In this article, the authors review the role of ultrasound guidance in MSK mini-invasive surgery. Ultrasound imaging has become an important tool in the field of musculoskeletal examination and has advantages over the X-ray guidance traditionally used by orthopaedic surgeons. Ultrasound provides the 3D localization of the area where the instruments are being used, does not require X-ray’s certified personnel, and poses less of a health risk to the patient and the medical staff. This article explores the development and application of ultrasound navigation in mini-invasive surgery, including the use of ultrasound during different stages of arthroscopic procedures or for the entire operation. Ultrasounds can assist in setting access points around the joint, localize the pathology and assure its complete resection, identify vessels and nerves, establish access to and constant control of difficult operating areas with a high potential for neurovascular complications. In this paper, the authors also acknowledge that there are some disadvantages, including the need for additional equipment and personnel, a long learning curve, and the potential elongation of the procedure. To identify all of the essential studies that report relevant information and data concerning the ultrasounds navigation in mini-invasive MSK surgery, an extensive search of the major and significant electronic databases was performed by two authors. An investigation was conducted in January 2023 using the following key terms: ultrasounds navigation, ultrasounds in arthroscopy, ultrasounds in MSK, with no limits regarding the year of publication. The authors focused both on the advantages and disadvantages of ultrasound navigation in MSK mini-invasive surgery, and also on particular techniques in mini-invasive and arthroscopic surgeries. The described techniques are the application of ultrasound in arthroscopy (knee, hip, and shoulder), hallux rigidus surgery, mini-invasive Achilles tendon surgery, gastrocnemius recession, carpal tunnel release, and hematoma evacuation.