Good morning, everybody. We're going to go ahead and get started. Thanks for joining us today for Treace Medical Concepts' Investor Day Event. I'm John T. Treace, CEO and Chairman of the company, and it's really great to be here with all of you at the NASDAQ Market Site in beautiful New York City. Our disclosures here for today's event. Here's our agenda. We've got an outstanding lineup of highly experienced foot and ankle surgeons here today. These are surgeons that all share a common passion of making bunion surgery better for their patients and also helping enable other surgeons across the country to do the same. I think you're really going to enjoy these talks. You're going to get a ton of information about these new innovations, how they're advancing the standard of care, and how they're going to help advance Treace's leadership in the bunion market.
From the company here today, we have Sean Scanlon, our Chief Innovation Officer. We have our CFO, Marc Hair, and we have our Chief Commercial Officer, Guy Guglielmino , present as well. I thought I'd start off with a little background on Treace Medical Concepts, why we exist, what's made us successful to date, and why we're so excited about the future we have ahead of us. This is a company that, from the start in 2014, has been driven by a focused mission, a passion for improving outcomes for bunion patients. In doing so, we went from a napkin sketch to over $200 million in revenue with essentially one patented bunion procedure that largely changed the way that bunions were evaluated and treated.
Now, in 2025, with an established commercial team in place and a large customer base, we're entering the next growth wave of the company, launching our best-in-class comprehensive bunion solutions portfolio. Bunions are a really big problem, and they can become painful, lifestyle-limiting deformities for a significant portion of the affected population. We believe the shortcomings of prior surgical procedures in the past, resulting in high recurrence rates and high patient dissatisfaction rates, have been a rate limiter to surgery. This said, we believe there's a significant opportunity to expand beyond the 1 million symptomatic surgical candidates as we develop even more effective solutions for surgeons, solutions that can bring faster recovery, improve cosmesis, more enduring corrections for patients, and then communicating the benefits to the clinical community. We believe there's a real opportunity for us to double the business in the years ahead.
We're currently around 3% penetrated in the symptomatic surgical candidate base, and with the technologies that we have today and those in our future pipeline, we believe we just need to get to 7% - 8% to achieve that milestone. Our company was founded on this realization that the vast majority of bunions have this overlooked, underappreciated third plane involved in the deformity. The negative impact that the failure to correct for that frontal plane, that third plane, can have in driving high recurrence rates is significant. With recurrence rates cited in the peer literature as high as 60% and 70% + with traditional two-plane surgeries of the past, you can see why a breakthrough like Lapiplasty, being the first-ever instrumented system to allow a comprehensive three-plane bunion correction to be performed in a reproducible, repeatable manner, fills such a significant gap.
That has led to the adoption of this technology by nearly one-third of all bunion surgeons by 2025. Since our first Lapiplasty cases in 2015, this company has been hyper-focused on iterating and evolving our designs, constantly making them more reproducible, faster, fewer steps for surgeons, and more recently, minimally invasive. It is this iPhone product development model that we've employed and then supporting our surgeons with great training and differentiating clinical evidence that's made Lapiplasty the gold standard for 3D Lapidus today. Now we're applying this successful model to address different categories of bunions with highly specialized solutions that can accelerate our penetration into the market. If you look at our over 3,100 surgeon customers today, with Adductoplasty and Lapiplasty alone, we believe we penetrated about 30% of their total bunion volume.
Here in Q3, we're launching three new systems: our Nanoplasty and Percuplasty 3D MIS osteotomy systems and our SpeedMTP Rapid Compression Implant system. These three new offerings address significant volume segments, giving us greater access to the untapped 70% of our surgeons' cases, while also allowing us to appeal to a much broader surgeon audience. We're leveraging platform technologies to bring even more breakthroughs to market, like our market-leading SpeedPlate Rapid Compression Implants technology and our first-to-market IntelliGuide PSI technology for bunion and midfoot deformity correction. Today, we're announcing the initial introduction of our new Percuplasty™ MIS power system. This is a power system that powers the single-use cutting burs that are used in the Percuplasty™ procedure but can also be applied to a variety of other minimally invasive foot and ankle procedures.
This specialized new addition to our line cements our commitment to becoming the one-stop shop for all of our customers' surgical bunion needs. You're going to hear more about all these exciting technologies and innovations and even more coming up next from our surgeon experts and Sean Scanlon. We have an incredible panel of surgeon experts here today to help out: Dr. Staccardo, Easley, Johnson, and Kaplan. Thanks again so much for being here to help educate this audience on these exciting technologies, the impact they're having on your patients, and on your practices. With that, I'm going to turn the floor over to Dr. Will DeCarbo. Will.
Is that what you advance with, the green?
Go green.
All right. Fair enough. Thank you, John. I appreciate being here. My name is Will DeCarbo from Pittsburgh. My brethren will be here in about four days. That may or may not make you excited with the Jets and the Steelers, the return of Aaron Rodgers, but we'll get through it together. In any event, my charge here is to talk about Lapiplasty® and Adductoplasty®, two of our flagship and main procedures and founding procedures with this. Again, just like John said, we're super excited about this technology, not just for today, but tomorrow, we continue to iterate this. As it was stated previously, when we look at bunions, there's over 130 different ways to treat a bunion. The way we looked at it from a company standpoint at Treace, there's not one good way.
Early on, we understood this, and we understood that triplanar issue that we'll speak about again. I'll show you the slide that John presented as well. In 2018, we proposed a classification system that kind of revolutionized the thought process behind what we're seeing when patients present with a "bunion," because there were four distinct categories of patients that presented with bunion. There's mild to moderate, mild to severe metatarsus adductus and arthritis. The arthritis is really branched into two components or two buckets. There's arthritis with a bunion, and then there's a primary pathology of arthritis of the first MTP. The SpeedMTP™ Rapid Compression Implant, which Dr. Easley will talk about, covers both of those, and we'll go over that with you. One of the things that we wanted to do was to create a system.
It was a philosophy change in an instrumented system in order to address each of these four subcategories, if you will, of "bunion" or midfoot/forefoot deformity. With that followed what we feel is a best-in-class fixation options, and we'll discuss that. For the mild to moderate, we have Nanoplasty™ and Percuplasty™. You'll go in depth on that with Dr. Kaplan and Dr. Johnson. For the mild to severe, we have Lapiplasty®. That was our flagship procedure and really the springboard into these other technologies and these other midfoot/forefoot deformities. Metatarsus adductus we'll discuss, and then the SpeedMTP™ for the first MTP fusion, which Dr. Easley will go over. At the bottom, as this does the intraoperative C-arm as well as the cartoon drawing, just shows you the power of this system. What we want is reproducible, consistent triplanar results with fixation that is best in class.
That's where we think we've landed, and that's what we're excited to present here today. The Lapiplasty® 3D Bunion Correction® System, as said, our flagship procedure, one of the aha moments, and John kind of touched on this, was the frontal plane. The frontal plane has been described since the 1950s, but until Treace Medical Concepts, nobody has really come up with a dedicated way to assess it and a dedicated way to fix it. That's what we've done. The transverse plane is kind of intuitive. The cartoon drawing here where you see the bump, we can understand that there's a transverse plane deformity, and that's the prominence. What's really interesting about it is, you know, there's a common misconception, and that's a growth or a bump, and you can just shave off a bunion.
The reality is the midfoot joint is unstable, and that allows that bone or that metatarsal to drift out of alignment, creating that prominence. The big toe kind of deviates to the lesser toes, and that's the deformity you see. The transverse plane, you can see that, you know, any layperson can see it. The sagittal plane, the metatarsal actually elevates, and you get a glimpse of this on radiographic analysis when we look at this. The frontal plane was really the key. The literature bears this out. When you look at work by Kim or Acuda, if the frontal plane deformity is not addressed, there's anywhere from 10 x- 12 x the likelihood of recurrence or patient dissatisfaction. This really is almost the missing link, so to speak, of bunions. What Treace did was develop systems that take into account this triplanar correction, this instrumented.
Each time for this, we tried to take an approach that simplifies the process. All of our options come down to four or five steps, and you can see through guided instrumented systems that created not only consistent results, but what it did was it took the variability of the surgeon out of it, good day, bad day, and where you trained. We were talking outside here with some of the investors, and really bunion surgery depended on where you trained, what part of the country you trained, what was prominent in that area. That's what surgeons did, not necessarily the best option for the patient. What we wanted to find was a best option for the patient that's consistent, and this triplanar correction is what we came up with. In 2015, we started with an open technology.
We were around a seven-centimeter incision in order to use all the instrumentation in order to get this done. As we developed an understanding for not just the pathology, but also the instrumentation, we were able to take that incision smaller and smaller. One of the main thrusts of this is how can we get the same triplane anatomic correction through a smaller incision? It's the iteration of the instrumentation in order to do that. As we started with 7 cm for Lapiplasty® 3D Bunion Correction® System, we now can go to a micro Lapiplasty® through a two-centimeter incision. We believe this is very important for a lot of reasons. The morbidity of surgery is something across the board, whether it be general surgery, vascular surgery, any part of orthopedics. The amount of damage caused to the body, the deconditioning is really powerful, and it really matters.
With the advent of the smaller incisions and minimally invasive surgery, we're doing less scarring, less deconditioning of the patient. This is really a great iteration to start us moving forward. We'll talk about the fixation. There will be a dedicated slide because as we went into instrumentation that allowed us to do these procedures through smaller incisions, we needed complementary fixation in order to fit through that procedure. The micro Lapiplasty® for Lapiplasty® 3D Bunion Correction® System was the first advancement in this MIS technology. Two main things came out of this. One, what we call an external positioner. Instead of that cup being put on the bone, we were able to do it on the outside of the skin. That alone lengthened the incision by several centimeters off the bat. The cut guide was narrowed on the transverse plane and thinned.
What this allowed with a percutaneous approach was just the width of the saw to get in to make the appropriate cuts. Once we did that, complementary products came out because now we had to retrieve the bone out of that joint in order to create the fusion. We have Lapitome, RazorTome, and then SpeedRelease. These are instrumentations that complement the MIS surgery because when you're working through a two-centimeter incision, that visibility and that ability to get the bone out that you just cut is critical. We developed this. Lastly, which will be coming up, we'll show a dedicated slide, is SpeedPlate™ Rapid Compression Implants. The SpeedPlate™ technology is really unique. I'll save it for the slide on this.
Why this was developed is because as we went through these smaller incisions, we need an implant to fit through these smaller incisions with the same load to failure and cycle to failure as the traditional plating. At this point, we've had thousands of patients treated. We had published papers. You know, we had the data. We needed to recreate those same results through a smaller incision. All this instrumentation helped to do that. You'll see several instruments here, like an incision guide and some release tools that we'll talk about. What we noticed early on is to do these procedures through the smallest incision possible, you had to really know where you were anatomically on the foot because that incision mattered.
If you want to go through a two-centimeter incision and you're a half centimeter off over top of that joint, by definition, you're already at two and a half, and that wasn't the goal. For this and Adductoplasty®, we have incision guides for this. Dedicated instrumentation is needed in order to do the same triplanar anatomic correction at the tarsal metatarsal joint. You can see the size of the guide. That became the rate-limiting step: how do we do this same procedure through this? It developed into this system. That leads us to SpeedPlate™. The SpeedPlate™ technology is really fantastic. Mark will talk about the SpeedMTP™. This is where this kind of comes from for the first MTP fusion. The idea was not only did we need an incision smaller, we needed fixation to fit in that incision.
For efficiency, how do we get this plate and four screws in as one monolithic structure? What was developed was four tines that act as those screws that go in all at once. We lessened that to a two-tine SpeedPlate™ and then a micro quad. All that is to create the stability we have with biplanar plating with the traditional plates and screws, but allow that circumferential stability. This is very unique because it functions as a plate. It goes in with the ease and efficiency and the compression of a staple, but it really is designed off of our traditional four-hole plate and screws. It does not contain nickel, and it's anatomically contoured. The anatomic contour allows us to place it on the bone segments where we want it without impeding into any of the soft tissue structures like the tendons, without impeding into the surrounding joints.
This has really been an iteration that has transcended Lapiplasty®, Adductoplasty®, and first MTP fusion. These plates are even used in hindfoot, midfoot fusions, fractures, these sorts of things. This is really good. When we look at our triplanar correction through a small incision, you can see the pre-op, the post-op, and then the clinical image. Again, the goal was a triplanar correction like we had through a smaller incision. You see the incision there, the lack of length on the incision, the lack of swelling within that area. If you compare and contrast this to our traditional open, you see on the right side, there was a traditional open incision with maybe seven centimeters, and then we have our two-centimeter Lapiplasty®. Besides the skin, obviously, you have less trauma to the tissue. The X-ray is what I want you to focus on for one reason.
We wanted the same triplanar consistent approach through a small incision, and we were able to capture that with micro Lapiplasty®. That is really the key to this. That is Lapiplasty® in the iteration through micro through the two centimeter. As we move on, metatarsus adductus. Metatarsus adductus is a very important condition with bunions. We'll get into statistics in a subsequent slide. One of the things we realized as we were able to dial down what we call intermetatarsal angle or correct the deformity of the big toe, we were getting down to 0°- 4° . There was a subset of patients that even if we got down to zero, they still had a deviation of their toe, and it looked like clinically they still had a bunion. This is a subset of patients. It's called metatarsus adductus. I'll show you a slide on this.
In a traditional bunion, just the bone behind the big toe called the first metatarsal is deviated out of alignment. For that, we have three offerings of triplanar correction: Nanoplasty™, Percuplasty™, and Lapiplasty®. With metatarsus adductus, the two midfoot metatarsals, the second and third, also deviate with the first. That creates an entire midfoot deformity. You can see, you can make an argument that the space between the first and the second metatarsal, the long bone behind the toes, is not really increased, but yet they have a clear deformity and a clear bunion. We needed a system in order to do a triplanar correction with consistency in order to fix that. Before Adductoplasty® with Treace Medical , this deformity was just overlooked for the most part. There was no consistent way in order to correct this.
You can see that the deformity in the foot, both radiographic and clinically, still persists. What that does is lead to very dissatisfied patients, to say the least. The number one question that we got is, who needs Adductoplasty®? When do we do it? Who has metatarsus adductus that we need it? We came up with a system called a Pumline. We published this in 2023. The second author that's not on here is very famous. Thank you, Sean. The idea of this is we took a line from the medial midfoot bone called the cuneiform and extended that laterally where the first metatarsal would line up to the cuneiform in a corrected position. If that line did not touch or cut into the second metatarsal, that's what we call Pumline negative. That means we have enough room to correct that first metatarsal with Nanoplasty™, Percuplasty™, or Lapiplasty®.
In contrast to that, and this is the animation going over, in contrast to that, you see the foot to the right with metatarsus adductus. We draw the same line and extend it, and it crosses into the second metatarsal. This is very intuitive. Patients understand this immediately. Most importantly, other surgeons understand this immediately. If you look, if I correct the first metatarsal into its anatomic alignment, the first and second metatarsal compete for the same space. We physically do not have the room in order to do it. We have to consistently move the second and third metatarsal out of the way, and then we can go forward with the first metatarsal for its anatomic alignment, hence the birth of Adductoplasty®. What that came out of is four steps, just like the Lapiplasty®, where we prepare the joint, cut the joint, compress the joint, and fixate the joint.
This takes a very complex midfoot deformity that had no real consistent answer, and it made it streamlined and consistent with the results. Just like everything else, this started out as a full open procedure, about seven centimeters. Over time, as we learned from doing the procedure and understanding instrumentation, we can get this down to a mini Adductoplasty® through four centimeters. A lot of times that could even be three and a half. That is my take, not Treace Medical Concepts. What we realized is we don't have to cut both joints at the same time. You can see the instrumentations. Just like every iteration of the instrument or the system, instruments followed to complement the procedure. We have to have a robust release between what's called the base of the third and fourth metatarsal, hence the Tritome, which is a single-use instrument. There are multiple guides.
What's unique about the Adductoplasty® is we also have single and double, no deformity of the midfoot, just primary arthritis. We have a guided system to fuse in isolation the second and/or second or third, just for midfoot arthritis, which is also very common. You saw the SpeedPlate™ at the end. The incision guide is a consistent theme. We have to be in the right spot so we know that our incision stays within the boundaries of the length that we want. You see the guide was reconfigured. It's the same transverse plane and cut angle. It's just reconfigured in order to cut one side at a time. You can see the results. The idea is the less trauma to the surgeon. You have a three and a half, four-centimeter incision, a two-centimeter incision that handled a very complex midfoot deformity.
It handled it with a guided system with a minimally invasive approach to it. Really fantastic. You can see how the skin heals and how the foot looks afterwards. Those are our two flagship, so to speak, procedures of Lapiplasty® and the iteration of such and Adductoplasty® and its iteration. My fellow colleagues will go over the rest of the systems. I appreciate your time and attention to this. Thank you. Now, my introducer, Mark. Okay, Dr. Mark Easley from Duke. He's not limping. He had knee surgery.
All right, thanks. Yes, I'm Mark Easley. I'm at Duke and with my colleague Jonathan Kaplan, who's here as well. I'll try to talk to you. I'll just thank you slide. Is there something I just advanced and it's good? All right, bunions are very common. I think you've got that. What I'm going to talk to you about is arthritis or when the white shiny surface starts wearing away on the big toe joint. I'm looking at the category. Will already showed you this, but I'm looking at the category that's all the way down at the end there. That one there where we're talking about what do you do about this arthritis? You think, arthritis, you have knee replacements and joint replacements. For the big toe joint, we're not there yet. What we typically do is a fusion or mending the joint together.
You think, wow, you're going to fuse that joint together? How are somebody going to walk? How are you going to, if you don't move your big toe joint? That's what we're going to talk about. It's a very common problem. There are tens of thousands of bunion surgeries done in the U.S. every year. This problem is a close second. Arthritis of the big toe joint, there's thousands and thousands of these operations done, these fusions of the big toe joint. What is Treace Medical going to do? I wasn't one of the founding surgeons to work with Treace. I actually approached them and said, I'm starting to do your operation. I love what you do. Could I somehow be involved? They invited me to be part of the team because it's the right way to do it.
What I want to emphasize today is that all of these instruments you'll see and these cool products, and they are important. What Treace does really well and the surgeon advisory team does, it's really the philosophy of how to do the surgeries. If you look at other products on the market, they typically roll these out with the screws and the plates and say, okay, have at it. What Treace does much better, in my opinion, that's why I joined the group or asked to join the group selfishly, was it's a philosophy, right? It's like the surge where they teach you how to do the techniques. Nobody teaches surgeons how to do surgery better than Treace Medical . I am a consultant with other companies too. This is hands down the best approach to teaching surgeons how to do the techniques.
Oh, by the way, we have some great instruments too that make that better. That's the distinction there. We're going to talk about arthritis of the big toe joint. You can have a bunion, just like Will eloquently just showed you and talked to you about, but you can have it with arthritis. Will or the others can make that toe as straight as they want, and cosmetically it'll look nice, but it's going to be incredibly painful because it's grinding bone on bone. We don't want that, right? That's when we talk about doing a fusion. There is a whole other category which I mentioned, and that is the toe is straight, but it has arthritis. Again, an incredibly common problem.
Tens of thousands of these done every year in the United States, and unfortunately not done exactly perfectly, but that's called hallux rigidus, just a stiff big toe, right? This year, there are studies done that show that if you have a stiff big toe joint, you're very debilitated. There are also studies that show if you fuse that joint and make it painless, even though it's stiff, you're still incredibly functional. You can play sports on a big toe joint. You can run on a big toe joint that's fused. It's not as though you're going to debilitate these people as long as the toe is put in an anatomic position. Will just talked to you all about the triplanar correction. These same principles apply to the big toe joint fusion.
I don't think surgeons fully understand that, but Treace and the team really teach us that well and then provide you with instrumentation to do that surgery well. This is a patient walking down a, you've been to the doctor's office, just walking up and down the doctor's office here. You can see that it looks pretty natural, right? You could even have this patient do some exercises or run if you want, but it's really hard for me to tell that that big toe joint's been fused. As long as it's put in the right position, the surgeons taught how to do this properly, and then you have instrumentation to make it fuse reliably and have them be able to walk on it right away because it's a stable fixation, then you'll be very natural and be very physiologic. The competitors are out there. Look at this.
This is all over it. MTP joint fusion is a very common orthopedic procedure. We do this on a very common basis along with bunion surgery. The problem is sometimes, or often, the implants are very bulky. They are not necessarily taught the technique. Everybody knows how to do this. Yes, a common procedure, but there's some subtleties to it that need to be taught properly so it's done correctly. Mistakes can be made. The toe's put in the wrong position. That's symptomatic and a problem. The plate's too bulky. It's symptomatic. There are ways around that. What Treace does is take a common problem. You learned from Will, here's a problem that hasn't been defined. 130 bunion surgeries. We got to make this reproducible and more consistent. In this year, yes, a very common operation. What Treace does well is innovate and make it better and make it reproducible.
I work with residents and fellows, people that I train. Every one of them says, "My God, this SpeedMTP, it is so easy and intuitive and it's reproducible." That impresses upon me. I just showed it to them one time and said, "This is a system I'd like to use." In addition, there are other instruments like Will showed you that make the operation easier. The competitors, yeah, maybe they have some of these, but usually you have to scramble in the operating room to try to find some of these things. These all come in the kit. Ways to make it easy to expose that joint. It's already stiff, so it's easy to work in that joint. Ways to smooth the surfaces because it comes with bone spurs, right? It's arthritis going to make bone spurs.
You have a system that with that SpeedPlate concept, SpeedMTP, and a way to target screws so they don't interfere with one another, the way the tines work so that the plate continues to compress to make it more stable. A way to add screw fixation to pull the plate down to the bone and make this an incredibly stable construct that allows the patient to walk on it right away. Yes, they have to protect it some, but it's not as though they have to get a knee scooter or they have to be laid up in bed. They can get right back to their activities and for six weeks have to protect it, and then they can get going on this. Here are some of the instruments with it, but it's the same SpeedPlate technology applied to the big toe joint.
That's unique in the system in the competitive market. It's the principles of the technique and then having instrumentation to put this implant in properly and then have it work for you. It's low profile. See here, there's arthritis. Sorry about the graphic pictures. I know maybe some of you just had breakfast, but if you look here, it's just bone spurs. You get the idea. We can smooth those down. This feather rasp idea, it can be applied anywhere. A really slick tool to make this easier so you can contour exactly the bone that has spurs on it so the plate and the implants can sit perfectly anatomically on the bone.
A targeting device, if you can imagine, if you're putting four tines in a bone, a little bone and just a big toe joint, and then you have two screws go in and you want to put one extra screw in for fixation, something's going to collide, right? You just don't want that to happen. You don't want to slow down the process. You don't want to be longer in the operating room than you need to. A targeting device so that never happens makes it a lot easier for you. You can see here, sorry, pretty graphic, I know, but it could be worse. This is what we do, okay? We're sharing with you what we do. It's a way to make it easier to get into the joint. You see this little tool here. It's really, I mean, it's a medical art, right?
It's actually, this is artist's work. That way, these instruments can, so this is actually one of my surgeries. You can see here where everything sits nicely because we've contoured it perfectly. We've positioned it. We taught the technique how to get the toe in the right position. It's step by step. It's real quick to drop these in. Here's the implant. Sits in very nicely. You can actually, it's so stable. You can just say, actually, you know, we're carpenters. You can hammer this in place and then drop these extra screws and give it really a nice fixation. Good. All right. There's more breakfast. Just be patient. We'll get through it. You can see here, this is in the operating room. You can see how stable that is. In other words, it's stable. You can go right away and walk on this.
Not dance on it, but you're going to go walk on it right away because it's stable. Here it is, then the process of it's nice. It's low profile, low contour. You can see around that implant to make sure the bone's healing the way you want it to without it being obscured by the hardware. Here's a bunion surgery. Bunion surgery, again, some other techniques. Not that that's wrong. It's just that sometimes those don't work. This is how we salvage it with this same operation where we do a fusion. You can see the patient's incredibly happy. How do you know the patient's happy from preoperative to postoperative? How do you know? Quick. The toenail polish. That's exactly right. It's good. Anyway, you get the concept.
What I want to emphasize with you is that, yes, there's a lot of innovation and new things that take something that's complex, 130 different bunion operations, to try to get it down to something that's reproducible, predictable, and works for patients and works for surgeons. There's also something that's very established, a big toe joint fusion. Again, a very common operation, but we can make it better. What impresses me is that Treace puts the effort in to make that better. Holly, I think is next. Good.
Good morning, everyone. I'm Holly Johnson from the Hospital for Special Surgery right across the island. I'm going to talk to you today about some of the more percutaneous options for bunion correction and try to give a little background, but also give the thought process behind why Treace would enter this market. We've seen this slide a couple of times, and I'm going to address class one. This is where we have a fairly straightforward bunion deformity without adductus, without arthritis. We have two new options for that: Nanoplasty™ and Percuplasty™.
When we think about how surgery in general has gone from open procedures to more minimally invasive procedures in virtually every side of surgery, even open heart surgery, general surgery, and in orthopedics, I think to make it the most relatable, everybody in this room has either had an ACL reconstruction, a knee scope, a shoulder labral repair, or they know someone who has. If you think about those people in your life who've had those operations, it's all done through small incisions. Really, the entire market is going towards small incisions for obvious reasons: decreased pain, decreased swelling, etc., faster recovery. When we think about the advancements in arthroscopic surgery, it started from advancements in the technology and training that allowed every surgeon to do it. At this point, I can't imagine a surgeon doing an open rotator cuff. It's just completely gone. It's off the table.
That procedure is not done anymore. I think that as we move forward in bunion surgery, we're going to go in that direction. Some graphic photos, but I think that it really makes the point that when we look at the foot on the left-hand side, traditional open procedure, and the foot on the right, what person in their right mind would ever want the surgery on the left? Honestly, right? There's not a single person ever who would rather have that surgery than the other surgery. When we think about that and what's available out there, Treace saw an amazing opportunity to expand patient interest in surgery. Historically, and for those of you, there are probably some people in the audience who have bunions or have a spouse that has a bunion. Traditionally, even the primary care doctors say, "You should never have bunion surgery. It hurts so much.
It's going to take years to recover. It's never going to be good." "Literally wait until you can't put a shoe on anymore." That is the worst advice because we know that from when a bunion starts, it continues to get worse over time. As it gets worse, the toes get involved, the foot gets much, much more problematic, and the ability to fix the foot in a nice way is basically eliminated. There is a subset of patients out there who want to have their bunion fixed, but they're afraid. Now people are seeing, "Look, we've got these minimally invasive approaches that have less pain, faster recovery. I want that." They are coming into their surgeon's office and they're demanding those techniques. I'll say just anecdotally, I do no marketing. I'm not on social media. My hospital doesn't really do any marketing for me. I literally have to push.
I have so many bunion patients. It's like they come because I operated on Susie, and then Susie's sister comes and sees me, and I do both of her feet, and then she goes and gets a pedicure, and then the woman who does the pedicure comes to see me, and it's just this circle of people coming in because they see a fast, painless recovery. When we think about where we are in the country of the current state of bunion correction, it's a trade-off between patient benefits and technically challenging surgical procedures. This is me doing the procedure on the left-hand side, this video. Basically, many of you may have seen it out there, but you have this power device with this. It's essentially a drill on it, and that's how you cut the bone. The drill diameter is two millimeters.
I can cut the bone through a 2 mm incision as opposed to a more traditional way where you have to have exposure for the saw. It's a complicated procedure where I cut the bone, I shift the head, I put in wires percutaneously, meaning not through an incision, and then I place two screws, and that's what the foot looks like at the end. Those are the incisions. No incisions on top of the foot. The problem is that it's really hard, and it's taken me a long time to become proficient enough to be able to do this in a reasonable timeframe and to be good enough to really want to offer it to all my patients. When we look at some of the X-rays that are out there, and I know that there's, you know, I'm showing three different X-rays here.
These are all percutaneous or minimally invasive bunion surgeries done really poorly. These are people who even post this on LinkedIn and things. These are done poorly, and the patients aren't going to do as well. When these patients come in and they say, "I want minimally invasive surgery, but I don't understand why everybody's not doing it." The reason is because the surgery is really hard, and it's a difficult surgery to learn. It's a difficult surgery to teach. If you think about how many you have to do to become proficient, it's anywhere from 40 - 50 bunion when you're using the freehand technique. Most bunion surgeons may not be doing 50 bunion procedures in a year. Why would they want to adopt a surgery or a type of technique that's going to take that long to do it when they can do it the old-fashioned way?
Maybe they don't get as many good results, but hey, they can do it. The problem is that now we have this entire patient population that was never going to have bunion surgery before that wants to have surgery, and we need to teach the surgeons how to do it. This is where Treace comes in. Basically, they've come up with two instrumented systems designed to dramatically reduce the learning curve of a three-dimensional minimally invasive surgery. There are two options that address really, I think, two different surgeon populations. There's Percuplasty™, which is the screw technique that you saw me doing percutaneously, but now we have an option for a jig, and then Nanoplasty™, which is an intramedullary device, a plate system that surgeons can still do with the saw if they don't feel comfortable with the burr, but they can do it through a very small incision.
With the Percuplasty™, it's a few very small poke holes in the skin, and with the Nanoplasty™, it's one singular centimeter and a half incision. Again, thinking about, does minimally invasive surgery work? We know it works. There have been multiple studies that show that you can get rotational correction. You can get that three-dimensional triplanar correction using the minimally invasive system, and you can have successful outcomes. There are multiple studies that have come out over the last five or six years that show excellent short-term and long-term results with this distal osteotomy technique. Now, of course, we have these patients coming in who want the surgery, and we're going to develop a system that's going to allow the surgeon to do it better. If we think about the Percuplasty™ portfolio, there are three aspects to it. There's a three-dimensional correction and targeting guide.
This is where I would say for Treace, it was better to be a little later to market. There are other jigs that are out there on the market now from our competitors, but honestly, the jigs just don't really help the surgeon. They're very bulky, they're difficult to even get on, and they don't get that three-dimensional correction. They're only correcting the bunion in two planes. If you recall where Will DeCarbo was talking about how you need to get that rotational correction, none of the jigs on the market other than Treace correct for that three-dimensional deformity. You can get the correction where you want it. It makes it very simple to place the screws and essentially makes the procedure much more boilerplate, which goes along with Treace's mission. There's a plug-and-play MIS power system that you can bring into any ambulatory surgery center, into a hospital.
That makes it simple for any surgeon to have access to the burrs. Then the screw system, which is pretty unique as well. Looking at the targeting guide, you're essentially making those same incisions. You're sliding this guide in, and the jig or the guide itself helps you to dial in the shift of that metatarsal head, but then also rotate it to get that rotational correction, that triplanar correction. It holds it in place. Another advantage of this jig is it's essentially hands-free. A lot of times when people are doing the bunion correction, they need two hands. They need somebody to hold the correction and another person to fire the screws. This jig allows a surgeon to do it single-handedly. You place your wires and then very easily place the screws over the wires.
When we think about the screws themselves, the heads are beveled, which means they're angled and they sit flush against the bone so that you're not feeling those screws through the skin, and there's a much lower rate of hardware removal. They have a self-drilling tip. What this does is it makes it so you don't have to drill the bone over the wire, and it basically just simplifies the entire workflow, and you save time in the operating room and effort. Here's the screw going in. Thinking about case examples, this is an example of, I don't know if you can get the sense of shifting the head, putting in the screws, and then at six months, yes, this patient has had a pedicure because they're quite happy, and that's actually a sign of a successful surgery. I agree.
Just addressing the market that's out there, we have two populations of people that we're capturing with this new minimally invasive technique. We're capturing all those, I mean, largely women who've been afraid to have bunion surgery in the past because of the pain and everything else. I will say, from a pain standpoint, one of you asked me earlier about pain medication. My patients take no narcotics after surgery. If you think about historically where bunion surgery has been described as very painful, this is not a painful operation anymore. We're addressing the surgeons who need to learn the technique, and we've got a great solution. Thank you.
Hi, everyone. I'm Jonathan Kaplan. I'm also from Duke University, like Mark Easley. I'm actually going to leave this slide up for a second before I go on because I get to talk about the Nanoplasty™, which I like that it's in the middle because I'm kind of giving you the best of both worlds. I think that's something that's a nice feature for most of our surgeons that are doing these procedures. Like I said, this is who I am and where I'm from. You've seen this over and over again. There's a reason we're showing you this slide repeatedly because it really does make sense. It helps surgeons develop an algorithm for their approach because historically, like Will talked about, most surgeons did what they learned, what they trained, what was in their area. That's not really a good way to practice medicine.
We want a way to sort out what patients need different procedures so that we can have more predictable results. I'm, like Holly, going to talk on the mild to moderate deformity, these distal osteotomies, and specifically I'm talking on the Nanoplasty™, that medullary system. Why are we talking about this in general? Again, these are instrumented systems that accelerate the growth, accelerate reproducibility for our surgeons, and we're decreasing the recovery for patients. What are the challenges with the osteotomies? I think Holly did a tremendous job explaining it so well that I don't have to hammer it out. Even admittedly, I'll say these are hard procedures. Holly and I have been doing them for many years at this point, and we even struggle still, right? Think about the average surgeon who's not doing hundreds of bunions a year.
It's going to be hard for them to adapt a procedure that is technically challenging, that they struggle through the surgery, they have unpredictable outcomes because at the end of the day, we care about our patients and we want our patients to do well. These are those black diamond procedures, and we're bringing them into that beginner. We're going to see them go into the green target that we want. These are accelerating that recovery and accelerating the MIS procedures. Holly talked about it. Why are MIS procedures important? We see this. There's good data that shows patients have less pain, less risk of wound complications, less swelling, shorter recovery. That's what patients care about. There are surgeons, and surgeons want precision, they want adaptability, they want accuracy, they want this to be more streamlined in the operation so that they can have a better outcome.
That is what these systems do. The Nanoplasty™ specifically kind of meets surgeons in the middle because you've seen Will talk about the open procedures where we're using saws, we're looking at everything. That is something that surgeons are used to throughout their training. At the same time, Holly showed an example where she's using a burr. A burr for us, Holly and I, is very natural now, but it's not necessarily natural for the average surgeon who doesn't have experience. The Nanoplasty™ allows surgeons to use a saw through a very small incision, allows them to be accurate, and then use the instrumentation to correct the three-dimensional deformity where they want it to be. Hopefully, you'll see that as we go. This is a comparison of what these look like.
An average bunion surgery done open is usually as small as three centimeters, can be up to seven centimeters in size, whereas with the Nanoplasty™, consistently, it's 1.5 cm. The other thing you don't see in this, but you'll see in the next slide, and I know Mark said, you know, you're eating, so just a forewarning. With a traditional procedure, we're actually having to lift all of the soft tissues. To not be too gory, imagine we have to lift everything off of the bone to be able to see it and do what we need to do. Logically, it makes sense. That is going to be more painful. It is going to have more swelling. It is going to have a longer recovery. That is why these horror stories exist with patients. That is why for years and years, patients have been afraid to have bunion surgery.
Even with the Nanoplasty™, it's 1.5 cm, but you don't have to lift the soft tissues. You're working through this nice little pocket, and you're able to do everything through that small incision. This is what it looks like. You can see the comparison. I won't leave this up too much so nobody gets nauseous, but that is the difference there. This is what it looks like in recovery. This is what patients see, right? They're not looking at their surgery. They're not watching their surgery, so they don't see that open picture, but they do see the after effect, right? The things that they're looking at, they're looking at the alignment of their nail, like Mark talked about. When you take the dressings off, they're looking at the size of the incision. You can see the difference here.
The picture on the left, it's a large incision, but not just the incision. You see bruising tracking down the toes, tracking up the foot. Patients can see that. With the smaller incisions, really what sticks out on the picture on the right is actually our surgical marker. That's purple lines that we draw in the anatomy. You can barely see the incisions, and you see less swelling. Patients are happy about that. They can get back to life quicker. What does the Nanoplasty™ do? Just like everything else, it's step by step. It's instrumented. It's allowing a three-dimensional triplanar correction. The first step is we're going to have a precision-guided cut with a saw, which again is very natural for most surgeons. We're able to insert the jig through that small incision, and we're really able to work through that small incision.
We're able to correct all three deformities. We're able to translate, meaning we move the head over into a position that we want it to be. We're able to angulate it. Looking from the side, we're able to get it lined up well. That third plane that is absolutely critical is the rotation. You're able to dial that in. It's possibly my favorite part of the procedure because it's very precise and accurate. You're going to see an example of that in a second. We're able to fixate it. The key with these minimally invasive procedures is we don't want to compromise outcome, and we don't want to compromise recovery just to have smaller incisions and less swelling and less pain. That's what these do.
They're really strong, stable constructs, allow patients to walk right away, allow patients to maintain good alignment because at the end of the day, the patients are looking for three things. Number one, they don't want their bunion to come back. They want predictability. Number two, they would like to have less pain with the surgery, with the recovery. Number three, they'd like to get back to life quicker, have a quicker recovery. That's what this does. This is what it looks like on an X-ray. The first picture on the left is where you can see our cutting guide. We're not just randomly making this cut. Surgeons can see on an X-ray where the cut is going to be. They can use a saw that's very familiar and natural to them. In the middle picture, we can see we're inserting that guide.
I'll bring your attention to the middle and then the third picture because there's a pin that you can see coming in at an angle on the metatarsal head. In the third picture, you see that it's up and down. What that's doing is that's essentially rotating. That's giving you your three-dimensional rotational correction. We'll show you an example of what that looks like in a second. This is our fixation on the right. What I didn't talk about earlier, but I'm going to point out here, is it's also very low profile. What we don't want to do is we don't want to remove the patient's bony bunion, meaning their anatomy, and give them a metal bunion, meaning give them hardware that's prominent and palpable and symptomatic where they have to go in and have another surgery to take it out. That's why
Holly Johnson talked about the beveled screws being low profile, and that was the goal with the Nanoplasty™ as well. You can see that. This is probably my favorite part of the procedure, which is the rotation. Essentially, it's very precise. Notice how we're just gently dialing it in. We're just turning in a controlled fashion, and we can be very, very accurate at getting our rotation. We're not trying to get it in the ballpark. We're getting it exactly where we want. We're essentially hitting a home run. This is what it looks like through the recovery. The picture on the left is preoperatively where you can see that they have an angulation in the bone. The picture in the middle is immediately postoperatively where you see the fixation. A lot of people ask me on the drift and try not to trip.
A lot of people ask, does it really heal in this area? That's what we've seen over time over the years. You saw that with Dr. Holly Johnson's examples, and you can see it on the right where all of that is new bony consolidation and new healing. A lot of patients will also add something called an Aiken osteotomy, which is we'll do an osteotomy on the proximal phalanx, and that's where the Percuplasty™ can come into play as well with this. It gives you a comprehensive portfolio, a comprehensive package for these patients. This is another example, and I like this one because you can see the clinical photo on the right where you're looking. They're about three months postoperatively. Common theme, their nail polish is done, they're back in regular shoes, they're running, they're active.
You can barely see the incision, you're really just looking at the skin folds, and it's really nice. Imagine that's looking directly medially or from the inside. Imagine looking from the top, you can't see any incisions at all. A lot of our patients will come in at three months and say two things. Three, really. One, when can I do my other side? Two, I sent a lot of family members to you. Three, most people don't even know I had bunion surgery. I think for us, that's important, right? That means they're happy. This is really kind of combining the best of both worlds. It closes the loop, giving you a really comprehensive portfolio, but in a really nice algorithmic approach. We're not guessing how to treat bunions anymore. I'm going to bring Dr. Mark Easley, my partner, back up to talk about the IntelliGuide PSI.
All right. Sorry, you stuck with me one more time. This is good. I do have a question for you. How often do you go to a meeting and you're not prepared? Can I see a show of hands? Really? How many want to do that? You really want to be prepared. Oh, okay. Good. Okay. One. All right. That's good. Spontaneous, off the cuff. What I love about this, this is patient-specific instrumentation. Okay. PSI. We're talking about, we really can talk about all of these things with this, but we'll focus on really these two center ones. That Lapiplasty or the Lapidus type procedure where the first ray, that bunion's corrected, or if you have that adductus problem you have to correct as well. That's what we can address. The difference here is that we can actually go to the operating room now with a plan in place.
We're not winging it. We're not seeing what might happen. We have a predictable plan going into the surgery. This is not new in orthopedics. This is not new in surgery. This is a lot where surgery is going, that we have the technology now where we can actually plan things ahead of surgery and then go in with that plan and execute that plan. Here it is. We use a CT scan, so a CAT scan. It's a three-dimensional way of looking at X-rays. I know that, or the foot. I know that before it was mentioned that one of the mistakes is looking at bunions in particular in two dimensions. I'm also a total ankle replacement surgeon. There are very few total ankle surgeons now that do total ankle replacements by winging it or just guessing where it needs to be.
We're pretty good at that, but we can use patient-specific instrumentation, a CT scan, to put those components, those metal pieces, just like hip or knee replacement, in the proper position. We can do that now with bunion surgery too. That's, again, that innovation that Treace brings to the table of looking at how can we predict this ahead of surgery. What you see all the way on the right after the CT scanning planning has been done is actually these cut guides. You saw a lot of different cut guides and a lot of different instruments today, but same principles applied. Plan R is in place. Guess what? The cut guide is not being put on and we're looking at a fluoroscopy or that live real-time image in the operating room. We actually put the cut guide on that's pre-made for that patient. We have that.
That's a little model in the operating room. You get the haptics, if you know what that is, right? Where you get a feel for that model, comes sterile in the operating room. You get a feel for how that sits on the bone. You can look at it even before the surgery starts. This can be sterilized. Then you take that and put it onto the patient. It's a patient-specific guide because it's going to make the cuts then, as long as you position it properly, exactly where you need it to be to get the correction you already planned. This is really looking innovatively into the future, where to go. Really old slide of an old type of ankle surgery that was done freehand for emphasis, really. There are ways we can do this with instrumentation, ankle replacement surgery. That's what I was talking about before.
There's a patient-specific guide. Surgery has been planned. Where do we want to make the cuts in that ankle bone so the component sits exactly where we want it to be and we're not guessing or trying to fiddle with it in the operating room to try to get it right. Same thing for bunion surgery. Where can we use this? It can be just a straightforward bunion. It can be that metatarsus adductus bunion. It can be a bunion or a foot surgery that's been previously done and potentially not done well, or there were some complications. We can correct that as well because we can make a preoperative plan and decide how to do it. Here it is. Right here, we got the cut guides based on three-dimensional analysis. This can be personalized. I like that word.
What it really is, is going to your meeting, having planned for the meeting, knowing exactly what your strategy is going in, and knowing what the end result is going to be because you've planned it ahead of time and you're going to execute it based on patient-specific instruments for that, which I think is terrific. You see that here, all these measurements mean something to us, but you can understand that we can take a computer now and do all this so we don't have to do all the heavy lifting with calculations. It can do it for us. What we really want to end up with is a plan like this. Here's the preoperative X-ray. Again, we're looking under the skin. Here's the X-ray. You've seen a lot of this already. What we want to end up is where the green is, right? That's in three planes.
We're going to move that. We're going to correct the bunion. If for some reason we have that metatarsus adductus, we're going to move those other metatarsals out of the way. We'll put the bunion where we need to be. We'll correct that in three planes, get the rotation exactly where we want it to be. We can tweak that, but it's all done before we ever step foot in the operating room. Here are these patient-specific cut guides. The beauty is that the Treace team is available. If surgeons want to do this, say they're a little unfamiliar with this, potentially, the Treace team will sit with them with the engineers and go over the plan with them.
Little tweaks are made, and there may be some surgeon preferences, and those can be all built into these cut guides that are patient-specific, specific to that particular patient or that particular bunion deformity. The big picture is that that's a reproducible technique that can be done over and over again. I think if you look five years from now, ten years from now, this is where it's going. It will be even more innovative, and Treace will continue to be at the forefront. The idea is that we're pushing this forward where it's very predictable. I don't have to do all these little adjustments because I already know where I need to be. I just have to put the guide in the proper position and make the cuts and then finish the operation from there. Yes, some more graphic pictures.
Maybe Holly would be disappointed in me because, you know, I actually made an incision. You can see here that it's a patient-specific guide, but I can look at a preoperative plan, put it on, look at the fluoroscopy image, and confirm that's where it is. Ideally, we get to the point where we just know where it's going to sit. We wouldn't have to look at the fluoroscopy until we're all done with it, right? That's where the evolution is going. Again, a little more invasive here, but the idea is the cut guide is made specifically for that patient. Yes, we can start making those smaller and smaller and smaller incisions for that as well. We're at the forefront of this right now working forward. You can see here this rotation. Remember the rotation? Think about it.
You can put this cut guide on and here for the bunion, for instance, and you see how right here we want to make this cut and we want to make this cut, and that's going to help correct the bunion, but also the rotation built in it. Can you see that these two pins? I can see down these pinholes, but I can't see down these. Here I can see a little bit better, but what's going to happen is I'm going to make all these cuts, and these pins will be in, and then I'll put another device on that actually just locks in, and it takes those two pins and rotates them in alignment and drops in, and then that corrects my rotation. I don't even have to think about it. It's already all pre-planned to make that a lot easier. That's for the Adductoplasty® as well.
You can see the pins are offset. I want to put the next guide on. He drops them in. The rotation is already done based on my preoperative plan before I ever stepped into the operating room, as I said. Here's the correction. You can see that the same implants. Those are important, but what's really important, I have a way of reproducibly doing this operation and plan it all before the surgery. What if you have a situation where somebody physiologically has a short first metatarsal? As you can imagine, there could be some problems if the foot isn't balanced properly. I can actually address that. I can, in my plan, say, okay, I got to lengthen this bone this much, and I can plan that exactly how I need it to be. That right there all the way on the right is some bone graft.
There are donors out there. You know, I can donate corneas and hearts. You can donate bone too. These are pre-cut. Treace has these too. The surgeon doesn't have to sit there with a saw and try to get it just right, and a lot of tailoring has to go into it. It's already pre-made for this particular problem in different sizes. Yes, it's human bone. That is immediately available and can drop in so I can make up for that deficit in length and address that with the same type of fixation, but all pre-planned. That's the difference. I think what's amazing about this, and I really think this is where it's going to go, is that all this can be pre-planned. Think about how predictable that is.
When you go to your meeting, you feel very comfortable going in because you have your strategy, your plan of attack, and you know what the result is going to be because you're prepared. That's the big difference. All of this can be done, but with a pre-planning in place, patient-specific instrumentation. Thanks.
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I'll need to introduce yourself.
Okay. Good job. All right. Thank you, Dr. Easley. Okay, that's loud. I'm Sean Scanlon. I'm Chief Innovation Officer at Treace Medical. I've been at Treace since just about the beginning. I like to say I have the best job in the world. I get to work with a company, join John Treace very early on that has invested in innovation since day one, and we're still accelerating our innovation. We work with surgeons that are super talented, visionary, and pioneers in minimally invasive surgery Lapiplasty in this field. We have a mission at this company that is very clear, and we went through it a lot today. It's how do we bring triplanar correction? How do we democratize it for all surgeons in order to improve bunion surgery?
We've done this through highly instrumented techniques that we can take a surgeon, do one training lab, and they can get out and get a great result in any of these procedures. We've worked hard over the last couple of years on how do we expand this three-dimensional correction to the osteotomies, to MTP fusion. This is really a coming out party for us this year as we launch this full system. We also have these enabling technology platforms that we talked about through the different talks. These are things we're going to continue to build on as we grow the company. Where are we going to play? How are we going to continue to grow? We talked about the bunion opportunity. It is still a massive opportunity that is underpenetrated.
Through our open procedures, Lapiplasty, Adductoplasty, and then as we go into minimally invasive surgery procedures, we think we can move further up the funnel, as we talked about, bring more patients in that are on the fence for bunion surgery and expand through penetrating the bunion market. We're also going to use some of these core kind of technology platforms to expand the market and grow within the market too. There's a lot of adjacent procedures with bunion surgery. There are 28 bones in the foot. There are all the common pathologies associated with bunions. How do we become one-stop shop with the best instrumented systems for all the different pathologies a surgeon needs to address in the bunion case?
Five growth drivers, and this is a bit of a summary of what I just went through, but number one, continue to advance our core procedures and penetrate the bunion market. Two, we're going to expand our portfolio into these other highly adjacent procedures with bunions. We are going to do this by growing our three main platforms: our MIS systems, our SpeedPlate™ platform, and scaling the PSI digital solutions that we're working on as well. This first thing is something that you've seen a lot today and something that we're super passionate about. By being highly focused on bunions, we can continuously be very close to our surgeons and MVs cases, become experts in these procedures, and look at the unmet needs in the procedures to c ontinue
to make them better. I like to call it kind of, and John mentioned kind of the iPhone model. We're always working on the next iPhone on the core Lapiplasty®, Adductoplasty®, and now the MIS and MTP systems. How do we make them easier to use, more reproducible, and then provide less invasive options for them as well? You can see an evolution. There are actually like 12 different versions of Lapiplasty® over the past 10 years. This year we're actually launching at the end of the year a limited release of our Lightning system, which is a way that really integrates Lapiplasty® with SpeedPlate™ and makes it a truly hands-free system that's really conducive to the speed and efficiency of SpeedPlate™.
Also, as we've been deep in these procedures and paying attention to detail around what are the other unmet needs in the procedure, how do you make these procedures more efficient, faster, and improve outcomes? We've talked about a good bit of these single-use instruments. These are all highly unique to Treace. These are procedure specific. They're problems we see in the case and how do we make the case go better? Examples are, we talked about a little bit, you know, laparotome. You make a small incision, you make a bone cut. How do you get that bone slice out of the small incision without breaking the bone and having to dive in and pick it out? This is an osteotome, like a little chisel, but it has a hook on the bottom. You release the bone and then you can hook the bone and pull it out.
The speed release, it's common to do a, it's called a sesamoid release at the big toe joint when you're doing Lapiplasty®. We saw surgeons just using a scalpel, and many of them would spend about five minutes digging around in there blindly trying to do the release. We found a very incomplete release affecting our outcomes. How do we make a guided instrument that allows them to do that release very efficiently? Both improves the speed and efficiency of the case, but also leads to better outcomes. These have become a large part of our revenue base in these procedures too. Once surgeons try these, they can't go back to doing the cases without these tools. They're such great problem-solving tools. The second part of this is expanding our portfolio.
Like I mentioned, there are 28 bones in the foot. There are a lot of other common pathologies associated with bunions. How do we take our recipe of highly instrumented techniques and address these other adjacent procedures too? We're just getting started into some of these different areas. A couple of examples here, you saw in some of the cases an Aiken osteotomy, which is an osteotomy to help straighten out the big toe joint. It's commonly done in bunion surgery. Often use a staple for this. Many of the staples in the market were very blocky, very prominent for the patient. We're able to use our SpeedPlate technology platform and make a very low-profile staple. You can see how well this staple fits to the contour of the bone. We also mentioned bone grafts.
Other procedures in the foot, flat foot, other things that we're moving into, how do you address those? We're able to use our SpeedPlate platform you see in the bottom right, bone graft to both lengthen the first metatarsal. If you look in the back of the foot, that's actually in the heel, that's an osteotomy to address flat foot. These are areas we're going to continue to build instrumented systems, train surgeons on, and bring these solutions to help kind of really be one-stop shop for everything that's performed in a bunion case in addition to our core procedures. All right, the third thing, and we spent a lot of time today, I'm really excited about MIS and where this is going. How do we accelerate access to MIS? These are challenging procedures like we went through.
How do we take our surgeon base, the majority of them are not doing MIS, and how do we help train them and give them the tools to be very proficient in MIS after just one surgery? You see a stat here. This is the fastest growing area of bunion surgery when we pull our surgeons. MIS is also used in many adjacent procedures throughout the foot. Against a platform as we move from bunions, also throughout the foot to other pathologies. There are two really main limiters here in addition to the training. One is we talked about burrs. A low-speed, high-torque burr is used for MIS surgery. This is a capital piece of equipment. How do we provide access to surgeons and they're able to do this?
We are announcing today a partnership where we can have a really plug-and-play MIS system that's dialed in for a foot and ankle surgery where they just plug in the hand piece and all the settings are pre-ready to go. This is highly scalable for us to have a very capital-efficient way to address minimally invasive surgery (MIS) power systems. The other side of MIS is, you know, how do you make the instrumented systems like we talked about with Nano and Percuplasty™ that the surgeon can go to one lab and get a great result in their first case. We are going to continue to iterate and expand on MIS and grow this throughout the foot. The fourth thing is expanding on our SpeedPlate™ platform.
We have also covered this a bit through many of the talks, but this is a highly differentiated implant platform that only Treace Medical has. The benefits are surgeons love nylon staples that have been in the market. They love the dynamic compression of nylon staples. They're fast and easy to put in. They like the compression. If you look at the data in the bottom right, this is some head-to-head testing that we did of our titanium SpeedPlate™ versus nylon staples. Titanium is much stiffer, so you get a lot more compression from titanium, kind of pound for pound. It is much better in fatigue. As the patient walks, you can see the cycles of failure of a SpeedPlate™ in the bottom right, the red bars versus nylon. It is much better in fatigue. Patients can weight bear faster with our titanium SpeedPlate™ technology.
The other benefit, and we talked about how do we get into small incisions, is that we can actually do highly anatomic shapes and machining of titanium that you can't do with nylon. Things like the micro quad would not be possible with nylon. We can do it with titanium, make a very robust fixation through very small incisions. We are also expanding with SpeedMTP™ into this hybrid fixation, which combines the best of both worlds. You have the dynamic compression of SpeedPlate™, but then you also get the locking screws of a typical plate. That gives off-angle support and stability. That makes the SpeedPlate™ even more stable.
As we look at these other pathologies in the foot, and as we continue to advance our core procedures, but also these adjacent procedures, SpeedPlate™ is a platform that we are going to be applying throughout the foot where we can make very anatomic designs in order to address many different pathologies throughout the foot. The fifth one is PSI and other digital solutions. Dr. Easley did a great job of, you know, who wouldn't want a personalized solution to go in as a surgeon and to be able to communicate to the patient, here's your anatomy in three dimensions, here's what I plan to do, and know what the outcome is going to be pre-planned before you step foot in the OR.
The challenges that we're planning to address here, and we've been investing in this area a lot, is how do we bring software solutions and AI-driven solutions into this in order to make this highly scalable for Treace and for our surgeons and also just make it accessible for all surgeons out there? How do we make the process easier, smoother, less costly so that we can expand this throughout the entire bunion correction surgery, which is a much more common procedure than something like, you know, total ankle we talked about? I am super excited about where this digital technology is taking us from both a surgeon and intraoperative guidance, but also as a patient communication tool to help educate patients of what their pathology is and why they need bunion surgery and what the reconstructive plan is.
Those are the five growth drivers that are going to continue to grow Treace Medical as we expand from where we are now to kind of doubling the size of the company in the next several years. That is all. Thank you. We're going to take a little mini break and then do a panel Q&A.