FIRST AMENDMENT TO LOAN AGREEMENT

Exhibit 10.23

FIRST AMENDMENT TO LOAN AGREEMENT

THIS FIRST AMENDMENT TO LOAN AGREEMENT (the “Amendment”) is made and entered into as of June 11, 2009, by and between MERCANTILE BANK, a division of Carolina First Bank, (“Lender”), RTI Biologics, Inc. (“RTI”), a Florida corporation, Tutogen Medical, Inc. (“Tutogen”), a Florida corporation and Tutogen Medical (United States), Inc. (“Tutogen US”), a Florida corporation (collectively, RTI, Tutogen and Tutogen US, the “Borrowers”) (Lender and Borrowers, the “Parties”).

R E C I T A L S

A. Lender and Borrowers entered into, and executed, that certain Loan Agreement dated as of January 28, 2009 (the “Loan Agreement”), which provided for the making of the following loans to Borrowers: (i) a revolving line of credit loan in the principal amount of $10,000,000.00; and (ii) a term loan in the principal amount of $1,750,000.00 (collectively, the “Existing Loans”).

B. RTI has requested an additional term loan in the amount of $848,000.00 (the “Term Loan 2”) evidenced by a promissory note dated the date hereof (the “Term Note 2”).

C. The Parties are entering into this Amendment to modify the terms and conditions of the Loan Agreement to include the Term Loan 2 as a Loan under the Loan Agreement, to amend the definition of EBIDA, and to amend certain other terms of the Loan Agreement.

NOW, THEREFORE, for and in consideration of the premises and the mutual terms and conditions contained herein, and for other good and valuable consideration, the receipt, adequacy and sufficiency of which are hereby acknowledged by the Parties hereto, the Parties agree as follows:

““EBIDA” means the sum of earnings before interest expense plus depreciation and amortization expense plus goodwill impairment plus asset impairments and abandonments minus any non-cash income.”

“Loan Documents” means this Loan Agreement, the First Amendment to Loan Agreement, the Notes, the Security Agreement, the First Amendments to Security Agreements, any guaranty agreements, financing statements, collateral documents, consents and all other documents, instruments, certificates and agreements executed and/or delivered by Borrowers, or any third party, in favor of Lender in connection with the Loan or the Lender’s security interest in the Collateral.

“First Amendment to Loan Agreement” means the first amendment to loan agreement dated as of June 11, 2009 by and among the Lender and the Borrowers.

“First Amendments to Security Agreements” means, collectively, the first amendments to security agreement dated June 11, 2009 between each of the Borrowers and the Lender.

“Term Loan 2” means that certain term loan made to RTI in the original principal amount of $848,000.00 more particularly described in Section 2.1 hereof.

“Term Note 2” means the term loan note dated June 11, 2009 or borrowing in favor of Lender in the amount of the Term Loan 2 as set forth in Section 2.1, as well as any promissory note or notes issued by RTI in substitution, replacement, extension, amendment or renewal of any such promissory note.

(f) Term Loan 2 - Lender hereby agrees to make a term loan in the amount of Eight Hundred Forty-Eight thousand Dollars ($848,000.00) to RTI for the purchase of certain equipment. The Term Loan 2 shall be evidenced by the Term Note 2 and payable in accordance with the terms thereof.

(g) Usury. Borrowers agree that at any time the effective interest rate under any of the Notes would, but for this paragraph, exceed the maximum lawful rate, the effective interest rate under the Notes shall be the maximum lawful rate, and any amount received by Lender in excess of such rate shall be applied to principal and then to fees and expenses, or, if no such amounts are owing, returned to Borrowers.

“; provided that for the first year of consolidated operations of the Borrowers, the Funded Debt to EBIDA ratio will be calculated on prorated basis extrapolating the numbers for quarters in which the Borrowers have been consolidated over a twelve month period. After the first year of consolidated operations of the Borrowers, the Funded Debt to EBIDA ratio will be measured on a rolling four-quarter basis.”

IN WITNESS WHEREOF, the Parties have executed and delivered this Amendment to be effective as of the date first above written.