Prior research indicates that ultrasounds can be used in batch reactors as pre-treatment before anaerobic digestion, but the specific energy required at laboratory-scale is too high. This work evaluates both the continuous ultrasound device performance (efficiency and solubilisation) and the operation of anaerobic digesters continuously fed with sonicated sludge, and presents energy balance considerations. The results of sludge solubilisation after the sonication treatment indicate that, applying identical specific energy, it is better to increase the power than the residence time. Working with secondary sludge, batch biodegradability tests show that by applying 30 kWh/m3 of sludge, it is possible to increase biogas production by 42%. Data from continuous pilot-scale anaerobic reactors (V=100 L) indicate that operating with a conventional HRT = 20 d, a reactor fed with pre-treated sludge increases the volatile solids removal and the biogas production by 25 and 37% respectively. Operating with HRT = 15 d, the removal efficiency is similar to the obtained with a reactor fed with non-hydrolysed sludge at HTR = 20 d, although the specific biogas productivity per volume of reactor is higher for the pretreated sludge. Regarding the energy balance, although for laboratory-scale devices it is negative, full-scale suppliers state a net generation of 3–10 kW per kW of energy used.