In recent years, spillway rehabilitation has increased in importance and become the subject of many projects worldwide. One solution for this problem is the implementation of a new type of labyrinth spillway, called Piano Key Weir (PK-Weir ). This is an excellent alternative for increasing the overflow capacity of existing dams. Similarly to traditional labyrinth weirs, the hydraulic capacity of a PK-Weir is a function of its geometrical characteristics. Currently, there is a lack of systematic experiments, and the existing data does not allow the proposition of a universal design procedure. This paper reviews the previous studies on the efficiency of planned and built PK-Weirs. The results are evaluated by comparing an actual PK-Weir’s discharge to that theoretically obtained for a sharp-crested spillway with crest length equal to the width of the PK-Weir for a given hydraulic head. On the basis of this evaluation, a preliminary design procedure is proposed.