Concerns over groundwater depletion and ecosystem degradation have led to the incorporation of the concept of groundwater sustainability as a groundwater policy instrument in several water codes and management directives worldwide. Because sustainable groundwater management is embedded within integrated, co-evolving hydrological, ecological, and socioeconomic systems, implementing such policies remains a challenge for water managers and the scientific community. The problem is further exacerbated when participatory processes are lacking, resulting in a communication gap among water authorities, scientists, and the broader community. This paper provides a systematic review of the concept of groundwater sustainability, and situates this concept within the calls from the hydrologic literature for more participatory and integrated approaches to water security. We discuss the definition of groundwater sustainability from both a policy and scientific perspective, tracing the evolution of this concept from safe yield, to sustainable groundwater management. We focus on the diversity of societal values related to groundwater sustainability, and the typology of the aquifer performance and governance factors. In addition, we systematically review the main components of an effective scientific evaluation of groundwater sustainability policy, which are multi-process modeling, uncertainty analysis, and participation. We conclude that effective groundwater sustainability policy implementation requires an iterative scientific evaluation that (i) engages stakeholders in a participatory process through collaborative modeling and social learning; (ii) provides improved understanding of the coevolving scenarios between surface water-groundwater systems, ecosystems, and human activities; and (iii) acknowledges and addresses uncertainty in our scientific knowledge and the diversity of societal preferences using multi-model uncertainty analysis and adaptive management. Although the development of such a transdisciplinary research approach, which connects policy, science, and practice for groundwater sustainability evaluation, is still in its infancy worldwide, we find that research towards groundwater sustainability is growing at a much faster rate than groundwater research as a whole.