It is imperative teachers use evidence-based practices to instruct all learners. Yet, there are limited reviews focused on educational practices to support secondary students with learning disabilities in algebra. This evidence-based systematic review focused on research published in peer review journals between 1999 and 2019. Eighteen studies across 17 articles were reviewed and analyzed, of which 14 met the Council of Exceptional Children standards of high quality. Researchers identified eight mathematical instructional approaches to teach algebra related content to secondary students with learning disabilities. The main result was that no instructional approach met the necessary criteria to be considered evidence-based for this particular demographic and mathematical content. However, five mathematical practices (i.e., CRA, manipulatives, enhanced anchor instruction, schema based instruction, and peer assisted learning strategy) were found to be potentially evidence-based.