in a clinical specialist to make sure they follow all the steps.
But you follow the steps, and we've got a procedure that you don't go through 40-50 cases. You get trained, and you're immediately doing these cases in your OR, and you're getting good results. And that's what we're so great at, is developing elegant, controlled instrumentation that can help democratize these procedures that were once in the hands of very few surgeons and being performed in a limited fashion. And then the third part is we're delivering it through a sales team that is highly experienced and expert in bunion correction, all facets of it. And that level of confidence in the OR that the doctor has when they're employing this new procedure, that's critically important. And a lot of diversified players just have a hard time having that concentrated level of expertise that we bring to this.
Do you think data is important as you roll out these products? I know that was one of the key differentiators as you initially launched Lapiplasty. So should we expect you to be investing in studies or trials in the future?
Yeah, that's a core philosophy of ours, and we'll continue to, once we get to the right point, embark on studies to follow the results of these procedures, yes.
I guess, how do you see both Lapiplasty and these new MIS osteotomy solutions fitting into your portfolio and the treatment paradigm for bunions more broadly? Do you think there are certain patient populations that are better suited for one versus the other?
Yeah, that's another great question. And I think yes. We've been very successful in driving Lapiplasty into a lot of doctors' hands to use across a broad spectrum. But if you look at our 3,100 customers today, we're only getting on aggregate 25% of their bunion cases. So there's a huge opportunity to bring these technologies into our current base and get pretty quick uptake. We just have to train them on them and support them. That said, Lapiplasty is generally in most surgeons' minds a more moderate to severe treatment. And the majority of our customers probably use it predominantly there. Where these new focused technologies are coming into play is in the milder-moderate segment. So I think they will target that segment a little more strongly.
Then, of course, the arthritic toe segment is a complete greenfield for us, and a new application will be able to hit as well.
Got it. I appreciate that you haven't formally guided for the year yet, and it's still early, but any thoughts you can share on how to think about growth this year, and especially in light of these new product launches and competition dynamics? Any headwinds or tailwinds qualitatively that we should be keeping in mind?
Yeah, another great question, and so the way we think about it is really what John was talking about. We believe we have a lot of tailwinds as we come into 2025. First and foremost is all these new products that we have. I think it provides a very new approach for our sales reps going into customer accounts and having really a solution for any bunion deformity and for their patient needs, so that's first. That's a great tailwind for us. Secondly, as John presented, we continue to add new surgeons every year, so we've got a growing base of surgeons. We ended with 3,135, but that continues to grow, and so we're anticipating further growth in our surgeon base. On top of that, we continue to get more revenue on average per surgeon every year, and so that continues to ramp.
And that's what these new products are going to do. So that's going to be another tailwind. In addition to that, we have even a more tenured direct sales channel. And so we feel like they are very energetic. They're excited about this broader portfolio. They won't miss out on the opportunities with their customers. And then finally, reimbursement. That's significant. And so we believe that that could be another tailwind for us. So with all that, there's a lot going for us in 2025. And today, we're not giving specific guidance on 2025. There will be a little bit of a cadence of how this will roll out. Our new products really are in limited market release. That means they're in limited hands right now. And we will build and ramp those volumes of inventory and the kits to support that really through midway through this year.
So it's going to be more of a back-end of 2025 story as far as the opportunity to really benefit from these new products.
Got it. I appreciate that you're not breaking out kits and physician count regularly anymore, but could you qualitatively talk through how you're thinking about utilization and new doc ads trending into 2025? And how do you see each of those pieces contributing to growth this year? And where do you see the biggest opportunity?
Yeah. So John mentioned that as a baseline, we're thinking about adding around 200 new customers in 2025. And the reason why our focus is a little bit shifting is we will continue to add and bring on new customers. But really, our focus this year is we have a very large customer base, and we have lots of new products for them. And so the quickest way that we can benefit from all these new products is to go after and to provide this large customer base with all of our new technologies. And so that's a little bit of a shift in our focus. We think it's going to be the biggest return and the best way to move the top line this year.
So that's why we're thinking in terms of the quantities, maybe a little bit of a step down versus what we just experienced in 2024, but we think we can have a larger movement and benefit to the top line by focusing on this large customer base.
You've been able to keep ASPs moving consistently higher as you've added more and more ancillary products to the portfolio. So should we expect that to continue in 2025, or does competition being greater than in the past change that dynamic at all?
Yeah, maybe I'll take a shot, and John can answer as well. So ASPs have continued to grow. One of the benefits that we've had is our newer technologies, SpeedPlate technologies, that's at premium pricing. And we've had really through 2024, going from a very small mix of our overall revenue and procedures to over 50% in one year. So our surgeons really see the benefits of this new fixation technology, and so they continue to adopt that. So there'll be opportunities there. The other opportunities that we have are that when we talk about Adductoplasty or that midfoot deformity, we continue to see year after year a higher adoption rate. So when patients are receiving Lapiplasty, they're also receiving Adductoplasty. And that really comes at the same price point as a Lapiplasty.
As that attachment rate continues to increase, that's going to be another benefit to us overall to contribute to increased revenue in 2025.
Got it. You mentioned reimbursement earlier. That's stepping up close to 100%, I think, in both the ASC and the hospital setting. So how meaningful of an impact do you think that could have on adoption this year? And does that create even more room for taking price?
Yeah, it's an exciting development. It's one that we view that it can be nothing but helpful. We've surveyed some of our surgeons. They've given us some of their perspectives on what they think it may and could do and how it could benefit. But we're very early here. We're two weeks into January. And I think we get to our Q1 call, and maybe we'll have a little more insight to share on what material impact this might be having.
And one other thing that I'll mention on that, we've had the question a lot of times, are we taking price as a result? So we're not proactively changing our price structure for our customers. But what we see, and going back to your prior question, what we see is greater adoption of our premium technologies or a higher attachment rate of adductoplasty. So we continue to see maybe that ASP or that revenue per case lifting, but we're not taking price, quote-unquote, because of this reimbursement. But we do think it could be definitely a positive. And we'll see how that plays out. We're really early into January right now.
Got it. Maybe shifting gears a little bit. You talked about being Adjusted EBITDA break-even this year. So first, could you talk through the key levers and the P&L that'll get you there? And second, how are you balancing driving P&L leverage while still investing behind reinvigorating the top line and supporting all these new product launches that you have?
Yeah, great. Do you want that one, or should I jump in?
Yeah, no, it's pretty straightforward. The sales team, we've been having to invest very aggressively. Now we've got the sales team we want. They're maturing more than we're on straight commission. We're not splitting aggressively and paying double commissions and salaries plus. So we're getting a lot of natural leverage just from the maturation and productivity of that sales team that's been established. So the sales and marketing line, there's a lot of opportunity for leverage there just naturally. And then in terms of being able to grow, this is very straightforward for us. We've got a capital-light product development model with low inventory requirements. We can just drop these products that we've been working on for the past three years into our sales force's hands and ramp the top line. So we can do both at the same time.
It's a great year for this, and we're excited about it.
One of the best drivers for that profitability is we have a great gross margin. So we've been 80+% . So that benefits us. As we continue to grow, a lot of that's going to drop through. We're not anticipating any incremental CapEx either as we have all these new products because it's this capital-light model that John was talking about. So we believe we can introduce all these new innovations and product offerings and not really drive a lot of cash needs for the CapEx to deliver that top-line revenue growth.
Got it. Question from the group here. You talked about adding new products and that helping keep ASPs moving in the right direction. So where do you think average revenue per surgeon can go taking into account all these new products that you're adding to the bag?
Yeah. So going back to what John has said and the way we view the market, a lot of our surgeons right now are giving us, it's called 25%-30% of their overall bunion cases. And so as we add these new products, we have the opportunity to gain that other missing 70%-75% of procedure volume. So there's a huge opportunity. We don't necessarily believe we're going to get all that immediately this year, but we will continue to ramp, train more surgeons, and we'll continually have them adopt these new technologies. But that's the huge opportunity that we have is a lot of this volume that we're not getting today.
Got it. I think we're just about at the top of the hour here, so maybe we can wrap it up there. Thanks so much to the Treace team for being here, and thanks for everyone for joining.
Thanks, Lily.
Thanks.
Thanks, April.