Over the last year I have learned about an MRI finding called Bone Marrow Edema, (BME) and a new procedure developed in Philadelphia to treat joint pain coming from BME.. I have noted this finding in some patients with osteoarthritis, many patients with failed microfracture, and some patients with inflammatory arthritis. This patient was having severe knee pain and although he does have concurrent arthritis, he is not a candidate for a knee replacement at age 50, and in a high demand occupation . I performed the subchondroplasty procedure in December of 2013 and his pain dissipated to almost zero within 2-3 weeks. it is of course too soon to comment on long term results, but clear that in at least some patients we should be looking at the subsurface issues as well as the surface (cartilage) issues.