Liver fibrosis, a progressive condition resulting from chronic liver injury, is a critical determinant of liver disease progression and prognosis. Accurate assessment of liver fibrosis is essential for guiding management and treatment decisions. Ultrasound elastography has emerged as a non-invasive technique for evaluating liver stiffness, which correlates with fibrosis severity. This paper provides a comprehensive review of the effectiveness of ultrasound elastography in liver fibrosis assessment. It examines various elastography techniques, including transient elastography (TE) and acoustic radiation force impulse (ARFI), evaluates their diagnostic performance against liver biopsy, and discusses challenges and future directions for this imaging modality.