The game uses a side-view perspective and presents a sequence of scrolling stages. The main objectives are to move through hazardous environments, defeat enemies, collect useful items, and rescue April O'Neil or other hostages. Players can switch between Leonardo, Donatello, Raphael, and Michelangelo when the situation calls for a different weapon or when a turtle is defeated.

Movement, jumping, attacks, and special weapons are central to progression. The stages include platforms, ladders, pits, traps, and boss encounters. Health and weapon supplies must be managed carefully, because losing all four turtles ends the game.

Use the turtle whose weapon best suits the space ahead: Donatello's bo has the greatest reach, while Leonardo is dependable in close quarters. Keep weaker turtles out of unnecessary fights so that the team retains reserves for later stages.

Study enemy patterns before advancing, especially near pits and moving hazards. Collect weapons and health items when safe, and avoid rushing into boss rooms with depleted health.