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Align: Selling Innovation to Late Adopters

Executive Summary

Align Technology emerged from an unlikely source-two second-year Stanford business students with no previous start-up experience. These entrepreneurs were able to sign on major venture backers in a field which has never before attracted much interest from medical device investors: orthodontics. The founders' idea was that, by using advanced product design and manufacturing processes, the company could produce the Invisalign system of removable, clear plastic dental appliances that, for certain orthodontic patients, particularly adults-a large untapped market--could take the place of traditional metal braces. The challenge for the new company: to tap into a fragmented physician market not accustomed to new technology, moreover with a consumer-preferred device.

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The Knee Market Begins to Bend for Start-Ups

The $4.6 billion worldwide market for knee arthroplasty is technologically mature, but it is underpenetrated today and it's still growing at a robust 14% annual rate. Furthermore, changes in demographics and patient expectations have created a large, unmet clinical need: the 50-something year old with unbearable knee pain. Today, that is the focus of a great deal of technological innovation-most of it incremental-on the part of large companies that seek to increase the longevity of devices with wear-resistant materials, and technologies that improve device fit, or the precision of placement and the accuracy of alignment of implants. But recently, and somewhat surprisingly, venture-backed start-ups have also begun to enter joint reconstruction with their own technological solutions. Four new companies believe they've staked out spaces ranging from operating alongside multi-billion dollar companies without facing crushing competition from them, to taking a more head-on competitive posture, and in each case, to make a clinical difference.

The Knee Market Begins to Bend for Start-Ups

The $4.6 billion worldwide market for knee arthroplasty is technologically mature, but it is underpenetrated today and it's still growing at a robust 14% annual rate. Furthermore, changes in demographics and patient expectations have created a large, unmet clinical need: the 50-something year old with unbearable knee pain. Today, that is the focus of a great deal of technological innovation-most of it incremental-on the part of large companies that seek to increase the longevity of devices with wear-resistant materials, and technologies that improve device fit, or the precision of placement and the accuracy of alignment of implants. But recently, and somewhat surprisingly, venture-backed start-ups have also begun to enter joint reconstruction with their own technological solutions. Four new companies believe they've staked out spaces ranging from operating alongside multi-billion dollar companies without facing crushing competition from them, to taking a more head-on competitive posture, and in each case, to make a clinical difference.

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