It's been five years since the first women came forward publicly in 2016 to accuse the former USA Gymnastics national team doctor of sexual abuse under the guise of medical treatment.
Since then, hundreds of young women and girls have come forward. In 2017, Nassar pleaded guilty and was sentenced to 60 years behind bars for child pornography and other charges. One year later, he again pleaded guilty and was sentenced to an additional 40 to 175 years for multiple counts of sexual assault of minors.
While Nassar, 57, remains behind bars, the scars of his abuse linger on.
In wake of the crisis, USA Gymnastics, the national governing body for U.S. gymnastics, and the United States Olympic and Paralympic Committees have scrambled to repair their reputations and the trust of athletes, all while juggling multiple lawsuits. USAG also faces a threat from the USOC to decertify it as the organization overseeing the sport.
Despite touting reforms, athletes like Simone Biles and Aly Raisman have actively called out the organizations and distanced themselves from them for letting Nassar carry out his years of abuse.
This year, Biles, the most decorated gymnast of all time, will headline her own post-Olympic tour, which USAG usually runs, along with other elite female gymnasts.
At the U.S. Championships in 2019, she called out the organization in front of reporters while standing next to a USAG spokesperson.
"It's hard coming here for an organization, having had them fail us so many times," Biles said, tears welling in her eyes.
So, what has changed since then?
Reforms in the gymnastics world
Since the Nassar scandal, USAG has overhauled its leadership and went through four new presidents and CEOs in 23 months.
Current President Li Li Leung said USAG has gone in a new direction since 2016, and is focused on "creating a safe, inclusive and positive culture."
"We recognize how deeply we have broken the trust of our athletes and community, and are working hard to build that trust back," Leung said in a statement to ABC News. "We know that this kind of meaningful and lasting culture change does not happen overnight."
Following a damning 2017 independent investigative report that found USAG had "significant gaps regarding the prevention and reporting of child sexual abuse," the organization said it would adopt 70 recommendations, such as improving the screening of coaches, training to combat sexual abuse and the process for filing misconduct reports. USAG told ABC News "a vast majority" have been implemented already.
Since the Nassar scandal, USAG now requires 33% athlete representation on all boards and committees and created an Athlete Bill of Rights that focuses on protecting athletes from all forms of abuse.
The organization also created platforms for athletes to express their views and report concerns anonymously, without fear of retribution. Furthermore, a bill was passed in Congress in 2017 naming Safesport as an independent organization to respond to reports of sexual misconduct.
Vince Finaldi, an attorney representing about 300 Nassar survivors in a pending lawsuit against USAG and USOC, told ABC News that none of these efforts "really matter."
"They had policies and procedures before; they didn't follow them. They tightened up the policies and procedures, but unless they're followed, kids are going to be vulnerable and kids are going to get abused," Finaldi told ABC News.
Even with reforms, the relationship between USAG and its athletes is "forever damaged," Finaldi said.
Calls for 'the truth'
USAG told ABC News that it has participated in "at least six independent investigations" led by several congressional committees; the Indiana attorney general; Walker County, Texas; and the independent law firm of Ropes & Gray to look into the abuse of athletes, but some gymnasts say those probes were not truly independent.
Aly Raisman, who was captain of the 2012 and 2016 U.S. women's Olympic gymnastics teams and is now retired, has repeatedly said those probes aren't enough.
"I don't know why USAG is saying they're cooperating. I've spoken to many members of law enforcement who have said they've been extremely difficult, they're not handing over all their documents and data," she told CNN in a March interview. "Until we understand everything that happened -- we have access to every single email, phone calls, data, every single thing you can imagine, we can't believe in a future that's safe for the sport."
The saga continued last week with the release of the bombshell Department of Justice's Inspector General report, which pointed to widespread failures within the FBI in investigating Nassar allegations. The report was released just before the 2021 U.S. Olympic gymnastic teams jetted to Tokyo for the games.
Complaints were first made against the doctor in 2015, but it took months for FBI agents to act on it, according to the report. In that time, "approximately 70 or more young athletes were allegedly sexually abused by Nassar" between July 2015, when USA Gymnastics first reported allegations about Nassar to the Indianapolis Field Office, and September 2016, according to the report.
Legal challenges drag on
For many Nassar survivors, there has been no closure as lawsuits against USAG and the USOC drag on in court.
Michigan State University, where Nassar was employed, agreed to a $500 million settlement with 332 Nassar survivors in 2018. However, a lawsuit is still pending in the case against USAG and USOC, which has about 550 claimants who claim they were abused by Nassar, due to USAG's bankruptcy declaration also in 2018.
Leung said in June that the COVID-19 pandemic has prolonged the mediation process, but she's hopeful it'll be settled soon.
"Obviously, we would love to be out of bankruptcy [so] that we can be able to more freely move forward with all of the things that we have been working on and to not have this be a part of the narrative," Leung told The Associated Press.
In 2020, USAG offered a $215 million settlement, but an agreement has yet to be reached. Even that proposal was ripped as a "cover up" by athletes like Raisman as the deal would release several people and groups from liability, including former USAG President and CEO Steve Penny, who was in power at the time of the Nassar scandal.
John Manly, an attorney who works with Finaldi to represent Nassar survivors, including Biles, said when it comes to USAG "largely the rhetoric has changed," but there has been little other meaningful movement.
"The changes that matter to the athletes honestly are because Simone insisted on it. The fact that the Karolyi Ranch closed, USA Gymnastics didn't do that voluntarily," Manly told ABC News, citing the national team training camp site in Texas where Nassar worked.
"I continue to believe that this is an organization that is incapable of putting athletes first. Its set up and its senior staff is focused on two things: money and medals," Manly said. "Until you begin to focus on athletes' well-being as your primary goal, and until we have a full accounting of what happened, there's no moving forward."
Sarah Klein, a former competitive gymnast and survivor of Nassar's abuse, told ABC News that U.S. gymnastics hasn't turned over a new leaf.
"No athlete that I know has anything but disdain for USAG and USOPC. How could you believe in organizations who have the blood of little girls on their hands?" she said. "My heart goes out to the athletes competing at these Olympics who deserved -- and deserve -- more. Nothing has changed for the better. As the lies and cover-up continue to be unpacked and exposed, it is fair to say that things are far worse."
Heading into the 2021 Games while moving past the abuse and USAG turmoil isn't easy.
The "Fierce Five" team -- Raisman, Gabby Douglas, McKayla Maroney, Kyla Ross and Jordyn Wieber -- that won gold at the 2012 London Olympics, as well as some members of the 2016 Games' "Final Five," including Biles, achieved top honors in the sport despite the abuse they suffered.
"They all won gold, despite having to endure what [Nassar] did to them," Manly said. "You think about that, in the context of Simone Biles and what she's been able to achieve despite that, [it] is nothing less than heroic."
Earlier this month, Biles opened up about the depression she suffered after she was abused by Nassar in an episode of her Facebook Watch show, "Simone vs. Herself."
"With gymnasts, if you get injured ... your 'heal time' is four to six weeks. But then with something so traumatic that happens like this, there's no four to six weeks," she said. "There's like actually no time limit or healing time for it."
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