Four randomized controlled trials (n= 221) were included in this review comparing clinical outcomes of patients who have undergone bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction with or without patellar tendon defect closure. Qualitative analysis of results from the four included studies suggested limited differences in clinical examination outcomes, patient-reported outcome measures, or imaging outcomes between groups in which the patellar defect was closed and those in which the patellar defect was not closed. Methodological quality of all four included studies was rated poor.