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Sporticus said:
AO means the game can't be released in the States unless its through the Xbox 360.

 Microsoft also doesn't allow AO releases on their consoles either:

 "GameSpot has confirmed with Nintendo and Sony that one of those options, which would be to accept the ESRB's judgment and release the game with the AO rating, isn't an option at all. Both companies forbid licensed third-party publishers from releasing games rated AO for Adults Only on their various hardware platforms. Though Manhunt 2 isn't slated for any of Microsoft's systems, the company has also confirmed that it does not allow AO-rated titles on the Xbox or Xbox 360."

Link 

If you want to get an AO game out, PC is currently the only way to go.