import json

data = {
 "topic": "Osgood-Schlatter Disease",
 "slug": "osgood-schlatter-disease",
 "category_id": 15582,
 "summary": "Osgood-Schlatter disease is a self-limited traction apophysitis of the tibial tubercle from repetitive quadriceps/patellar tendon stress in growing, active adolescents, treated with activity modification and NSAIDs until the growth plate closes.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "Signs and Symptoms in Pediatrics", "author": "Henry M. Adam,Jane Meschan Foy", "pages": [309]},
  {"title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online", "author": None, "pages": [878, 879]},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [4352]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [899]},
  {"title": "Diagnostic Imaging: Pediatrics", "author": "A. Carlson Merrow Jr. MD", "pages": [872]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [907, 1497]},
  {"title": "Berkowitz's Pediatrics", "author": "Berkowitz, Carol D.;", "pages": [910]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle at the insertion of the patellar tendon, caused by repetitive quadriceps traction during running/jumping sports\n"
   "- Typical age range is 11-15 years; one source specifies boys 12-15 years and girls 11-13 years, with the vast majority being boys 13-17 years old in another series\n"
   "- Bilateral involvement occurs in about 25% of cases, though symptoms are often asymmetric; a prior history of Osgood-Schlatter is present in 25% of imaged cases\n"
   "- Underlying mechanism: the portion of the physis deep to the tibial tubercle ossification center is composed of strong fibrocartilage that converts to weaker hyaline cartilage near physeal closure, coinciding with increased muscle strength and athletic activity - forceful quadriceps contraction with extension (jumping) or passive knee flexion during quadriceps contraction (landing) produces microavulsions\n"
   "- Presents with gradual-onset localized pain and swelling over the tibial tubercle, worsened by activity, kneeling, or crawling, and relieved by rest; the knee may be held in mild flexion with inability to fully extend actively\n"
   "- Diagnosis is clinical; radiographs are not required but, when obtained, may show soft tissue swelling or fragmentation/irregular ossification of the tibial tubercle\n"
   "- Associated injuries occur in under 5% of cases: patellar tendon tears, ACL tears, collateral ligament or meniscal tears, and compartment syndrome\n"
   "- Management is symptomatic: rest/activity modification, NSAIDs, ice after activity, protective padding or a knee strap, and stretching/physical therapy focused on the quadriceps and hamstrings; casting or surgical reattachment of the quadriceps ligament is reserved for rare cases\n"
   "- The condition is self-limited, resolving as the tibial tubercle apophysis closes with skeletal maturity - symptoms typically resolve around 14-15 years of age, though full resolution can take 12-18 months\n"
   "- Rare complications include growth arrest with recurvatum deformity and rupture or avulsion of the patellar tendon/tibial tubercle"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Osgood-Schlatter disease is a traction apophysitis occurring at the tibial tubercle, the site where the patellar tendon inserts on the proximal tibia. Repetitive stress transmitted through the patellar tendon produces a series of microavulsions of the secondary ossification center and the underlying cartilage, resulting in a painful, swollen tibial tubercle."
  )},
  {"title": "Epidemiology", "content": (
   "The condition occurs most commonly in running and jumping athletes in the pre-teen and adolescent years, generally cited as ages 11-15 years, prior to closure of the tibial growth plate; one source specifies boys aged 12-15 years and girls aged 11-13 years, and another notes the vast majority of cases are boys aged 13-17. Boys are affected more often than girls overall, although rising participation of girls in running/jumping sports has been associated with an increasing incidence among girls. Bilateral involvement is described as usual by some sources and as occurring in about a quarter of cases in others, though symptoms are commonly asymmetric even when bilateral. A prior history of Osgood-Schlatter disease is found in approximately 25% of imaged cases."
  )},
  {"title": "Pathophysiology", "content": (
   "The tibial tubercle apophysis has a predisposing anatomic vulnerability: the portion of the physis deep to the ossification center is composed of strong fibrocartilage, but as the patient nears physeal closure this converts to weaker hyaline cartilage - a transition that coincides with increasing muscle strength and athletic activity. Repetitive traction from the patellar tendon, driven by forceful quadriceps contraction during knee extension (as in jumping) or passive knee flexion during active quadriceps contraction (as in landing), causes fragmentation and microfractures of the tibial tubercle during this vulnerable period of rapid growth. This is fundamentally an overuse injury of the knee extensor mechanism, related to the same mechanism underlying patellofemoral stress syndrome."
  )},
  {"title": "Clinical features", "content": (
   "Patients present with gradually increasing pain and swelling localized to the tibial tubercle. Discomfort is exacerbated by activities that load the quadriceps - running, jumping, squatting, kneeling, or crawling - and is relieved by rest. On exam, there is a visible and palpable bony prominence with swelling and tenderness directly over the tibial tubercle; the degree of swelling can be striking. The knee may be held in mild flexion, with inability to fully actively extend it, and patients may refuse to perform a deep knee bend or have difficulty with stairs, though gait on level ground is typically normal. The remainder of the knee exam is usually normal, aside from possible mild limitation of flexion."
  )},
  {"title": "Diagnostics", "content": (
   "Osgood-Schlatter disease is a clinical diagnosis; radiographs are not required to confirm it. When obtained - typically to exclude other pathology such as neoplasm or an acute avulsion fracture - lateral knee radiographs may show soft tissue swelling over the tibial tubercle or fragmentation/irregular ossification of the tubercle. Radiographs can be normal early in the disease course, and fragmentation of the tibial tubercle can also be a normal variant in adolescents, so imaging findings must be correlated with the clinical picture. In advanced disease, avulsions from the secondary ossification center can form separate ossicles visible on lateral radiograph."
  )},
  {"title": "Differential diagnosis", "content": (
   "Key differentials for anterior knee pain in an adolescent athlete include a patellar sleeve avulsion fracture, patellar tendon rupture, a normal ossification variant of the tibial tubercle, patellofemoral stress syndrome, patellar tendinitis (jumper's knee), Sinding-Larsen-Johansson syndrome, and an acute traumatic avulsion of the tibial tubercle (which, unlike Osgood-Schlatter, causes acute disability rather than days-to-weeks of gradually worsening symptoms). Associated injuries found alongside Osgood-Schlatter in under 5% of cases include tears of the patellar tendon, ACL, collateral ligaments, or menisci, and compartment syndrome."
  )},
  {"title": "Treatment", "content": (
   "Management is symptomatic and conservative, since the underlying process is self-limited and resolves with skeletal maturity. Standard measures include activity modification/relative rest, NSAIDs for pain control, ice application after activity, and a protective pad over the tibial tubercle to guard against direct trauma; therapeutic taping and well-fitted knee sleeves or straps may also improve comfort. Stretching and physical therapy targeting the quadriceps and hamstrings is recommended, following PRICE principles (protection, rest, ice, compression, elevation). Patients and families should be counseled that resolution is usually slow, often taking 12-18 months, with symptoms typically settling by around 14-15 years of age as the tibial tubercle apophysis closes. Casting or surgical reattachment of the quadriceps/patellar ligament is required only in rare, severe cases."
  )},
  {"title": "Complications", "content": (
   "Complications are rare but can include growth arrest of the tibial tubercle apophysis with resulting recurvatum (hyperextension) deformity of the knee, and rupture or avulsion of the patellar tendon or tibial tubercle."
  )}
 ],
 "clinical": [
  {"title": "Management at the bedside", "content": (
   "Diagnose Osgood-Schlatter disease clinically in an adolescent runner/jumper with gradual-onset pain and swelling localized to the tibial tubercle, worsened by quadriceps loading and relieved by rest - radiographs are not required but are reasonable if there is concern for an acute avulsion fracture, neoplasm, or if the presentation is atypical (e.g., acute onset with severe disability, which points instead toward a traumatic avulsion). \n\nStart with conservative, symptomatic treatment: activity modification (reducing but not necessarily fully stopping sport, guided by symptom severity), NSAIDs for pain, ice after activity, and a protective pad over the tibial tubercle for athletes returning to contact or kneeling activities. Add quadriceps and hamstring stretching and physical therapy. Counsel the family explicitly that this is self-limited but slow - resolution commonly takes 12-18 months and symptoms typically settle around age 14-15 as the tibial tubercle apophysis closes - so the goal is symptom control and continued function rather than a quick fix. Reserve escalation to bracing/casting or surgical referral for the rare case with a suspected patellar tendon avulsion, rupture, or growth arrest with recurvatum deformity."
  )}
 ]
}

with open("/tmp/osgood-schlatter.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")