Disgraced ex-sports doctor Larry Nassar has been jailed for another 40 to 125 years for molesting young gymnasts.
Nassar already faced a lifetime in jail for two prior sentences for sexually abusing girls at USA Gymnastics and Michigan State University.
The judge said while it ends Nassar’s criminal legal proceedings, “it does not end the emotional and physical suffering he has caused”.
The number of women who accuse Nassar of abuse has grown to more than 265.
With Monday’s sentence, Nassar has now been given at least 300 years in jail for his crimes.
He was sentenced to 60 years in prison on child pornography charges in December and received up to 175 years in jail on sexual abuse charges in January.
This case, which regarded abuse at the Twistars gymnastics training centre, follows weeks of emotional testimony from scores of young athletes.
More than 200 women in total have delivered impact statements on his abuse in both hearings.
“It’s impossible to convey the depth and breadth of how sorry I am to each and every one involved,” Nassar said in an apology on Monday.
“The visions of your testimony will forever be present in my thoughts.”
But Judge Janice Cunningham dismissed his remarks, saying: “I am not convinced that you truly understand that what you did was wrong, and the devastating impact that you have had on the victims, their families and friends.”
“Clearly you are in denial. You don’t get it.”
The Nassar case has rocked the US Olympic Committee, the sport’s governing body USA Gymnastics and Michigan State University, where he also worked as a sports doctor.
Top officials at USA Gymnastics and Michigan State University have resigned in recent weeks amid the fallout, and the case has prompted several investigations into whether complaints against the doctor were ignored.
More change to come
Rajini Vaidyanathan, BBC News
That Larry Nassar will spend the rest of his life behind bars is no surprise. But these hearings have opened up deeper conversations around the issue of sexual abuse, which will have a profound and lasting impact.
Firstly, the huge outpouring of testimony cast an honest spotlight on the raw pain and suffering of so many survivors which few people get to see.
By waiving their anonymity in court, the brave young women who faced Nassar have inspired countless other survivors of abuse – women and men – to speak out.
But these sentencing hearings also revealed another truth about sex abuse – the failure of many institutions to take complaints seriously. Many of the women pointed the finger at USA Gymnastics, a body they say failed to listen to their concerns, instead allowing Nassar to continue his abuse.
Already heads have rolled at the organisation, and questions are being raised in other sports. What these young women achieved in the court room will never erase the pain or abuse they have endured, but the power and courage they demonstrated, has definitely made a difference.
Several upcoming USA Gymnastics events have reportedly been cancelled and gymnasts will be now be required to be chaperoned by someone other than their coaches, according to emails obtained by USA Today.