Recently, great progress has been made in particularly in the imaging of cartilage and bone structure. Increased interest has focused on high-field (3 Tesla) imaging and more recently on ultra-high field (UHF) magnetic resonance imaging (MRI) at 7 T for in vivo imaging. Because the signal-to-noise ratio (SNR) scales linearly with field strength, a substantial increase in SNR is expected compared with lower field strengths. This gain in SNR can be used to increase spatial resolution or reduce imaging time. The goal of this review was to highlight recent developments and challenges in in vivo musculoskeletal (MSK) imaging using UHF-MRI at 7 T. One focus of this review is on the emerging methodology of quantitative MRI for the assessment of trabecular bone structure at the tibia, wrist, and knee. In particular for this application, susceptibility effects between the bone and bone marrow transitions that scale with field strength have to be considered. Another important MSK application is the characterization of knee cartilage morphology. The higher SNR provided by UHF-MRI is a potential advantage for visualizing, segmenting, and analyzing cartilage. Standard clinical MSK imaging relies heavily on T1, T2, and proton density weighted fast spin echo sequences. However, fast spin echo imaging has proven to be very challenging at higher fields because of very high specific absorption rates, using multiple pulses in a short time frame; thus the imaging protocols have to be adapted and gradient echo sequences may be more beneficial. Imaging of more central body parts such as the spine at 7 T is still in its infancy and dedicated coils have to be developed.