Reinforced tissue graft

1. A biocompatible tissue graft comprising:

an extracellular matrix (ECM) derived from collagen; and

a plurality of fibers stitched into the ECM in a cross-hatched reinforcement pattern, each of the fibers comprising the plurality of fibers having opposing terminal ends, the plurality of stitched fibers mitigating tearing and/or improving fixation retention of the ECM;

wherein the plurality of fibers comprises a plurality of interconnected stitches;

wherein the opposing terminal ends of at least one fiber of the plurality of fibers are stitched together to form a continuous stitching construction.

2. The tissue graft of claim 1 , wherein the fiber is selected from the group consisting of silk, sericin free silk, modified silk fibroins, polyglycolic acid (PGA), polylactic acid (PLA), polylactic-co-glycolic acid (PLGA), polyhydroxyalkanoates (PHA), polyethylene terephthalate (PET), ultra-high molecular weight polyethylene (UHMWPE), blends thereof, and copolymers thereof.

3. The tissue graft of claim 1 , wherein the ECM is decellularized.

4. The tissue graft of claim 1 , wherein the ECM further comprises at least one progenitor cell.

5. The tissue graft of claim 1 , wherein the ECM further comprises at least one biologically active molecule selected from the group consisting of vaccine antigens, clotting factors, angiogenesis factors, regulatory proteins, transcription factors, receptors, and combinations thereof.

6. The tissue graft of claim 1 , wherein the at least one fiber constitutes a polymer braid having a PGA core and a sheath around the core comprising PLA and PGA.

7. The graft of claim 1 , wherein the at least one fiber imparts the ECM with resistance to cyclic fatigue loading at physiologically relevant loads.

8. The graft of claim 1 , wherein improving fixation retention is maintained during simulated in vivo conditions.

9. The tissue graft of claim 1 , wherein at least one of the ECM and the fiber is modified to improve adhesion between the ECM and the fiber.