Small and medium-sized enterprises (SMEs) play a fundamental role in society, as reflected in their high representativeness, contribution to employment, and provision of basic and essential services. However, their small size and financial constraints require the adoption of innovative practices to ensure their long-term sustainability. This study aims to identify the key topics explored by the scientific community regarding the enhancement of sustainability in SMEs through innovation, as well as the collaboration patterns among countries. Using bibliometric analysis tools, both well-established themes and emerging trends in the literature indexed in SCOPUS were identified. The results indicate that traditional approaches focus on open innovation, eco-innovation, competitive advantage, corporate social responsibility, knowledge management, and intellectual capital. In contrast, more recent approaches promote green innovation, circular economy, digital transformation, and technology transfer as key mechanisms for SME modernization. These findings suggest that SME strengthening policies should prioritize responsible innovation that considers environmental and social impacts. This should be achieved by developing digital capabilities through technology transfer mechanisms from more complex enterprises and, particularly, from academia. The preliminary results suggest that country clustering patterns in collaboration are seemingly influenced by geographical, linguistic, economic, and cultural factors.