Eight randomized controlled trials were included in this meta-analysis comparing a range of outcomes between the quadriceps-sparing (QS) approach and the medial parapatellar (MPP) approach in total knee arthroplasty. For surgical outcomes, QS groups demonstrated significantly longer operative time by approximately 20 minutes, with no significant differences on measures of blood loss. For clinical outcomes, a statistically significant difference in favour of QS groups was observed in Knee Society Function scores, though differences fell short of clinical importance (MCID 6 pts); otherwise, no significant differences in pain, clinical scores, or range of motion were observed between QS and MPP groups. For radiographic outcomes, the rates of femoral component, tibial component, and mechanical axis outliers were significantly greater among QS groups compared to MPP groups.