Background: Osteoarthritis is a condition that impacts all of the tissues in a joint. Evidence suggests that the subchondral bone is the most important component in both pain genesis and disease progression Aim of the study: Prospective outcome research to see how effective is subchondroplasty surgery at relieving pain and improving knee function in patients having osteoarthritis-related bone marrow lesions of the knee. Patients and Methods:The study included 30 patients between the ages of 40 and 75 who had been suffering from atraumatic knee pain for at least three months, had failed conservative treatment for at least three months, had BML on MRI imaging in a loading area, and had localized pain in the BML area. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and visual analog scale (VAS) pain scores have been acquired preoperatively, at 2 weeks, 3 months, 6 months, and 12 months after surgery. Under fluoroscopic guidance, subchondroplasty was conducted by injecting nanocrystal hydroxyapatite cement into the bone marrow lesion's location.Results: Following a one-year follow-up, the WOMAC scores improved considerably, from 62.03+-11.19 to 21.83 +-8.18 (p < 0.001). All of the patients' pain, stiffness, and physical functions improved significantly. Furthermore, after surgery, the mean VAS values showed a considerable improvement. At the end of the year, the patient improved from 6.98 +-1.16 to 1.81 +-1.00 (p < 0.01), which is highly statistically significant. Conclusion: Subchondroplasty is a promising approach for treating osteoarthritis-related bone marrow lesions of the knee, providing significant pain relief and functional results with low rates of complications in the short term results.