Manipulatives are concrete or virtual objects (e.g., blocks and chips) often used in elementary grades to illustrate abstract mathematical concepts. We conducted a systematic review to examine the effects of interventions delivered with manipulatives on the learning of children with mathematics learning disabilities (MLD). The outcomes observed in the sample (N = 38) were learning, maintenance, and transfer in a variety of mathematical domains. Interventions using manipulatives were reported to be effective for a range of learning objectives (e.g., conceptual understanding and computational fluency), but several methodological weaknesses were observed. Analyses also highlighted considerable heterogeneity in the studies reviewed in terms of participant characteristics, intervention approaches, and methodology. We discuss overall effects of interventions with manipulatives in the MLD population, the methodological quality across the sample, and implications for practice.