Alphatec Holdings, Inc.

ATEC reported Q2 2026 revenue of $214 million, up 15% year over year, including surgical revenue of $196 million, up 17%, and EOS revenue of $17 million, essentially flat year over year. Gross margin was 72.5%, up 260 basis points year over year, and adjusted EBITDA was $36 million, up approximately 53% year over year, with margin expanding to 17%. The company generated about $34 million of operating cash flow and approximately $1 million of positive free cash flow in the quarter. For the full year, management maintained revenue guidance of approximately $882 million, including surgical revenue of approximately $805 million and EOS revenue of approximately $77 million, and raised adjusted EBITDA guidance to approximately $140 million from $134 million; it still expects at least $20 million of free cash flow. For Q3, management guided to $4 million to $6 million of free cash flow.

Pat Miles framed the quarter as evidence that ATEC’s long-running strategy is compounding: create clinical distinction, earn surgeon trust, and scale through a disciplined sales force. He highlighted lateral, EOS, Valence, SafeOp, deformity, and international expansion as multiple catalysts reinforcing one growth engine, and said the company is still early in its opportunity. His tone was notably confident and upbeat, repeatedly emphasizing that the company has “just scratched the surface” and is building for the long term.

Todd Koning emphasized that the business is translating revenue growth into operating leverage and cash generation. He cited 72.5% gross margin, adjusted EBITDA of $36 million, $119 million of cash, $85 million of available borrowing capacity, and roughly $204 million of total liquidity. He also noted $33 million of inventory/instrument-set investment in the quarter, about $34 million of operating cash flow, roughly $1 million of free cash flow, and that the new term loan A/revolver structure should reduce annual interest expense by more than $6 million and extend maturities to 2031.

Analysts focused on sales-force productivity, biologics attachment, surgical trends, free cash flow timing, EOS execution, and whether ACA changes or broader orthopedic volume softness were affecting demand. Management said surgical demand remained robust, that ACA exposure is less than 5% and is effectively a non-factor, and that the main revenue-per-case pressure came from biologics attachment rather than deformity or core procedure weakness. On EOS, management said installation can be bumpy, but EOS Insight adoption is growing, with about a 32% implant-revenue lift within 6 months after go-live in established accounts, and that the installed base penetration is still only around 15% to 20%.