Internal combustion engines have played a crucial role in the advancement of society. Consequently, there has been a persistent need to enhance their efficiency and performance. The water-injected six-stroke engine is based on conventional four-stroke engines, producing additional power by injecting water into the hot combustion products during the expansion stroke, thereby increasing the overall engine efficiency. However, a comprehensive review that consolidates existing knowledge and identifies future research opportunities in six-stroke engine technology is lacking. This study addresses this gap by thoroughly examining the thermodynamic operation of six-stroke engines and analyzing the impact of water injection on engine performance. The review covers literature from 1994 to 2023, categorizing studies based on the modeling approach, working fluid, thermodynamic cycle, and consideration of heat transfer. Among the 18 analyzed articles, predominantly published from 2015 to 2019, half utilize analytical models, while the rest employ experimental models addressing heat transfer losses. Notably, water injection exhibits a substantial influence, manifesting as a 5.18% increase in brake power and a 1.55% enhancement in thermal efficiency, particularly with acetylene as the working fluid. Finally, a literature overview of water injection in hot gas environments within the engine cylinder was conducted in addition to a preliminary thermodynamic analysis of the Otto and Diesel cycles to compare different configurations outlined in the literature. The lack of studies, experimental setups, and non-idealized models that consider factors such as heat transfer or water evaporation during injection is evident. By critically synthesizing the available literature, this study offers valuable insights into the potential advantages, limitations, and prospects of six-stroke engine studies.