The former USA Gymnastics doctor Larry Nassar is sentenced to an additional 40 to 125 years in prison in a Michigan courtroom for sexually abusing young female gymnasts.
The ruling follows an earlier sentence of up to 175 years last month.
The case has sparked investigations into how governing bodies failed to investigate complaints against Nassar.
The former doctor is also serving a 60-year federal sentence for child pornography convictions.
Monday's sentencing followed days of testimony from scores of Nassar's victims, who offered emotionally wrenching accounts of his abuse masquerading as medical treatment, sometimes with their own parents present in the exam room.
All told, the two sentencing hearings saw more than 200 victim impact statements, and prosecutors have said there are approximately 265 known victims in total.
Nassar offered a brief apology to his victims on Monday, saying, "The visions of your testimonies will forever be present in my thoughts."
But the judge, Janice Cunningham, said Nassar had again suggested in a pre-sentencing interview with authorities that he had not done anything wrong, even after he was sentenced in Ingham County.
"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," Cunningham told an expressionless Nassar. "Clearly you are in denial. You don't get it."