Concrete is the most widely used material in construction and infrastructure, and is often reinforced by steel to improve tensile strength. Despite its enduring popularity, the material’s inherent weaknesses – namely corrosion damage and material fatigue – combined with ageing infrastructure, poses a challenge to both decision-makers and civil engineers to optimise sustainable infrastructure services. This article explores and synthesises the sustainable potential of maintenance and repair methods using concrete and cement-based composite materials. We draw on published case studies where sustainability assessments have been applied within this field. We also included cases that describe themselves as a type of sustainability assessment, but lack the assessment of all dimensions. Our research aims, firstly, to identify what maintenance interventions were assessed by means of sustainability criteria. Second, it explores the basic conceptual understanding which underlies each sustainability assessment. Third, it analyses the many methodological choices made for system boundaries, selection of indicators, or forms of aggregation. We have applied a systematic literature review to develop evidence-based management knowledge; this shows that current sustainability assessments are diverse regarding system boundaries, their scope, levels of detail, and overall quality. Although there is a trend towards more holistic types of assessment, environmental and economic sustainability dominated our sample, with global warming and energy consumed being most often reported. External costs, if included in the assessment, drive the overall economic score, while life cycle sustainability assessment is applied to only three cases. The most critical and challenging issues were shown to be the long-term orientation of maintenance measures and the complexity of undertaking a truly holistic sustainability assessment. To that end, we have stimulated scholarly discussion on further methodological progress to align with the good practices identified in our review, and call for greater application of these methods in the construction industry.