In many large enterprises, scaling agile has become a central part of broader digital transformation efforts. While the benefits of agile at the team level are well documented, the role of managers, particularly those in middle management, remains conceptually underdeveloped and practically ambiguous. This paper presents a structured review of 15 recent studies on large scale agile transformations published between 2019 and 2025. The synthesis identifies four recurring domains of managerial tension. These domains are leadership and authority, decision making and governance, coordination and integration, and performance and sustainability. The analysis interprets these tensions as paradoxes that require managers to reconcile autonomy with control, short term delivery with long term capability building, and local experimentation with enterprise stability. Drawing on paradox theory and dynamic capabilities, the paper develops a conceptual framework that positions middle managers as brokers of paradox across organizational levels. The framework contributes to scholarship by integrating fragmented evidence on managerial work in agile transformations and by extending paradox theory into the context of large scale agile. For practitioners, it offers a lens for redesigning leadership development, governance arrangements, and performance systems so that managers are better equipped to sustain agility over time.