Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain.

Sonographically guided percutaneous tenotomy of tendinosis was effective in improving patient symptoms without complications. Further investigation with additional patients and comparisons to alternative treatments is needed to validate these preliminary results.

Ultrasound-guided needle fenestration warrants further investigation for the treatment of recalcitrant patellar tendinopathy.

Increased years of running experience does not appear to significantly influence running mechanics. However, age and running speed do influence biomechanical variables associated with injury in distance runners. Thus, there may be factors, other than running mechanics, that contribute to less risk in more experienced runners.

The presence of a well-defined area of tendinosis on sonography was associated with clinical improvement after percutaneous sonographically guided fenestration of the patellar tendon. All tendons either improved (76%) or showed no change (24%) in the functional pain score at 4 weeks after fenestration.

Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. The history and physical examination remain the primary means of diagnosing this injury. Plain radiographs are helpful to confirm the diagnosis and to provide information regarding fracture classification, prognosis, and treatment options. The emphasis of this article is on the management of these injuries. Historically, only unstable distal clavicle fractures were treated operatively. However, recent well-conducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and non-union, compared with non-operative treatment. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture.

The sonographic findings of painful cortical irregularity and focal synovitis should raise the possibility of intraarticular osteoid osteoma, prompting the search for characteristic findings on correlative imaging studies.

This article reviews the recent literature on the use of anabolic-androgenic steroids (AAS) for performance enhancement. Recent studies utilizing supraphysiologic doses of testosterone have demonstrated increases in strength and improvements in body composition, despite earlier assertions by the medical community that steroids were ineffective as ergogenic aids. Although data that support the theory of conversion of prohormones, such as androstenediol, to testosterone in the body is available, support for testosterone precursors alone as ergogenic aids is lacking. Drug testing laboratories are utilizing new techniques that analyze carbon-13 levels of urinary steroids to detect exogenously administered steroids as well as the use of urine-manipulating agents. Investigations that seek to refute athletes' various claims for positive drug tests are ongoing. The recent discovery, characterization, and development of a urine test for tetra-hydro-gestrinone, a designer steroid, has brought the issue of performance enhancement once again into the public spotlight. Increasing attention is also being paid to the long-term effects of AAS abuse, as more authors characterize the changes to hematologic, hepatic, lipid, and hormone profiles as a result of years of steroid use. Although the understanding of AAS and testosterone precursors as performance-enhancing drugs continues to advance, there are likely to be more revelations as scientific investigations continue.