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BACKGROUND: Musculoskeletal ultrasound has the advantages of non-invasiveness, real-time dynamics and good repeatability, and has been gradually used in the diagnosis of lateral epicondylalgia. However, its diagnosis accuracy has not been confirmed. OBJECTIVE: To explore the accuracy of musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia for providing evidence for clinical practice. METHODS: The trials about musculoskeletal ultrasound in the diagnosis of lateral epicondylalgia were searched in the databases of PubMed, EMbase, The Cochrane Library(Issue 6, 2018), CNKI, CBM and WanFang from inception to June 1, 2018. Two researchers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. Then meta-analysis was performed by using Meta-Disc 1.4 software and Stata 12.0 tool. RESULTS AND CONCLUSION: Seventeen articles were included. The random effects model was used to analyze the heterogeneity among the results of studies. The subgroup results of meta-analysis showed that the pooled sensitivity, specificity for gray-scale ultrasonography diagnosis lateral epicondylalgia was 0.81(95%CI 0.76 to 0.85), 0.79(95%CI 0.73 to 0.85), respectively. The pooled sensitivity, and specificity for gray-scale ultrasonography combined power Doppler ultrasonography diagnosis lateral epicondylalgia was 0.69(95%CI 0.64 to 0.73), and 0.82(95%CI 0.76 to 0.86), respectively. In summary, gray-scale ultrasonography holds high sensitivity and specificity in the diagnosis of lateral epicondylalgia. But it still needs more studies to validate the result because the limitation of quality and quantity of the included studies. [ABSTRACT FROM AUTHOR]