Begin by cooking the elbow macaroni according to package instructions. Drain and set aside.
In a large skillet, brown the ground beef over medium heat until fully cooked, about 5-7 minutes. Drain excess oil if necessary.
Add the diced onion and minced garlic to the skillet and sauté until the onion is soft, about 3-4 minutes.
Pour in the beef broth and milk, followed by the ketchup, mustard, Worcestershire sauce, salt, and pepper. Stir to combine.
Bring the mixture to a gentle simmer, then add the cooked macaroni into the skillet. Stir well until the pasta is evenly coated.
Sprinkle the shredded cheddar cheese over the mixture and stir until the cheese melts and everything is heated through, about 2-3 minutes.
Taste and adjust the seasoning as needed.
Serve hot, topped with pickles and additional cheese if desired.