The second TMNT game for the Game Boy brings more of the same action that we saw in the first. The story is basically unchanged. Shredder and Krang have an evil plot to take over the world, and have kid-napped April. You have to guide the four turtles to rescue her and save the day.

Back from the Sewers features 6 side-scrolling levels. In between levels, you are treated to bonus games that allow you to increase your health meter or rescue captured turtles.

The music in the game is a surprisingly accurate rendition of the music found in the cartoon series. This is also one of the first Game Boy games to feature digitized speech.