Over the past decade, parent advocacy groups led a grassroots movement resulting in most states adopting dyslexia-specific legislation, with many states mandating the use of the Orton-Gillingham approach to reading instruction. Orton-Gillingham is a direct, explicit, multisensory, structured, sequential, diagnostic, and prescriptive approach to reading for students with or at risk for word-level reading disabilities (WLRD). Evidence from a prior synthesis and What Works Clearinghouse reports yielded findings lacking support for the effectiveness of Orton-Gillingham interventions. We conducted a meta-analysis to examine the effects of Orton-Gillingham reading interventions on the reading outcomes of students with or at risk for WLRD. Findings suggested Orton-Gillingham reading interventions do not statistically significantly improve foundational skill outcomes (i.e., phonological awareness, phonics, fluency, spelling; effect size [ES] = 0.22; p = 0.40), although the mean ES was positive in favor of Orton-Gillingham-based approaches. Similarly, there were not significant differences for vocabulary and comprehension outcomes (ES = 0.14; p = 0.59) for students with or at risk for WLRD. More high-quality, rigorous research with larger samples of students with WLRD is needed to fully understand the effects of Orton-Gillingham interventions on the reading outcomes for this population.