Musculoskeletal shear-wave elastography in the paediatric population: a systematic review

In the literature, shear-wave elastography (SWE) is most often described for evaluating the elasticity of internal organs; nevertheless, it has also been increasingly used to assess the musculoskeletal system. In clinical and research settings, changes in the mechanical properties of musculoskeletal tissues can be observed in conditions related to overuse, sports injuries, congenital anomalies, neurological disorders, and other musculoskeletal conditions. SWE enables the assessment of these changes and may facilitate monitoring of disease-related alterations, therapeutic effects, and adaptations associated with physical training. The aim of this systematic review was to identify and synthesize all studies using SWE to assess the musculoskeletal system in the paediatric population. A total of 67 studies involving 2,558 children aged 1 day to 18 years were included. SWE was applied to a wide range of musculoskeletal structures and clinical populations, with substantial heterogeneity in study designs, ultrasound systems, measurement protocols, anatomical positioning, and reported outcomes. Twenty two studies assessed the reliability of SWE measurements, with reliability varying according to the examined structure and measurement conditions. Due to the substantial methodological and clinical heterogeneity of the included studies, a quantitative meta-analysis was not performed. Overall, the available evidence demonstrates a broad range of potential applications of SWE in paediatric musculoskeletal assessment, while also highlighting the need for greater methodological standardization and further research to establish robust reference values and clinically applicable protocols.