Many dairy cattle worldwide are housed in tiestalls, meaning that they are tethered by the neck to individual stalls. On some farms, tied cattle are permitted seasonal access to pasture, but otherwise their movements are restricted compared with cows housed in freestall barns or other loose housing systems. The aim of this systematic review is to summarize the scientific literature pertaining the welfare of tied dairy cattle through comparison with less-restrictive housing systems. Articles identified by PubMed and Web of Science underwent a 5-phase screening process, resulting in the inclusion of 102 papers. These papers addressed measures of welfare related to affective state, natural behavior, and health (with the lattermost category subdivided into hoof and leg disorders, lameness, mastitis, transition disease, and other diseases or conditions). Health was the most researched topic (discussed in 86% of articles); only 19% and 14% of studies addressed natural behavior and affective state, respectively. Our review highlights different health benefits for tethered and loose cattle. For example, tied cattle experience reduced prevalence of white line disease and digital dermatitis, whereas loose cattle experience fewer leg lesions and injuries. The prevalence of mastitis, transition diseases, and other conditions did not differ consistently across housing types. We found that the expression of certain natural behaviors, particularly those associated with lying down (e.g., time spent kneeling, unfulfilled intentions to lie down), were impaired in tiestalls. Articles addressing affective state found benefits to loose housing, but these studies focused almost exclusively on (1) physiological measurements and (2) cow comfort, a concept that lacks a consistent operational definition across studies. We call for future research into the af-fective state of tied cattle that extends beyond these explorations and employs more sophisticated methodologies.