Biobased polylactide (PLA) films were modified with low reticulate polysiloxane gel acting as a scalable platform for the hydrophilization of polymeric film surface. The PLA thin film was first coated with poly(methylhydrogenosiloxane) (PMHS) by the sol-gel transition via the condensation of diethoxymethylsilane (DH) and triethoxysilane (TH) using trifluoromethanesulfonic acid as a catalyst. Then, hydrosilylation of Si-H bonds in the presence of Karstedt's catalyst allowed the covalent grafting of hydrophilic alkene-containing molecules, i.e., triethylene glycol monomethyl allyl (TEGMEA) and a new zwitterionic allylcarboxybetaine (ACB) synthesized for the first time by the quaternization of dimethyl allyl amine (DMAA) with β-propiolactone. PMHS coating on the PLA film was evidenced by Fourier transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy (XPS). The observation by atomic force microscopy (AFM) revealed a homogeneous coating with low roughness (RMS = 0.29 nm). The hydrophilicity of functionalized PLA films was determined by water contact angle (WCA) measurements using the captive bubble method. A large increase in wettability properties was observed for both grafting with TEGMEA (WCA = 38°) and ACB (WCA = 42°) in comparison with the native PLA film (WCA = 80°). Moreover, the biocompatibility and antifouling efficiency of functionalized PLA films were evaluated by protein adsorption, bacterial adhesion, and cytotoxicity tests. The results indicate that the grafting of the two types of hydrophilic compounds does not affect the biocompatibility of PLA while significantly reducing protein adsorption and bacterial adhesion, thus showing the great potential of this surface functionalization strategy for applications in the medical field.