The rising demand for food, escalating water security, the impact of climate change, and global policy initiatives have heightened research focus on sustainability in agricultural water management. However, the field suffers from a lack of conceptual coherence and the persistence of conceptual ambiguity, resulting in limited transferable knowledge production. This study addresses these gaps through a systematic review using the Search, Appraisal, Synthesis, and Analysis (SALSA) framework, encompassing literature published by the end of 2021. Quantitative bibliometric analysis revealed an upsurge in literature (an average annual increase of 33.88% from 1970 to 2021), reflecting alignment with scientific priorities and global policy initiatives. However, conceptual advancement has not kept pace with this rising volume. Keyword proliferation and disciplinary concentration indicate ongoing ambiguity, with sustainability often framed through environmentally centric and context-specific perspectives. The economic and social pillars remain insufficiently explored, and the production of knowledge is disproportionately centered in the Global North. Qualitative synthesis evidence, definitional plurality, and methodological diversity, hindering comparability and transferability across contexts. We integrate our findings into a cohesive thematic structure based on the three pillars of sustainability. Conceptual consolidation and consistent application of sustainability principles require a shift toward more integrative research practices. For this, we recommend focusing on stakeholder co-production, inclusive research agenda, expanded coverage of all three pillars, and increased representation from the Global South.