84 Part I Chapter 3 Figure 6 Suggested imaging flowchart for imaging in the postoperative painful knee. WB ap, weight bearing anterior-posterior. After meniscus and or cartilage surgery MRI is the gold standard of postoperative evaluation. Bone-SPECT/CT does significantly add for the assessment of in-vivo loading of the different joint compartments. It is well known that increased BTO on bone-SPECT/CT is related to the degree of cartilage and meniscus lesions or degeneration . After corrective osteotomy bone-SPECT/CT can adequately visualize the most common complications: mal-alignment, non-union, intraoperative fracture, vascular injury, post-operative recurrence of deformity and patella baja. This is reached through accurate 3D localization of the “culprit lesion” by depicting the highest bone turnover and the SPECT part is unhampered by metallic implant artefacts and provides clinically relevant information on bone suffering from altered biomechanics in the knee joint [7, 41] (Figure 7).