Background: Despite cocoon silk’s well-known strength, biocompatibility, and hypoallergenic properties, its potential medical applications remain largely unexplored. This review, therefore, is of significance as it evaluates the mechanical properties and clinical potential of cocoon silk, a material with promising applications in biomaterials and tissue engineering. Methods: We conducted a comprehensive systematic review adhering to PRISMA guidelines. Our focus was on the primary outcomes of tensile strength and elongation at break, and the secondary outcomes included other mechanical properties, applications, and complications. Results: Out of the 192 silk-related studies, 9 met the criteria. These studies revealed that cocoon silk derivatives exhibit a wide range of tensile strength, from 0.464 to 483.9 MPa (with a median of 4.27 MPa), and elongation at break, from 2.56% to 946.5% (with a median of 60.0%). Biomedical applications of cocoon silk derivatives span from tissue regeneration (n = 6) to energy harvesting (n = 4). Complications often arose from material fragility in non-optimized derivative components. Conclusions: While cocoon silk shows expansive promise due to its suitable mechanical properties and low complication risk, plenty remains to be discovered. Future research is crucial to fully realizing its vast surgical and biomedical potential.
