Globally, arid and semiarid regions are experiencing drought during summers, and freshwater scarcity is worsening yearly with climate change. The aquifer storage and recovery (ASR) technique stores freshwater during a surplus availability period in saline groundwater and ensures its recovery during dry periods. Many studies have portrayed ASR as a positive solution to the growing threat of freshwater availability, while others have also highlighted their challenges, including poor recovery efficiencies in saline regions. This article studies the peer-reviewed and grey literature on managed aquifer recharge in saline groundwater regions. Hydrogeological, design, and operational factors have been split into several phases for the effective installation and operation of an ASR system based on the variables identified from the literature. Planning, investigation, design, and operation/maintenance are the four steps considered for implementing an ASR project. A framework for efficient aquifer storage and recovery for saline groundwater regions has been developed to understand the influence of various hydrogeological, design, and operational factors on ASR performance. The findings of this research will help to understand the optimal site selection and ASR design to achieve higher performance and high freshwater availability.