Exhibit 99.1





Symmetry Medical Inc. 2004 Employee
Stock





Purchase Plan





Report of Independent Registered Public
Accounting Firm and Financial Statements


December 31, 2008 and
2007












Report of Independent Registered Public
Accounting Firm








Audit and
Compensation Committees


Symmetry
Medical Inc.


Warsaw,
Indiana








We have
audited the accompanying statements of financial condition of Symmetry Medical
Inc. 2004 Employee Stock Purchase Plan as of December 31, 2008 and 2007, and the
related statements of operations and changes in plan equity for each of the
years in the three-year period ended December 31, 2008.  The
Plan’s management is responsible for these financial statements.  Our
responsibility is to express an opinion on these financial statements based on
our audits.




We
conducted our audits in accordance with the standards of the Public Company
Accounting Oversight Board (United States).  Those standards require
that we plan and perform the audits to obtain reasonable assurance about whether
the financial statements are free of material misstatement.  The Plan
is not required to have, nor were we engaged to perform, an audit of its
internal control over financial reporting.  Our audits included
consideration of internal control over financial reporting as a basis for
designing auditing procedures that are appropriate in the circumstances, but not
for the purpose of expressing an opinion on the effectiveness of the Plan's
internal control over financial reporting.  Accordingly, we express no
such opinion.  Our audits also included examining, on a test basis,
evidence supporting the amounts and disclosures in the financial statements,
assessing the accounting principles used and significant estimates made by
management and evaluating the overall financial statement
presentation.  We believe that our audits provide a reasonable basis
for our opinion.




In our
opinion, the financial statements referred to above present fairly, in all
material respects, the financial position of Symmetry Medical Inc. 2004 Employee
Stock Purchase Plan as of December 31, 2008 and 2007, and the results of
its operations for each of the years in the three-year period ended
December 31, 2008, in conformity with accounting principles generally
accepted in the United States of America.










/s/BKD, LLP








BKD, LLP





Fort
Wayne, Indiana


March 3,
2009





Federal
Employer Identification Number:  44-0160260












Symmetry Medical Inc. 2004 Employee
Stock Purchase Plan


Statements of Financial
Condition


December 31, 2008 and
2007




2008
                        
                        2007AssetsCash
                        
                        $
                        515
                        
                        
                        $
                        1,587Plan Equity
                        
                        $
                        515
                        
                        
                        $
                        1,587





See Notes to Financial
Statements








Symmetry Medical Inc. 2004 Employee
Stock Purchase Plan


Statements of Income and Changes
in Plan Equity


Years Ended December 31, 2008, 2007
and 2006




2008
                              
                              2007
                              
                              2006AdditionsParticipant
      contributions
                              
                              $
                              213,627
                              
                              
                              $
                              188,776
                              
                              
                              $
                              246,112ReductionsWithdrawals and terminations
      paid-in cash
                              
                              
                              (337
                              )
                              
                              
                              (1,002
                              )
                              
                              
                              (550
                              )Purchase and distribution of stock
      (21,250,11,859and17,823shares)
                              
                              
                              (214,362
                              )
                              
                              
                              (188,227
                              )
                              
                              
                              (248,699
                              )(214,699
                              )
                              
                              
                              (189,229
                              )
                              
                              
                              (249,249
                              )Loss and Changes in Plan Equity
      for the Year
                              
                              
                              (1,072
                              )
                              
                              
                              (453
                              )
                              
                              
                              (3,137
                              )Plan Equity, Beginning of
      Year
                              
                              
                              1,587
                              
                              
                              
                              2,040
                              
                              
                              
                              5,177Plan Equity, End of
      Year
                              
                              $
                              515
                              
                              
                              $
                              1,587
                              
                              
                              $
                              2,040





See Notes to Financial
Statements









Symmetry Medical Inc. 2004 Employee
Stock Purchase Plan





Notes to Financial
Statements





December 31, 2008, 2007 and
2006








Note 1: Summary of Significant
Accounting Policies





Plan Administration





The
Compensation Committee (Committee) of the Board of Directors of Symmetry Medical
Inc. (Company) administers the Symmetry Medical Inc. 2004 Employee Stock
Purchase Plan (Plan).  The Committee has the authority to interpret
the Plan, to prescribe, amend and rescind rules and regulations relating to the
Plan, and to make all other determinations necessary or advisable for the
administration of the Plan.  The administration, interpretation or
application of the Plan by the Committee will be final, conclusive and binding
upon all persons.  The Company will bear the expenses of administering
the Plan, except that any stamp duties or transfer taxes applicable to
participation in the Plan may be charged to the accounts of the
participants.




The
purpose of the Plan is to provide eligible employees of the Company the
opportunity to purchase the Company’s common stock through semiannual offerings
financed by payroll deductions.  Participants may elect to have up to
10% of compensation deducted from their pay annually to purchase
shares.  Participant contributions for any Plan year may not, in the
aggregate, exceed an amount that allows the participant to purchase Company
stock with a collective fair market value of more than $25,000 on the date of
the grant to purchase Company stock.







Organization





The
Plan was originally adopted by the Board of Directors on December 2,
2004.  A total of 600,000 shares of common stock have been reserved
for issuance under the Plan.  The number of shares reserved for
issuance will be increased each year until 2014 by the lowest of 100,000 shares,
1% of all shares outstanding at the end of the previous year or a lower amount
determined by the Board of Directors.  The shares of common stock
issued under the Plan may be newly issued shares or shares reacquired in private
transactions or open market purchases.  In 2005, all shares issued
under the Plan were newly issued.  Shares are issued to participants
in their name, and the shares are not included in Plan assets.




The
Plan began enrolling participants on March 28, 2005, in an initial enrollment
period that ended April 8, 2005.  During the initial enrollment
period, participants were permitted to purchase shares with a lump sum
contribution not to exceed 10% of eligible compensation participants have
received or expected to receive during the six-month period ended June 30,
2005.  Participants enrolled prior to June 30, 2005, were able to
purchase stock at 85% of the lower of the Company’s initial public offering
price of $15 per share or the closing price at June 30, 2005, as quoted on the
New York Stock Exchange.  Subsequent to June 30, 2005, participants
can purchase shares at 95% of the closing price on the last day of each exercise
period.




In
2006, the Company issued 9,740 shares at $14.63 per share and 8,083 shares at
$13.14 per share in June and December, respectively, to participants in the
Plan.  As of December 31, 2006, the Plan had 165
participants.




In
2007, the Company issued 6,038 shares at $15.21 per share and 5,821 shares at
$16.56 per share in June and December, respectively, to participants in the
Plan.  As of December 31, 2007, the Plan had 159
participants.




In
2008, the Company issued 6,821 shares at $15.41 per share and 14,429 shares at
$7.57 per share in June and December, respectively, to participants in the
Plan.  As of December 31, 2008, the Plan had 149
participants.









Note 2: Income Tax
Status





The
Plan is not and will not be qualified under Section 401(a) of the Internal
Revenue Code of 1986, as amended (Code).  The Plan is intended to
qualify as an employee stock purchase plan under Section 423 of the
Code.  Consequently, the difference between the purchase price and the
fair market value of the stock purchase under the Plan is not includable in the
participant’s gross income for federal income tax purposes, unless a
disqualifying distribution occurs.