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.
“It’s impossible to convey the depth and breadth of how sorry I am to each and every one involved,” he said before his third and final sentencing.
The number of women who accuse Nassar of abuse has grown to more than 265.
Monday’s sentencing followed days of emotional testimony from dozens of Nassar’s victims.
More than 200 women in total have delivered impact statements on his abuse in both hearings.
Nassar offered an apology on Monday, but Judge Cunningham said he had suggested in a pre-sentencing interview that he had done nothing wrong.
The 54-year-old former doctor, who has also been sentenced to 60 years for child pornography, told the court: “The visions of your testimony will forever be present in my thoughts.
But the judge dismissed his apology, 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.”
Last week Judge Cunningham decided not to formally charge a father of two sexual assault survivors who leapt at Nassar after asking the judge for “five minutes in a locked room with that demon”.
A GoFundMe campaign raised more than $30,000 (£21,000) for the father, Randall Margraves, but the judge said that she would not press charges against him.
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.
A local Michigan police department last week publicly apologised to a victim for ignoring her 2004 complaint against Nassar.
The New York Times reported on Saturday that at least 40 girls were molested by Nassar during a 14-month period the FBI was investigating allegations against him.