Weak institutions are conceived as a major facilitating factor for adverse impacts of LSLAs on local livelihoods in target regions. However, the many faces of LSLAs challenge the development of middle range theories that would explain how in detail local, national and international institutions affect trajectories and outcomes of LSLAs in diverse socio-economic, cultural and biophysical settings. This study synthesizes 25 case studies of LSLAs by adopting a systematic review methodology (structured literature selection, iterative coding, structured data analysis). Our findings provide, first, a diagnostic framework for LSLAs that identifies a parsimonious set of critical institutional, socioeconomic, cultural and biophysical factors which shape trajectories and outcomes of LSLAs. Based on this, we extract repeated diagnostic patterns of institutional deficits that explain adverse impacts of LSLAs. Thus, this paper contributes to efforts of diagnosing causes of adverse impacts of LSLAs and to identify possible leverage points and intervention strategies.