Laser pulsed energy will be delivered over an optical fiber to create channels into damaged cartilage of the knee or knees. The channels have a diameter of approximately 100 microns or less and an approximate depth of 1 millimeter or less. Bone marrow aspirate will then be delivered into the damaged joint.

The creation of micro-channels into damaged knee cartilage will facilitate the movement of fluid into and out of the tissue to allow for more efficient nutrient diffusion. The addition of bone marrow aspirate will provide additional growth factor enriched nutrition to the tissue. The goal of this combination therapy is to facilitates the body's own reparative processes leading to improved patient well being.

Inclusion Criteria:

Kellergren grading scale of 2 or 3 in at least one compartment of either or both knees with no compartment representing a stage 4 in either knee.

No significant MCL or LCL tear or laxity

No significant meniscal tear. ( i.e. bucket handle)

Exclusion Criteria:

• Injection with the past 6 weeks
• Stage 4 osteoarthritis in either knee
• Uncontrolled Diabetes or any other metabolic syndrome
• BMI greater than 28
• Significant lower extremity deformity
• Bilateral or tri compartmental Knee OA
• Adults unable to consent
• Individuals who are not yet adults (infants, children, and teenagers, age < 18)
• pregnant women
• Prisoners
• Stage 4 osteoarthritis in either knee
• Subjects, who, in the opinion of the investigator, for any reason other than those listed above, will not be able to complete the study per protocol.

Data will not be shared unless the principal investigator decides to make public either through podium presentations or written publication.

Sham laser means laser not turned on. Sham marrow means incision in skin made but no marrow drawn. Patient under conscience sedation. MRI and outcomes measures independently measured.