Through a review of the scientific literature and a more in-depth qualitative meta-analysis of 16 case studies distributed worldwide, this article aims to study impacts of MPAs on marine living resources, ecosystems and related fisheries and to highlight their criteria of efficiency as management tools for a sustainable exploitation. MPAs are efficient for conservation purposes and resource restoration, especially inside their borders. MPAs can also be part of fisheries management systems, but there is a lack of knowledge about their wider scale impacts on fish stocks, ecosystem and fisheries. Adjacent fisheries can increase their catches near closed areas, but such effects are delayed until after MPA establishment and are often limited over distance. Even though local specificities in ecosystems and fishing resources lead to high variability in MPA effects, four major criteria modulate the efficiency of MPAs for fisheries management: (1) the size of the closed area; (2) the level of protection of essential habitats for exploited resources; (3) MPA integration as part of wider integrated fisheries management plans; and (4) efficient monitoring and regulation systems, including participative decision making, to ensure that restrictive measures are respected.