<p>Inclined piles are widely used in geotechnical engineering to resist tensile forces induced by buoyancy effects, overturning moments, and lateral actions from wind, wave, and seismic loading. Although their effectiveness in enhancing pull-out resistance is well recognized, the axial pull-out behaviour of inclined piles in sand remains challenging to predict because of complex soil–pile interactions and divergent observations reported in the literature. This paper presents a comprehensive review of experimental, analytical, and numerical studies on the axial pull-out capacity of inclined piles in sand. Key influencing parameters—including inclination angle, embedment ratio, pile geometry, soil relative density, and interface characteristics—are critically examined. Emphasis is placed on identifying the sources of discrepancies in previous studies and synthesizing consistent, evidence-based conclusions regarding the behaviour of inclined piles under pull-out loading. The paper concludes with recommendations for future research aimed at further improving understanding and facilitating the effective application of inclined piles in modern geotechnical engineering practice.</p>