Effective teaching pedagogies and curriculum frameworks in school physical education have been regularly changing and widely debated. However, teachers have predominately used technical and sport-based approaches, but tactical game-centered approaches (TGAs) are becoming more common when teaching games in physical education. This review systematically described the content and the quality of research that compared TGAs with other teaching approaches within school physical education. All 24 studies that were found compared a technical approach (TA) or control group with a TGA, and most originated from Western Europe. Studies were conducted equally in primary and secondary schools, most research was mixed-gender, and the majority incorporated a single sport to compare teaching approaches. The quality of reporting was mostly low with a moderate to serious risk of bias. Studies commonly showed that TGAs improved student outcomes in tactical skill; skill execution; affective, procedural knowledge and/or physical activity; and TAs improved skill execution and technical skill.