The growing penetration of renewable energy sources has intensified the demand for safe, sustainable, and cost-effective energy-storage technologies. Aqueous lithium-ion batteries are promising candidates because of their intrinsic safety and high ionic conductivity, though their deployment is limited by narrow electrochemical stability window of water. Lithium titanate oxide (LTO) has emerged as an ideal anode material for aqueous systems because of its exceptional structural stability, negligible volume change during lithiation/delithiation, and relatively high operating potential that suppresses hydrogen evolution. This review examines the peer-reviewed literature (2010–2026) on LTO-based aqueous lithium-ion batteries, focusing on the interdependence between material synthesis, electrode fabrication, electrolyte engineering, and electrochemical performance. Scalable fabrication techniques, such as spray deposition and tape casting, are discussed alongside their pact on electrode quality. Attention is given to water-in-salt, gel-polymer, and localized high-concentration electrolytes that expand the stability window and improve interfacial behavior. Overall, the review highlights how electrolyte design, electrode architecture, and processing methods can be jointly tailored to support stable and scalable LTO-based aqueous lithium-ion batteries systems.